Pediatric refractive surgery: current opinion in ophthalmology.

PURPOSE OF REVIEW: Pediatric refractive surgery has been growing at a steady pace since its introduction in the early 1980 s. This article will review common laser refractive surgeries performed on pediatric patients along with controversies regarding the practice. RECENT FINDINGS: Pediatric refractive surgery is reserved for a small population of children who fail amblyopic treatment due to high anisometropic refractive errors. Publications over the years have treated these children with various types of laser refractive surgery. SUMMARY: Laser pediatric refractive surgery appears to be well tolerated and effective for the population of children that need it. It provides an alternative for anisometropic amblyopia treatment for children who would have otherwise not been able to improve their vision.

Six-month binocular stereopsis recovery and its influencing factors in children with intermittent exotropia.

OBJECTIVE: To investigate the recovery of binocular stereopsis recovery and its influencing factors in children with intermittent exotropia after successful correction of eye position. METHODS: Prospective clinical study. A total of 178 patients, aged 9 ∼ 14 (10.8 ± 1.7) years, who were successfully corrected after intermittent exotropia surgery at the Beijing Tongren Hospital Affiliated to Capital Medical University from October 2023 to September 2023 were collected, the follow-up duration was six-month or longer. Paired t test, Pearson correlation analysis and multivariable linear regression analysis were used to probe preoperative clinical features that may predict the stereopsis six months after surgery. RESULTS: Six months after surgery, the angle of deviation of the patients met the orthotopic standard, and there was significant difference compared with that before surgery (distant: -2.7△±3.2△ vs. -30.5△±8.4△, t=-25.3, P < 0.001. Near:-3.7△±4.1△ vs. -33.7△±8.0△, t=-26.1, P < 0.001). Distant stereopsis (3.0 ± 0.6 vs. 3.9 ± 0.4, t = 4.9, P < 0.05) and near stereopsis (2.3 ± 0.5 vs. 2.6 ± 0.4, t = 3.8, P < 0.05) were both significantly improved compared with that of before surgery. 17% and 22% patients rebuilt normal distant stereopsis and normal near stereopsis, respectively. Preoperative distant stereopsis (r=-0.26, P = 0.004) and near stereopsis (r=-0.23, P = 0.011) was significantly negatively correlated with convergence reserve. Multivariable analysis showed that patients' age (ß = 0.003, p = 0.037), anisometropia (ß = 0.015, p = 0.043), and preoperative distant stereopsis (ß = 0.456, p < 0.001) were significantly associated with postoperative distant stereopsis. Patients' age (ß = 0.005, p = 0.044), anisometropia (ß = 0.127, p = 0.034), angle of deviation (ß=-0.230, p = 0.020), and preoperative near stereopsis (ß = 0.136, p < 0.001) were significantly associated with postoperative near stereopsis. CONCLUSION: IXT patients could get eye position fixed after surgery, about 20% patients benefited from stereopsis improvement. Patient's age, binocular anisometropia, angle of deviation and preoperative stereopsis were independent factors influencing postoperative stereopsis.

Anterior Chamber Iris-Fixated Phakic Intraocular Lens Implantation for Treatment of High Anisometropia in Children: Long-term Results.

PURPOSE: To evaluate the long-term efficacy of anterior chamber iris-fixated phakic intraocular lens (PIOL) implantation in the treatment of high myopic (> -9.00 diopters [D]) or hyperopic (> +6.00 D) anisometropia in children with intolerance to spectacles or contact lenses. METHODS: A total of 58 children with anisometropic myopia (range: -9.25 to -18.50 diopters [D]) and 13 children with anisometropic hyperopia (range: +6.00 to +8.50 D) underwent unilateral iris-claw PIOL implantation from 2008 to 2018. The mean age was 6.7 years. The mean follow-up was 38.5 months. Target refraction was emmetropia. RESULTS: The cycloplegic refraction (mean spherical equivalent) improved from -12.47 D (range: -9.25 to -18.50 D) to -0.73 D (range: +0.75 to -1.50 D) in myopic eyes and reduced from +7.15 D (range: +6.00 to +8.50 D) to +0.94 D (range: -0.50 to + 1.75 D) in hyperopic eyes. Eighty-four percent of eyes were corrected to within ±1.00 D of emmetropia. The mean uncorrected distance visual acuity (UDVA) improved from 1.74 ± 0.36 to 0.45 ± 0.28 logarithm of the minimum angle of resolution (logMAR) (P = .0014). The mean corrected distance visual acuity (CDVA) changed from 0.68 ± 0.32 to 0.27 ± 0.15 logMAR (P = .02179). The safety index was 2.18 and the efficacy index was 1.51. The mean preoperative endothelial cell count of 2,874.7 cells/mm2 changed to 2,685.3 cells/mm2 at 2 to 6 years postoperatively. Binocular vision quality was improved in 55 patients. No patient had serious complications or lost any Snellen lines of CDVA. CONCLUSIONS: Iris-fixated PIOL implantation is an effective and safe method in the treatment of high anisome-tropic myopia and hyperopia and amblyopia in pediatric patients who are noncompliant with spectacles or contact lenses. [J Pediatr Ophthalmol Strabismus. 2023;60(3):203-209.].

