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Zdonczyk A, Tychsen L, Constantino JN, Culican SM, Badawi AA, Reynolds M. Impact of Ocular Conditions and Improvements After Refractive Surgery in Quality of Life for Children With Neurodevelopmental Disorders. Am J Ophthalmol 2023; 247:9-17. [PMID: 36343699 DOI: 10.1016/j.ajo.2022.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 10/21/2022] [Accepted: 10/24/2022] [Indexed: 11/06/2022]
Abstract
PURPOSE This study aims to characterize the eye-related quality of life of children with neurodevelopmental and ocular disorders at baseline and after refractive surgery. DESIGN Prospective interventional case series. METHODS We enrolled children and adolescents 5 to 18 of age with neurodevelopmental disorders undergoing refractive surgery (6 for pre-/postsurgical assessment and 14 for baseline analysis). Eye-related quality of life was measured using the Pediatric Eye Questionnaire (PedEyeQ). Baseline levels of adaptive functioning and social behaviors were measured using the Adaptive Behavioral Assessment System (ABAS-3) and Social Responsiveness Scale (SRS-2). We assessed the correlation between baseline PedEyeQ scores, number of ocular comorbidities, magnitude of refractive error, and ABAS-3 and SRS-2 scores. RESULTS At baseline, 14 patients demonstrated decreased median eye-related quality of life (<60/100) in 5 of 9 PedEyeQ domains, moderate deficiencies in social behaviors (SRS-2 median 71, range 49-90), and low adaptive functioning (ABAS-3 median percentile for age of 0.100). Baseline PedEyeQ scores did not correlate with magnitude of refractive error or adaptive functioning scores but did correlate with number of ocular comorbidities and social behavior scores. Six patients have undergone refractive surgery without complication. Postoperatively, 11 of 11 eyes were within ±1.5 diopters spherical equivalent. Four of 6 patients exhibited clinically significant improvements in PedEyeQ scores after surgery. CONCLUSIONS Even in the presence of significant social and adaptive impairments, quality of life in children with neurodevelopmental disorders is decreased by ocular disorders. Refractive surgery is associated with clinically significant improvements in eye-related quality of life.
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Affiliation(s)
- Alexandra Zdonczyk
- From the Department of Ophthalmology & Visual Sciences (A.Z., L.T., A.A.B., M.R.), Washington University School of Medicine, St. Louis, Missouri, USA
| | - Lawrence Tychsen
- From the Department of Ophthalmology & Visual Sciences (A.Z., L.T., A.A.B., M.R.), Washington University School of Medicine, St. Louis, Missouri, USA
| | - John N Constantino
- Department of Psychiatry (J.N.C.), Washington University School of Medicine, St. Louis, Missouri, USA
| | - Susan M Culican
- Department of Ophthalmology and Visual Neurosciences (S.M.C.), University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Amer Al Badawi
- From the Department of Ophthalmology & Visual Sciences (A.Z., L.T., A.A.B., M.R.), Washington University School of Medicine, St. Louis, Missouri, USA
| | - Margaret Reynolds
- From the Department of Ophthalmology & Visual Sciences (A.Z., L.T., A.A.B., M.R.), Washington University School of Medicine, St. Louis, Missouri, USA.
