Correction of large amblyopiogenic refractive errors in children using the excimer laser

Purpose: We sought to determine whether laser subepithelial keratomileusis (LASEK) and photorefractive keratectomy (PRK) are effective methods for correcting amblyopiogenic refractive errors in children. Methods: Thirty-six eyes in 35 amblyopic children, who ranged in age from 4 to 16 years (mean, 8.4 years), received treatment for large magnitude ametropia. Seventy-two percent (25/35) of the children had a neurobehavioral disorder and/or were noncompliant with spectacle or contact lens wear. Myopia ranged from -3.25 to -24.25 D (mean, -11.48 D); one patient had hyperopia of +5.87 D. Correction was tailored to match the refractive error of the nonamblyopic eye. VISX Star S2/S3 excimer lasers were used in manual or auto-tracking modes, and corneal centration was achieved using brief, general anesthesia. Mean follow-up was 29.2 months (range, 4-42 months). Results: Myopia correction averaged -8.95 ± 2.89 D (range, -3.25 to -15.50). Eighty-nine percent (31 children) were corrected to within ± 1.00 D of goal refraction and the remaining 11% to within 2.0 D of the goal (most were undercorrected). Acuity improved postoperatively in 97%; by 1 optotype line in 37% and by 2 or more in 60%. No child lost acuity. Binocularity improved in 69% (24/35) and remained the same in 31%. Corneal haze measured grade 0-1 in 78%, grade 2 in 14%, and grade 3-4 in 8%. Myopic regression exceeding ≅ 1.0 D/year (0.08 D/month) occurred in 50% (18/36) of eyes treated. No substantial differences were observed in PRK- (n = 18) versus LASEK- (n = 17) treated children. Conclusions: Laser refractive surgery is effective for correcting anisometropic myopia in amblyopic children. Recurrence of myopia is common. Further study is indicated to determine long-term stability and safety of the procedure in this population.