[A case of autologous corneal stromal lenticule transplantation and vision function training in the correction of hyperopia].

Hypermetropic anisometropia is often accompanied by visual fatigue, and the higher hyperopia is prone to form amblyopia. To avoid Wear glasses fatigue, the higher hyperopia is often under corrected and regulative spasm. Pseudomyopia may occur in the early stage after refractive surgery. In this case, autologous corneal stromal lenticule transplantation was used to correct hyperopia. After standard visual cognitive training, the Uncorrected Distance Visual Acuity was rapidly improved, and the binocular vision was normal.

Effectiveness of Laser Refractive Surgery to Address Anisometropic Amblyogenic Refractive Error in Children: A Report by the American Academy of Ophthalmology.

PURPOSE: To review the published literature assessing the safety and effectiveness of laser refractive surgery to treat anisometropic amblyogenic refractive error in children aged ≤ 18 years. METHODS: A literature search of the PubMed database was conducted in October 2021 with no date limitations and restricted to publications in English. The search yielded 137 articles, 69 of which were reviewed in full text. Eleven articles met the criteria for inclusion and were assigned a level of evidence rating. RESULTS: The 11 included articles were all level III evidence and consisted of 1 case-control study and 10 case series. Six studies used laser-assisted in situ keratomileusis (LASIK), 1 used photorefractive keratectomy (PRK), 1 used refractive lenticule extraction/small incision lenticule extraction, and the rest used a combination of LASIK, PRK, laser epithelial keratomileusis (LASEK), or refractive lenticule extraction/small incision lenticule extraction. Five studies enrolled patients with anisometropic myopia, 2 studies enrolled patients with anisometropic hyperopia, and the remainder were mixed. Although all studies demonstrated an improvement in best-corrected visual acuity (BCVA), the magnitude of improvement varied widely. As study parameters varied, a successful outcome was defined as residual refractive error of 1 diopter (D) or less of the target refraction because this was the most commonly used metric. Successful outcomes ranged between 38% and 87%, with a mean follow-up ranging from 4 months to 7 years. Despite this wide range, all studies demonstrated an improvement in the magnitude of anisometropia. Regression in refractive error occurred more frequently and to a greater degree in myopic eyes and eyes with longer follow-up, and in younger patients. Although one study reported 2 free flaps, most studies reported no serious adverse events. The most common complications were corneal haze and striae. CONCLUSIONS: Findings from included studies suggest that laser refractive surgery may address amblyogenic refractive error in children and that it appears to decrease anisometropia. However, the evidence for improvement in amblyopia is unclear and long-term safety data are lacking. Long-term data and well-designed clinical studies that use newer refractive technologies in standardized patient populations would help address the role of refractive surgery in children and its potential impact on amblyopia.

Visual and Refractive Outcomes Following Laser Blended Vision With Non-linear Aspheric Micro-anisometropia (PRESBYOND) in Myopic and Hyperopic Patients.