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Griščíková L, Autrata R, Krejčířová I, Alió JL, Žajdlíková B, Tomčíková D, Hložánek M. Anterior Chamber Iris-Fixated Phakic Intraocular Lens Implantation for Treatment of High Anisometropia in Children: Long-term Results. J Pediatr Ophthalmol Strabismus 2022; 60:203-209. [PMID: 35938645 DOI: 10.3928/01913913-20220610-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate the long-term efficacy of anterior chamber iris-fixated phakic intraocular lens (PIOL) implantation in the treatment of high myopic (> -9.00 diopters [D]) or hyperopic (> +6.00 D) anisometropia in children with intolerance to spectacles or contact lenses. METHODS A total of 58 children with anisometropic myopia (range: -9.25 to -18.50 diopters [D]) and 13 children with anisometropic hyperopia (range: +6.00 to +8.50 D) underwent unilateral iris-claw PIOL implantation from 2008 to 2018. The mean age was 6.7 years. The mean follow-up was 38.5 months. Target refraction was emmetropia. RESULTS The cycloplegic refraction (mean spherical equivalent) improved from -12.47 D (range: -9.25 to -18.50 D) to -0.73 D (range: +0.75 to -1.50 D) in myopic eyes and reduced from +7.15 D (range: +6.00 to +8.50 D) to +0.94 D (range: -0.50 to + 1.75 D) in hyperopic eyes. Eighty-four percent of eyes were corrected to within ±1.00 D of emmetropia. The mean uncorrected distance visual acuity (UDVA) improved from 1.74 ± 0.36 to 0.45 ± 0.28 logarithm of the minimum angle of resolution (logMAR) (P = .0014). The mean corrected distance visual acuity (CDVA) changed from 0.68 ± 0.32 to 0.27 ± 0.15 logMAR (P = .02179). The safety index was 2.18 and the efficacy index was 1.51. The mean pre-operative endothelial cell count of 2,874.7 cells/mm2 changed to 2,685.3 cells/mm2 at 2 to 6 years postoperatively. Binocular vision quality was improved in 55 patients. No patient had serious complications or lost any Snellen lines of CDVA. CONCLUSIONS Iris-fixated PIOL implantation is an effective and safe method in the treatment of high anisome-tropic myopia and hyperopia and amblyopia in pediatric patients who are noncompliant with spectacles or contact lenses. [J Pediatr Ophthalmol Strabismus. 20XX;X(X):XX-XX.].
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Comment on: Safety of phakic intraocular collamer lens implantation in 95 highly myopic special-needs children. J Cataract Refract Surg 2021; 47:1605-1606. [PMID: 34670949 DOI: 10.1097/j.jcrs.0000000000000852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kraus CL, Culican SM. New advances in amblyopia therapy II: refractive therapies. Br J Ophthalmol 2018; 102:1611-1614. [PMID: 29871968 PMCID: PMC6287570 DOI: 10.1136/bjophthalmol-2018-312173] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 05/23/2018] [Indexed: 11/11/2022]
Abstract
The treatment of anisometropic or ametropic amblyopia has traditionally enjoyed a high treatment success rate. Early initiation and consistent use of spectacle correction can completely resolve amblyopia in a majority of patients. For those with anisometropic amblyopia that fail to improve with glasses wear alone, patching or atropine penalisation can lead to equalisation of visual acuity. However, successful treatment requires full-time compliance with refractive correction and this can be a challenge for a patient population that often has one eye with good acuity without correction. Other barriers for a select population with high anisometropic or ametropic amblyopia include rejection of glasses for various reasons including discomfort, behavioural or sensory problems, postural issues and visually significant aniseikonia. When consistent wear of optical correction proves difficult and patching/atropine remains a major obstacle, surgical correction of refractive error has proven success in achieving vision improvement. Acting as a means to achieve spectacle independence or reducing the overall needed refractive correction, refractive surgery can offer a unique treatment option for this patient population. Laser surgery, phakic intraocular lenses and clear lens exchange are three approaches to altering the refractive state of the eye. Each has documented success in improving vision, particularly in populations where glasses wear has not been possible. Surgical correction of refractive error has a risk profile greater than that of more traditional therapies. However, its use in a specific population offers the opportunity for improving visual acuity in children who otherwise have poor outcomes with glasses and patching/atropine alone.
