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Refractive surgery in children


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Refractive surgery in children

  1. 1. Refractive surgery in children: Treatment options, Outcomes and Controversies By Hany EL-Defrawy Pediatric fellow, Bristol Eye hospital
  2. 2.  Medline Literature review (1950-2007) Cochrane library Cumulative index for nursing and allied health literature English language articles using MeSH terms and key wordsPediatric refractive errors & amblyopia, ansiometropia, hyperopia, myopia, LASIK, PRK,excimer laser, refractive intraocular lens
  3. 3. Alhazen (Ibn al-Haytham)(965 – 1040)
  4. 4. Spectacles
  5. 5. Problems with high poweredspectacles
  6. 6. Contact lenses Myopia Hyperopia Anisometropia Monocular aphakia Astigmatism (Toric)
  7. 7. Contact lens problems
  8. 8. LASIK
  9. 9. PRK
  10. 10. LASEK
  11. 11. COMPLICATIONS OF REFRACTIVESURGERY Regression Flap related complications Interface deposits Infection Post LASIK Kerato-ectasia
  12. 12. Cornea refractive surgery for myopicanisometropia
  13. 13. Refractive surgery in children IOL insertion in congenital cataract. Epikeratophakia
  14. 14. Refractive surgery in High myopia,preliminary studies
  15. 15. Cornea refractive surgery forhyperopic anisometropia
  16. 16. Artisan Iris Claw lens
  17. 17. Intraocular surgery studies for myopicAnisometropia
  18. 18. Risks and benefits of phakic IOLs
  19. 19. ARE WE READY?
  20. 20. Controversies At what age should refractive surgery be performed? Should the same limit of residual corneal thickness used in adults applied to children? Should conventional antiamblyopia therapy be carried out in conjunction to refractive surgery? How much myopic regression can be expected in pediatric patients with high myopia? What is the true rate of corneal haze? Can mitomycin be used safely to lessen the haze? What are the risks of general anesthesia ? Which technique?
  21. 21. Discussion Small number Selection bias Healing in children Flap related complications Visual acuity affected by amblyopia Regression Haze
  22. 22. Conclusion No multicenter long term controlled trial has been published on the use of refractive surgery in children Small retrospective short term studies show that refractive surgery is promising