PURPOSE: To report 6-month visual and refractive outcomes following PRESBYOND Laser Blended Vision (Carl Zeiss Meditec) treatment using non-linear aspheric micro-anisometropia laser in situ keratomileusis (LASIK) for the correction of myopic and hyperopic presbyopia. METHODS: A retrospective, non-comparative study of 139 consecutive patients with a mean age of 53.13 ± 5.84 years (range: 42 to 70 years) treated with LASIK-induced micro-anisometropia using the MEL 90 excimer laser and VisuMax femtosecond laser (both Carl Zeiss Meditec). The target refraction was plano for distance eyes (dominant eye) and between -0.50 and -1.50 diopters (D) for near eyes. Patients were observed for 6 months. RESULTS: A total of 278 eyes (78 myopic and 200 hyperopic) from 139 patients completed the study. Mean preoperative spherical equivalent (SE) was -3.40 ± 1.83 D (range: -0.50 to -8.25 D) for myopic eyes and +1.61 ± 0.98 D (range: -1.25 to +4.63 D) for hyperopic eyes. Mean postoperative SE refraction of distance eyes was +0.20 ± 0.35 D (range: -0.38 to +1.00 D) and -0.14 ± 0.42 D (range: -1.38 to +0.88 D) for myopic and hyperopic eyes, respectively. Mean postoperative SE refraction of near eyes was -0.90 ± 0.44 D (range: -0.13 to -2.25 D) and -1.21 ± 0.48 D (range: -0.13 to -2.25 D) for myopic and hyperopic eyes, respectively. Mean binocular uncorrected near visual acuity was 0.70 ± 0.28 logMAR (range: 0.32 to 1.00 logMAR) and 0.79 ± 0.27 logMAR (range: 0.25 to 1.00 logMAR) for myopic and hyperopic eyes, respectively. Mean binocular uncorrected distance visual acuity was 1.19 ± 0.18 logMAR (range: 0.63 to 1.25 logMAR) and 1.14 ± 0.26 logMAR (range: 0.40 to 1.25 logMAR) for myopic and hyperopic eyes, respectively. Stereoacuity was better than 100 seconds of arc in 79% of myopic eyes and 85% of hyperopic eyes and all vision quality scores were greater than 90 of 100. No eyes lost two or more lines. CONCLUSIONS: The non-linear aspheric micro-anisometropia protocol resulted in safe and effective visual outcomes in patients with both myopic and hyperopic presbyopia. [J Refract Surg. 2022;38(5):288-297.].

Aniseikonia and visual functions with optical correction and after refractive surgery in axial anisometropia.

PURPOSE: To evaluate differences in the subjective aniseikonia and stereoacuity in patients with axial anisometropia after full correction of the refractive error with spectacles, contact lenses, and refractive surgery. METHODS: A prospective study was performed in Cairo University Hospitals on 20 patients with axial anisometropia caused by unilateral myopia > 5 D with > 4 D inter-ocular difference in spherical equivalent who were suitable candidates for excimer laser ablation (LASIK) or implantable collamer lens implantation (ICL). All patients had measurement of best-corrected visual acuity (BCVA), fusion, stereoacuity, and magnitude of aniseikonia with spectacles, contact lenses, and after surgery. RESULTS: The mean age at time of surgery was 25.7 ± 3.1 years. There were no statistically significant differences in the BCVA or stereoacuity with spectacles, contact lenses, or after refractive surgery. Microkonia < 5%) was perceived with spectacles in 8 patients (40%) and remained unchanged in 7 of these 8 patients with contact lenses. Following LASIK (n = 11), there was an induced macrokonia < 2% in 4 patients (36%), persistent microkonia of 3% in 1 patient (9%), and no change in image size in 6 (55%) patients. Following ICL implantation (n = 9), there was a perceived macrokonia of 2% in 4 patients (44%), disappearance of microkonia in 1 patient (11%) and no change in 4 patients (44%). CONCLUSIONS: Differences in BCVA, stereoacuity, and aniseikonia after correction of anisometropia by glasses, contact lens and surgery are both clinically and statistically insignificant. Retinal or neural adaptation might have a role in correction for differences in image size.

Small Incision Lenticule Extraction for Correction of Pediatric Unilateral Anisometropic Myopia.

PURPOSE: To evaluate the effects of femtosecond laser small incision lenticule extraction (SMILE) on treating unilateral myopic anisometropia in children with spectacles or contact lens intolerance. METHODS: This was a retrospective study that included children with unilateral myopic anisometropic amblyopia who underwent a SMILE procedure at Alpha Vision Center, Zagazig, Egypt, from January 2014 to December 2016. RESULTS: One hundred twenty-four eyes of 124 patients were included in this study. The postoperative corrected distance visual acuity (CDVA) at the 3-month and 1-, 2-, 3-, and 4-year follow-up visits improved significantly (P < .05) compared to the preoperative CDVA, indicating the safety of the procedure. At the 3-month postoperative visit, 23% of cases showed improvement of one or more lines of CDVA, whereas only 2% of cases showed a decline of only one line. Moreover, the postoperative uncorrected distance visual acuity compared favorably to the preoperative CDVA, denoting the efficacy of the refractive correction. The spherical equivalent was within ±0.50 diopters of the intended correction in 75% of the cases and within ±1.00 diopters in 89% of the cases. The intraoperative complications were scarce and relatively innocuous. CONCLUSIONS: SMILE is a safe and effective alternative method for correcting myopic anisometropic amblyopia in children with spectacles or contact lens intolerance with good refractive results. A larger study with longer follow-up periods is necessary to determine the long-term effects of SMILE. [J Refract Surg. 2021;37(8):510-515.].

