Long-term outcomes of photorefractive keratectomy and laser-assisted subepithelial keratectomy in children

Purpose

To assess the long-term refractive, visual acuity, binocular vision, and quality-of-life outcomes of photorefractive keratectomy (PRK) and laser-assisted subepithelial keratectomy (LASEK) in children.

Setting

Non-hospital surgical facility with follow-up in a hospital clinical setting.

Methods

In this retrospective review, 56 eyes of 39 patients had PRK or LASEK under general anesthesia. Patients were examined preoperatively and postoperatively at 2 and 6 months and 1 year and then annually for a minimum of 3.5 years. Recorded variables included demographics, refractive error, best corrected visual acuity (BCVA), stereopsis, corneal haze, and quality of life.

Results

The mean age at surgery was 6.5 years (range 1.0 to 17.4 years). At the final postoperative examination (mean 5.15 years), the mean spherical equivalent was −1.73 diopters (D) in all patients, −3.20 D in PRK patients, and −1.37 D in LASEK patients. Refraction and corneal clarity were stable over the long term in all eyes. In 28 eyes that were measurable preoperatively, visual acuity improved by a mean of 1.6 lines (range 0 to 7 lines). Seven patients (18%) had measurable stereopsis before surgery and 19 (49%), after PRK or LASEK. No patient had reduced BCVA or loss of binocular fusion postoperatively. On a quality-of-life questionnaire, no family recorded negative opinions of the procedure or negative social or functional outcomes postoperatively.

Conclusion

Photorefractive keratectomy and LASEK were effective and stable surgical alternative treatments in children with refractive errors who were unable to tolerate or who failed conventional methods of treatment.