Laser in situ keratomileusis for treated anisometropic amblyopia in awake, autofixating pediatric and adolescent patients.

PURPOSE: To establish the safety and efficacy of laser in situ keratomileusis (LASIK) in pediatric and adolescent patients with anisometropic amblyopia who completed amblyopia therapy and had a visual acuity of 20/30 or better bilaterally. SETTING: Department of Ophthalmology and Visual Science, University of Texas-Houston Medical School, Houston, Texas, USA. METHODS: From August 2000 to March 2002, LASIK was performed in 21 eyes of 19 consecutive patients meeting eligibility requirements. The procedure was performed with the Summit Autonomous LADARVision 4000 excimer laser (Alcon Laboratories, Inc.) in the amblyopic eye for the correction of anisometropia or in both eyes. All patients were awake and autofixating during the procedure. RESULTS: The mean patient age was 13.14 years (range 8 to 19 years). Seventeen patients were treated in the amblyopic eye only to correct anisometropia; treatment was performed in both eyes of 2 patients who were older than 18 years. Patients were followed for a mean of 18.0 months (range 8.6 to 26.5 months). Anisometropia was greater than 2.00 diopters (D) in all cases (mean 4.43 D, range 13.25 to 2.25 D). The percentage deviation from the attempted correction in the myopic group was 4.0% +/- 4.0% (SD) (range 2.0% to 10.0%) and 38.0% +/- 13.0% (range 5.0% to 58.0%) in the hyperopic group. Anisometropia decreased uniformly to less than 2.00 D in all patients (mean 1.52 D). The percentage of patients with stereo acuity increased from 63.0% preoperatively to 84.0% postoperatively. CONCLUSIONS: Laser in situ keratomileusis safely and effectively reduced anisometropia in these patients. If stereo acuity is not possible preoperatively, it may be obtained postoperatively.

Laser in situ keratomileusis for high hyperopia in awake, autofixating pediatric and adolescent patients with fully or partially accommodative esotropia.

PURPOSE: To establish the safety and efficacy of laser in situ keratomileusis (LASIK) in pediatric and adolescent patients with bilateral visual acuity of 20/30 or better and accommodative or partially accommodative esotropia. SETTING: Department of Ophthalmology and Visual Science, University of Texas-Houston Medical School, Houston, Texas, USA. METHODS: The study comprised 30 eyes of 15 consecutive patients with accommodative or partially accommodative esotropia who met eligibility requirements and had bilateral LASIK using the Alcon Summit Autonomous LADARVision excimer laser to correct a refractive error after January 2001. All patients were awake and autofixating during the procedure. RESULTS: The mean age of the patients was 13.9 years (range 9.1 to 18.8 years) and the mean refractive error, +5.35 diopters (D) (range +3.75 to +8.50 D) with anisometropia of 2.0 D or less. The mean follow-up was 15.7 months (range 9.5 to 22.5 months). No intraoperative complications were encountered. The percentage of undercorrection [100% -[(treatment achieved/treatment attempted) x 100%]] [mean 34% +/- 17% (SD), coefficient of variation (SD/mean) 0.50, range 5% to 58%] was higher than expected. Seven patients (47%) required enhancement due to undercorrection of hyperopia with diplopia (6 patients) or astigmatism with decreased visual acuity (1 patient). In this small series, no patient lost best corrected visual acuity or stereo acuity. CONCLUSION: Laser in situ keratomileusis can safely and effectively reduce refractive error in this group of patients; however, patient selection is extremely critical and enhancement was required in almost half the patients.