Effect of keratorefractive surgery on choroidal thickness in anisometropic amblyopia.

PURPOSE: To evaluate postoperative change in choroidal thickness (CT) in patients with anisometropic amblyopia undergoing keratorefractive surgery. METHODS: Anisometropic amblyopic patients and nonamblyopic patients who underwent keratorefractive surgery were included in the study. The eyes were divided into three groups. Group 1 consisted of eyes with anisometropic amblyopia, group 2 were the nonamblyopic fellow eyes, and group 3 (control group) were nonamblyopic eyes which had undergone keratorefractive surgery. At the third postoperative month, the CT of these eyes were measured by Enhanced Depth Imaging OCT (EDI-OCT). The choroidal thickness (CT) was measured in the subfoveal area and at 500 micron intervals nasally and temporally. RESULTS: Twenty-three anisometropic amblyopia patients with amblyopic and fellow eyes and 23 control eyes were enrolled. The mean subfoveal choroidal thickness (CT) was 387.3±168.8µm in group 1, 412.2±88.8µm in group 2 and 337.3±99µm in group 3 (P: 0.019). Group 1 and group 2 showed higher choroidal thickness (CT) in the nasal and temporal quadrants than group 3 (P: 0.03, P: 0.04). At the third postoperative month, central foveal choroidal thickness was 356.6±115.5µm in group 1, 375.1±112.5µm in group 2 and 284.4±98.9µm in group 3 (P: 0.071). Choroidal thickness (CT) in the nasal and temporal quadrants at the third postoperative month was also similar (P: 0.210, P: 0.103). CONCLUSIONS: The macular choroid is thicker in amblyopic eyes and non-amblyopic fellow eyes than in the nonamblyopic controls. Improved fixation after refractive surgery may normalize CT.

Femtosecond Laser-Assisted LASIK in Children With Hyperopia and Anisometropic Amblyopia: 7 Years of Follow-up.

PURPOSE: To analyze clinical and functional results of femtosecond laser-assisted laser in situ keratomileusis (FSLASIK) in children with hyperopia and unilateral anisome-tropic amblyopia. METHODS: The study included 24 patients (24 eyes) aged 5 to 15 years. Before the surgery, the mean manifest refractive spherical equivalent (MRSE) of amblyopic eyes was +3.90 ± 1.60 diopters (D) (range: +1.50 to +6.80 D) and the mean refractive anisometropia was 3.06 ± 1.64 D (range: 0.87 to 7.50 D). Every patient had at least 1 year of ineffective traditional amblyopia treatment before surgery. The mean follow-up period was 7 years (range: 6.9 to 7.4 years). RESULTS: At the final follow-up visit, the mean MRSE of operated eyes was +0.41 ± 1.35 D (range: -1.13 to +3.88 D) (P < .001) and anisometropia in MRSE notation was 1.39 ± 1.15 D (range: 0.00 to 4.63 D). Postoperative spherical equivalent was within ±0.50, ±1.00, and ±2.00 D in 31%, 38%, and 92%, respectively. There were no complications. All patients showed a one to seven line gain of corrected distance visual acuity. CONCLUSIONS: FS-LASIK was an effective method of hyperopia correction in this cohort of children with amblyopia, resulting in reduction in anisometropia, restoration of refractive balance, and functional improvement in the amblyopic eye when traditional methods failed. [J Refract Surg. 2020;36(6):366-373.].

Long-term Effects After Pediatric LASIK for Anisometropic Amblyopia in Two Patients.

