Photorefractive keratectomy for pediatric anisometropia: safety and impact on refractive error, visual acuity, and stereopsis.

PURPOSE: To establish the safety and possible efficacy of excimer laser photorefractive keratectomy (PRK) for treatment of pediatric anisometropia.

DESIGN: Interventional case series

METHODS: This is a prospective, noncomparative interventional case series at an individual university practice of photorefractive keratectomy in 11 children aged 2 and 11 years with anisometropic amblyopia who were unable or unwilling to use contact lens, glasses, and occlusion therapy to treat the amblyopia. The eye with the higher refractive error was treated with PRK using a standard adult nomogram. The refractive treatment goal was to decrease the anisometropia to 3 diopters or less. Main outcome measures were cycloplegic refraction, refractive correction, degree of corneal haze, uncorrected and best spectacle-corrected visual acuity, and stereopsis over 12 months.

RESULTS: All patients tolerated the procedure well. The mean refractive target reduction was -10.10 +/- 1.39 diopters for myopia and +4.75 +/- 0.50 diopters for hyperopia. The mean achieved refractive error reduction at 12 months for myopia was -10.56 +/- 3.00 diopters and for hyperopia was +4.08 +/- 0.8 diopters. Corneal haze at 12 months was minimal. Uncorrected visual acuity improved by 2 or more lines in 6 (75%) of the eight children able to perform psychophysical acuity tests. Best spectacle-corrected visual acuity improved by 2 lines in 3 (38%) of patients. Stereopsis improved in 3 (33%) of nine patients.

CONCLUSIONS: Pediatric PRK can be safely performed for anisometropia. The refractive error response in children appears to be similar to that of adults with comparable refractive errors. Visual acuity and stereopsis improved despite several children being outside the standard age of visual plasticity. Photorefractive keratectomy may play a role in the management of anisometropia in selected pediatric patients.