Laser-assisted subepithelial keratectomy for bilateral hyperopia and hyperopic anisometropic amblyopia in children: one-year outcomes.

PURPOSE: To assess the refractive, visual acuity, and binocular results of laser-assisted subepithelial keratectomy (LASEK) in children with bilateral hyperopia or hyperopic anisometropic amblyopia. SETTING: Nonhospital surgical facility and hospital clinic, Calgary, Alberta, Canada. METHODS: This retrospective review comprised children with bilateral hyperopia or hyperopic anisometropic amblyopia who had LASEK. Refractive status, visual acuity, and binocular vision were assessed and recorded 2 months and 1 year postoperatively. RESULTS: The mean spherical equivalent (SE) in all 72 hyperopic eyes (47 patients) was +3.42 diopters (D) (range 0.00 to +12.50 D) preoperatively and +0.59 D (range -1.25 to +2.00 D) 1 year postoperatively. After LASIK, 41.7% of eyes had improved corrected distance visual acuity (CDVA). No patient had reduced CDVA or loss of fusional ability; there was a 25.0% improvement in stereopsis at 1 year. The mean anisometropic difference in the hyperopic anisometropic amblyopia subgroup (18 eyes, 10 patients) was 4.39 D (range +1.75 to +7.75 D) preoperatively and +0.51 D (range 0 to +0.875 D) at 1 year. One year postoperatively, 83% of anisometropic eyes were within +/-1.00 D of the fellow eye and 94.0% were within +/-3.00 D. Postoperatively, 64.7% of eyes had improved CDVA with no reduced CDVA or loss of fusional ability; there was a 22% improvement in stereopsis at 1 year. CONCLUSION: Laser-assisted subepithelial keratectomy improved visual acuity in pediatric hyperopia with or without associated hyperopic anisometropic amblyopia.

Surgical outcomes of primary foldable intraocular lens implantation in children: understanding posterior opacification and the absence of glaucoma.

PURPOSE: To evaluate visual and stereoscopic performance after pediatric cataract extraction with intraocular lens (IOL) implantation performed by the same surgeon over 24 years and to review the complications. SETTING: The Alberta Children's Hospital, Calgary, Alberta, Canada. METHODS: This retrospective review comprised children aged 1 month to 18 years who had small-incision cataract extraction with foldable posterior chamber IOL implantation from 1995 to 2008. RESULTS: The postoperative follow-up was 6 months to 12 years. Posterior capsule opacification (PCO) requiring secondary surgical membranectomy developed in 22.7% of the children. Younger children developed PCO more often than older children. The PCO rate was 70.8% in children younger than 1 year and decreased steadily to 6.1% in children older than 7 years. The mean onset of PCO was 6.1 months postoperatively. Other complications were vitreous tags (12.0%), IOL dislocation (4.7%), and loose corneal sclera sutures (2.7%). Of the eyes in which vision could be recorded, 89.5% had improved corrected visual acuity, with no eye losing acuity. Stereopsis was present in 35% of testable children preoperatively and 91% postoperatively. CONCLUSIONS: Cataract surgery in children younger than 2 years should be considered a 2-stage procedure in view of the higher incidence of PCO. Secondary glaucoma decreased significantly when surgery was performed after 30 days of age and the eye was left pseudophakic after surgery. Further improvements in IOL design, surgical instrumentation, and implantation techniques will continue to improve the ability to visually rehabilitate children.