PURPOSE: To report long-term follow-up of two pediatric patients who underwent laser in situ keratomileusis (LASIK) for myopic anisometropic amblyopia. METHODS: Case series. RESULTS: Two patients who underwent unilateral LASIK in 1999 for anisometropic amblyopia were clinically assessed 16 years after their initial procedure with visual acuity testing, refraction, stereopsis, axial length, corneal topography, slit-lamp examination, and quality of life assessment. Patients had stable corrected distance visual acuity, balanced refraction, improved stereopsis, and good visual quality of life. Corneal topography showed a mildly decentered ablation bed with no evidence of ectasia. CONCLUSIONS: LASIK in the pediatric population requires special considerations, including fixation and centration issues, microkeratome selection, and refractive endpoint. The two patients were found to have stable corneal topography, visual acuity, and stereopsis 16 years after initial treatment. [J Refract Surg. 2019;35(6):391-396.].

ICL versus SMILE in management of anisometropic myopic amblyopia in children.

OBJECTIVE: We compare the predictability, safety, and efficacy of posterior chamber phakic intraocular lens (PCpIOL) versus small-incision lenticule extraction (SMILE) for correcting myopic anisometropia in amblyopic children. METHODS: A prospective randomized study enrolled 30 children, aged 4-12 years, with unilateral myopic anisometropic amblyopia whose refraction ranged between -5 and -10 diopters (D) and myopic astigmatic error -1 to -6 D. Patients were subdivided into group A for unilateral PCpIOL implantation and implantable collamer lens (Visian ICL/TICL) of V4C design and group B for SMILE procedure. Pre- and postoperative corrected distance visual acuity (CDVA), uncorrected visual acuity, and cycloplegic refractive spherical equivalent (CRSE) were performed in all patients and compared between both groups. Follow-up was for at least 18 months. RESULTS: Of the 15 children in group A, 12 (80%) revealed prevention of amblyopia and improvement in CDVA of 3-6 lines, and 3 children (20%) gained 1-3 lines. In group B, 6 (40%) eyes gained 3-5 lines, 6 (40%) eyes gained 1-3 lines, and 3 (20%) children gained 0-1 line. Stereoacuity improved in 93.33% of cases. Mean CRSE decreased in both groups 18 months postoperative (p < 0.001). Improvement in stereoacuity occurred in 86.66% of cases. CONCLUSIONS: To eliminate significant anisometropic myopia in children who are noncompliant with conventional treatment, PCpIOL or SMILE may be considered as alternative modalities of treatment. Being an extraocular procedure, SMILE was found to be a safer procedure with fewer and less serious complications compared to ICL.

V4B implantable collamer lens versus Intacs corneal rings to manage anisometropic myopic amblyopia in children.

OBJECTIVE: To compare the safety and efficacy of phakic intraocular lens (PIOL) versus intrastromal corneal ring segments (Intacs), for correcting high myopic anisometropia in amblyopic children. DESIGN: Nonrandomized prospective multi-center study. PARTICIPANTS: Thirty children, aged between 4 and 12 years, with unilateral high myopic anisometropic amblyopia were included in this study. METHODS: Patients who were prospectively subdivided into group A, with mean preoperative manifest refraction spherical equivalent (MRSE) of -12.96 ± 4.17 D, underwent unilateral phakic posterior chamber intraocular lens implantation. Patients with mean preoperative MRSE of -8.60 ± 1.16 D in group B were treated by Intacs corneal rings. Pre- and postoperative visual acuity, ocular examination, stereoacuity, axial biometry measurements, cycloplegic refraction, and endothelial cell counts were performed in all patients. RESULTS: Group A revealed prevention of amblyopia with improvement in spectacle-corrected distance visual acuity, where 4-6 lines were achieved in 77% of children, 2-3 lines in 4%, and just 0-1 lines restricted to 19% of children. Improvement in stereoacuity was noted in 93.33% of group A cases, whereas group B showed fewer cases of successfully improved vision, with 4-6 lines in 70% of children, 2-3 lines in 3%, and just 0-1 lines restricted to 27% of children. Improvement in stereoacuity was noted in 86.66% of cases. Two cases of cataract and 1 case of glaucoma with 1 case of uveitis were noted in the implantable contact lens (ICL) group. CONCLUSIONS: Posterior chamber PIOLs or Intacs may provide a safe alternative in treating anisometropic myopic patients. Intacs implantation is safer with fewer complications than ICL. However, ICL implantation is advantageous over the corneal ring segment procedure owing to the wide range of errors to correct.

[Analysis of corneal biomechanical changes after femtosecond laser-assisted laser in situ keratomileusis in children with hyperopic anisometropia]. / Analiz biomekhanicheskikh izmenenii rogovitsy posle lazernogo intrastromal'nogo keratomileza s femtolazernym soprovozhdeniem u detei s gipermetropicheskoi anizometropiei.

