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Keratographic assessment was similar bilaterally, but there was a between-eye
difference by wavefront analysis. The predominant aberration in the left eye was
defocus and in the right eye, x-axis trefoil. This resulted in different wavefront profiles
and point-spread functions, which could have caused amblyopia during the critical age
period. The case shows a previously unreported but logically probable cause of
amblyopia. Since a single case can suggest the biological plausibility of a hypothesis
but cannot prove the strength of the association, further research is required in patients
with no cause or an insufficient explanation for amblyopia, especially patients with a
mild refractive error difference.
Refractive surgery in children.
Kohnen T.
J Cataract Refract Surg. 2007 Dec;33(12):2001.
Comment on:
J Cataract Refract Surg. 2002 Jun;28(6):932-41.
Photorefractive keratectomy in children.
Astle WF, Huang PT, Ells AL, Cox RG, Deschenes MC, Vibert HM.
PURPOSE: To evaluate photorefractive keratectomy (PRK) in pediatric patients who fail
traditional methods of treatment for myopic anisometropic amblyopia and high myopia.
SETTING: Nonhospital surgical facility with follow-up in a hospital clinic setting.
METHODS: Photorefractive keratectomy was performed in 40 eyes of 27 patients. The
patients were divided into 4 groups based on the type of myopia: myopic anisometropic
amblyopia (15 eyes/13 patients), bilateral high myopia (20 eyes/10 patients), high
myopia post-penetrating keratoplasty (3 eyes/2 patients), and combined corneal
scarring and anisometropic amblyopia (2 eyes/2 patients). All procedures were
performed under general anesthesia using the VISX 20/20 B laser and a multizone,
multipass ablation technique. Appropriate corneal fixation was achieved with
appropriate head positioning (turn and tilt) and an Arrowsmith fixation ring. Myopia was
as high as -25.00 diopter (D) spherical equivalent (SE), but no treatment was for more
than -17.50 D SE.
RESULTS: The mean SE decreased from -10.68 D to -1.37 D at 1 year, a mean change
of -9.31 D. At 1 year, the mean best corrected visual acuity improved from 20/70 to
20/40 in the entire group. Forty percent of eyes were within +/-1.0 D of the targeted
refraction. There was no haze in 59.5% of eyes. Three eyes initially had 3+ haze; 1
improved to 2+ and 2 required repeat PRK with significant haze reduction. Five eyes (3
patients) with greater than -17.00 D SE myopia before PRK (range -17.50 to -25.00 D)
had 3.42 D more effect than predicted (range 0.50 to 5.50 D). A functional vision survey
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