AIM: to analyze corneal hysteresis (CH) and corneal resistance factor (RF) readings obtained with the Reichert Ocular Response Analyzer (ORA) before and after hyperopic femtolaser-assisted laser in situ keratomileusis (FS-LASIK) in children with anisometropia as well as to establish factors that may cause changes in these parameters. MATERIAL AND METHODS: CH and RF were evaluated before and 1.5 years after FS-LASIK performed on amblyopic eyes of 28 patients aged 6-14 years. Preoperatively, there was a correlation between CH and RF (r=0.41, p=0.03). No correlation was found between CH and age (r=-0.02, p=0.82) or between CH (r=0.00, p=0.98), RF (r=0.04, p=0.83), and cornea thickness. RESULTS: The mean preoperative CH was 12.56±1.21 mmHg, RF 12.31±1.57 mmHg. Postoperatively, a statistically significant change occurred to both CH (by 0.97±1.51 mmHg, p=0.002) and RF (by 1.42±1.55 mmHg, p=0.000). No correlation was found between CH before and after surgery (r=0.11, p=0.57) as well as between the ablation depth and changes in CH (r=0,04, p=0.83) and RF (r=0.21, p=0.28). Regression analysis showed that the extent of CH (r2=0.52, p=0.00) and RF (r2=0,48, p=0.00) changes was closely related to their preoperative values. CONCLUSION: The statistically significant relative change in CH and RF after hyperopic FS-LASIK was 8% and 12%, respectively. CH and RF changes correlated with their preoperative values, but not with the ablation depth or cornea thickness.

The effect of Lasik surgery on myopic anisometropes' sensory eye dominance.

Lasik is a common surgery for treating anisometropia. In this study, we asked a specific question: what's the effect of Lasik surgery on anisometropes' sensory eye dominance ? Fifteen myopic anisometropes (mean age: 23 ± 6.9 years old; 6 females) participated in our experiment. We quantitatively measured participants' sensory eye dominance before and after the Lasik surgery using a binocular phase combination paradigm. We found no significant change of sensory eye dominance within 16 weeks (measured between 8 to 96 days, for one or two repetitions) after the surgery (t(14) = -1.44, p = 0.17). A further following on eight patients showed that patients' two eyes were much more balanced at 16 weeks or more (measured one or two times between 112 to 408 days) after the surgery (t(7) = -3.79, p = 0.007). Our results suggest that the benefit of Lasik surgery on anisometropes' sensory eye dominance is not immediate, a long-term 'adaptation' period (16 weeks or more) is necessary to enable the surgery to be truly effective.

[Refractive Surgery in Children with Myopic Anisometropia and Amblyopia in Comparison with Conventional Treatment by Contact Lenses]. / Refrakcní chirurgie pri myopické anizometropické amblyopii u detí a srovnání s konzervativní lécbou kontaktními cockami.

UNLABELLED: Our study evaluated the visual and refractive results of LASEK and anterior chamber phakic intraocular lens (pIOL) implantation performed for high myopic anisometropia with amblyopia and contact lens intolerance in children compared with conventional treatment by contact lenses.Fourty-three patients (Group A) aged 3 to 7 years (mean, 5,6 years) with high myopic anisometropia and amblyopia had performed multizonal LASEK (27 eyes) or pIOL Verisyse implantation (16 eyes) on the more myopic eye in general anesthesia. Surgery was followed by patching of the dominant eye. Postoperative visual and refractive outcomes were analyzed and all children had minimally two years follow-up after procedure. Refractive surgical data were reported in standard format to describe safety, efficacy, predictability and stability of the procedure. This Group A of 43 children was compared with control Group B of 37 children (mean age 5,4 years), in whom myopic anisometropia and amblyopia were treated conventionally by contact lenses (CL) and patching of the dominant eye. Visual acuity (VA) and binocular vision (BV) outcome were analyzed and compared in both groups.The mean preoperative spherical equivalent (SE) cycloplegic refraction in Group A was - 9,45 ± 2,47 diopters (D) (range -6.0 to -18.25 D) and the mean postoperative SE -1,48 ± 1,13 D (range + 0,75 to - 2,25 D). The mean preop. decimal uncorrected visual acuity (UCVA) 0,023 ± 0,017 increased to 0,46 ± 0,18. The mean preop.decimal best-corrected visual acuity (BCVA) in Group A was 0,28 ± 0.22 and changed to 0,78± 0,19 by 2 years after surgery. The mean BCVA in Group B was 0,23 ± 0,19, at start of CL correction and amblyopia therapy, and improved to 0,42 ± 0,15 after two years. The mean BCVA at final examination was significantly better in Group A (P < 0,05). Binocular vision improvement expressed by the proportions of subjects gained fusion and stereopsis, was overall better in Group A (81 %) than in Group B (33 %), (P < 0,05). There were no complications after surgery.Refractive surgery in children, multizonal LASEK and pIOL Verisyse implantation, are effective and safe methods for correction of high myopic anisometropia, and has an important role in the treatment of amblyopia in children when contact lens intolerance. Visual acuity and binocular vision outcomes were better in children who received permanent surgical correction of anisometropia, than in children conventionally treated by contact lenses. KEY WORDS: myopic anisometropia, amblyopia, children, laser subepithelial keratomileusis (LASEK), anterior chamber phakic intraocular lenses (AC pIOL), binocular vision.

Implantation of spherical and toric copolymer phackic intraocular lens to manage amblyopia due to anisometropic hyperopia and myopia in pediatric patients.

PURPOSE: To evaluate the safety and efficacy of implantation of the Visian Implantable Collamer Lens phakic intraocular lens (pIOL) (spherical and toric models) for management of amblyopia due to anisometropic hyperopia and myopia in children. DESIGN: Retrospective case series. SETTING: Tertiary care eye specialty hospital, Dhahran, Saudi Arabia. METHODS: Eyes of patients who underwent the implantation of the pIOL for refractory anisometropic amblyopia were identified. None of the patients were compliant with spectacle/contact lens correction. Preoperative and postoperative clinical evaluation included visual acuity, cycloplegic refraction, slitlamp microscopy, intraocular pressure, orthoptic evaluation, anterior chamber depth, and ICL vault. RESULTS: A total of 11 eyes (9 myopic, 2 hyperopic) of 11 patients aged 5 to 15 years were identified. Of the 9 myopic eyes, 6 eyes received spherical ICLs and 3 received toric ICLs. Both hyperopic eyes received spherical ICLs. Preoperatively, the mean cycloplegic refractive spherical equivalent (CRSE) was -11.07 D (range -7.75 to -21.88 D) in myopic eyes, and +8.75 D (range +8.63 to +8.87 D) in hyperopic eyes. The mean corrected distance visual acuity (CDVA) was 20/171 (range 20/40 to 20/400) in myopic eyes, and 20/130 (range 20/60 to 20/200) in hyperopic eyes. At a mean follow-up of 16.8 months (in myopic eyes), the mean CRSE was -1.40 D (range 0 to -2.25 D), and mean CDVA was 20/51 (range 20/20 to 20/100). In hyperopic eyes, at a mean follow-up of 15 months, the mean CRSE was +1.82 D (range +1.75 to +1.88 D) and the CDVA had improved to 20/25 in both eyes. Although complications occurred in the 2 hyperopic eyes, the complications were either temporary or visually insignificant and did not necessitate reoperation or ICL explantation. CONCLUSION: ICL implantation may be considered a safe and effective treatment option for refractory amblyopia due to anisometropic hyperopia or myopia in children who are noncompliant with conventional therapy. FINANCIAL DISCLOSURE: The authors have no financial or proprietary interest in a product, method, or material described herein.

The Safety and Predictability of Implanting Autologous Lenticule Obtained by SMILE for Hyperopia.

PURPOSE: To evaluate the safety, effectiveness, stability, and predictability of implanting autologous lenticules obtained from small incision lenticule extraction for the treatment of hyperopia. METHODS: Five patients (10 eyes) with one myopic eye and one hyperopic eye were enrolled. The myopic eye was treated with small incision lenticule extraction; a lenticule was extracted and subsequently implanted in the hyperopic eye. Follow-up was at 1 day, 1, 3, 6, and 9 months, and 1 year postoperatively. Patients received a complete ophthalmologic examination at each visit, including uncorrected distance visual acuity, corrected distance visual acuity, anterior segment optical coherence tomography, and corneal topography. RESULTS: There were no complications in any eye during follow-up. Compared with preoperative levels, at the last follow-up visit the eyes with lenticule implantation showed mean spherical equivalent reduced by 5.53 diopters (residual spherical equivalent was +1.13 to -2.63 diopters), mean uncorrected distance visual acuity increased approximately two lines (approximately 20/63 to 20/40 Snellen), and corrected distance visual acuity in 4 (80%) eyes gained one line, 2 (40%) eyes gained two lines, and 1 (20%) eye gained more than two lines. There was no significant difference (P > .05) in spherical equivalent compared with 1 day postoperatively and the last follow-up visit. Corneal topography showed that the lenticule was uniform and located well; anterior segment optical coherence tomography images showed that the lenticule was transparent and the demarcation line was visible. CONCLUSIONS: Implanting an autologous lenticule obtained by small incision lenticule extraction for hyperopia might be safe, effective, and stable, but its predictability should be improved in the future.

[Implantation of a sulcus-fixated toric additive intraocular lens in a case of high astigmatism after a triple procedure]. / Implantation einer additiven Intraokularlinse in den Sulcus ciliaris zur Korrektur eines hochgradigen Astigmatismus nach Triple Procedure.

BACKGROUND: Residual refractive errors, especially high-grade astigmatism after penetrating keratoplasty, often lead to a significant loss of vision. If high anismetropia could not be corrected with glasses or contact lenses, different kinds of surgical procedures are available for visual rehabilitation (intraocular lens exchange, astigmatic keratotomy, Excimer laser treatment, intrastromal corneal ring segment implantation and additive intraocular lens implantation). Toric add-on IOLs are especially designed for sulcus implantation and correcting high astigmatism in pseudophakic eyes. All toric IOLs are individually manufactured according to subjective refraction and biometry. Depending on the underlying manufacturer high-grade astigmatism can be corrected with a cylindrical power up to + 30.0 D. CASE REPORT: A 74-year-old patient presented with endothelial decompensation and an uncorrected distance visual acuity (UDVA) of 1.0 logMAR for penetrating keratoplasty on the right eye due to a Fuchs endothelial dystrophy. Postoperatively, the uncorrected distance visual acuity improved to 0.8 logMAR, with pinhole correction to 0.5 logMAR. After removing the sutures a high and irregular corneal astigmatism of 21.0 D was found. The corrected distance visual acuity (CDVA) with a refraction of + 5.5 D sph, - 21.0 D cyl 90° was 0.24 logMAR. Therefore an individually manufactured toric additive intraocular lens of + 25.0 D cylindrical and - 18.0 D spherical power for sulcus implantation was chosen and implanted uneventfully. Eight months after surgery refractive astigmatism was reduced significantly to - 0.75 D with an UDVA of 0.08 logMAR and a CDVA of 0.02 logMAR. During the 8-months follow-up period the additive IOL remained centered and no IOL rotation could be observed. CONCLUSION: Toric add-on IOLs are a safe and successful method for reducing high astigmatism and anisometropia after penetrating keratoplasty. One of the main advantages is the reversibility of the procedure by an explantation of the IOL.

The stability of the monofixation syndrome.

PURPOSE: To determine etiology, characteristics, and stability of the monofixation syndrome (MFS) in a chart review of 63 consecutive patients in a private practice of pediatric ophthalmology. DESIGN: Retrospective, consecutive chart review. METHODS: The charts of 63 consecutive patients with MFS, encountered from 2007-2012 followed for a minimum of 3 years were included. Best visual acuity, motor angle deviation at near, fusion, and stereoacuity as recorded on the most recent visit during the follow-up period were examined. Stability of the MFS was determined by comparing the dates of diagnosis with the last examination for those patients who remained stable. Decompensated patients were also studied for characteristics and results of secondary surgery. RESULTS: The etiology of the MFS was esotropia in 58 (92.1%), anisometropia in 2 (3.2%), and exotropia in 3 patients (4.8%). The majority of patients, 57 of 63 (92%), had stable MFS for a mean of 13.9 years. Six esotropic patients decompensated after a mean of 6 years; 5 of these patients were restored to MFS by secondary surgery and 1 spontaneously recovered. Five patients were found to have improved stereoacuity to 60 arc seconds or better by the end of the study. CONCLUSIONS: The MFS is a relatively stable binocular status during the first 2 decades of follow-up. A small percentage of patients decompensated, requiring secondary surgery to restore the MFS binocular status. A similar small percentage of MFS patients developed a higher grade of stereoacuity when followed for a sufficient interval of time.