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Affiliation(s)
- Courtney L Kraus
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland, USA
| | - Susan M Culican
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, Missouri, USA
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Refractive Surgery in Pediatric Patients. CURRENT OPHTHALMOLOGY REPORTS 2017. [DOI: 10.1007/s40135-017-0147-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Tychsen L, Faron N, Hoekel J. Phakic Intraocular Collamer Lens (Visian ICL) Implantation for Correction of Myopia in Spectacle-Aversive Special Needs Children. Am J Ophthalmol 2017; 175:77-86. [PMID: 27939561 DOI: 10.1016/j.ajo.2016.11.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 11/23/2016] [Accepted: 11/29/2016] [Indexed: 11/24/2022]
Abstract
PURPOSE A subset of children with high anisometropia or isoametropia and neurobehavioral disorders have chronic difficulties with spectacle or contact lens wear. We report the results of refractive surgery in a series of these children treated using bilateral or unilateral intraocular collamer lens (Visian ICL) implantation for moderate to high myopia. DESIGN Prospective nonrandomized cohort study. METHODS Clinical course and outcome data were collated prospectively for 40 implanted eyes in 23 children (mean age 10.2 ± 5.3 years, range, 1.8-17 years). Myopia ranged from -3.0 to -14.5 diopters (D), mean -9.2 ± 3.5 D. Goal refraction was plano to +1 D. Correction was achieved by sulcus implantation of a Visian ICL (STAAR Surgical, Monrovia, California, USA) under general anesthesia. Mean follow-up was 15.1 months (range, 6-22 months). RESULTS Thirty-five eyes (88%) were corrected to within ±1.0 D of goal refraction; the other 5 (12%) were corrected to within 1.5 D. Uncorrected distance visual acuity improved substantially in all eyes (from mean 20/1050 [logMAR 1.72] to mean 20/42 [logMAR 0.48]). Spherical regression at last follow-up was an average of +0.59 D. Visuomotor comorbidities (eg, amblyopia, nystagmus, foveopathy, optic neuropathy) accounted for residual postoperative subnormal visual acuity. Thirteen of the 23 children (57%) had a neurobehavioral disorder (eg, developmental delay/intellectual disability/mental retardation, Down syndrome, cerebral palsy, autism spectrum disorder). Eighty-five percent (11/13) of those children were reported to have enhanced visual awareness, attentiveness, or social interactions. Endothelial cell density was measureable in 6 cooperative children (10 eyes), showing an average 1% decline. Central corneal thickness, measured in all children, increased an average of 8 μm. Two children (8%) required unplanned return to the operating room on the first postoperative day to alleviate pupillary block caused by a nonpatent iridotomy. No other complications were encounterd. CONCLUSION Visian ICL implantation improves visual function in special needs children who have moderate to high myopia and difficulties wearing glasses or contact lenses.
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Niyaz L, Can E, Seymen Z, Eraydin B. Comparison of Anterior Segment Parameters Obtained by Dual-Scheimpflug Analyzer Before and After Cycloplegia in Children. J Pediatr Ophthalmol Strabismus 2016; 53:234-7. [PMID: 27182749 DOI: 10.3928/01913913-20160427-02] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 03/08/2016] [Indexed: 11/20/2022]
Abstract
PURPOSE To assess the changes of anterior segment parameters with cycloplegia. METHODS A cross-sectional study of healthy pediatric patients was performed. Anterior segment parameters were obtained by the Galilei Dual-Scheimpflug analyzer (Ziemer Group, Port, Switzerland) before and 40 minutes after the instillation of cyclopentolate. The effect of gender was evaluated. RESULTS There were 43 boys and 50 girls with a mean age of 7.76 ± 2.7 years. There was a significant increase in anterior chamber depth, anterior chamber volume, and pupil diameter after the cycloplegia (P < .05). The anterior chamber angle increased after cycloplegia in the nasal, temporal, and inferior quadrants (P < .05), but not in the superior quadrant (P > .05). The mean values of anterior segment parameters were similar in both genders. CONCLUSIONS The values of anterior chamber depth, anterior chamber volume, anterior chamber angle, and pupil diameter measured with the Galilei Dual-Scheimpflug analyzer increased significantly after cycloplegia. Gender did not have an effect on anterior segment parameters. [J Pediatr Ophthalmol Strabismus. 2016;53(4):234-237.].
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Abstract
Phakic intraocular lenses revolutionize refractive surgery and continue to serve as an excellent option for vision correction in patients who are not ideal candidates for laser vision correction. This article will review special indications of phakic intraocular lenses in the clinical practice.
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Affiliation(s)
- Roberto Pineda
- Keratorefractive Surgery Service, Massachusetts Eye and Ear Infirmary, Boston MA, USA
| | - Tulika Chauhan
- Keratorefractive Surgery Service, Massachusetts Eye and Ear Infirmary, Boston MA, USA
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Emara KE, Al Abdulsalam O, Al Habash A. Implantation of spherical and toric copolymer phackic intraocular lens to manage amblyopia due to anisometropic hyperopia and myopia in pediatric patients. J Cataract Refract Surg 2015; 41:2458-65. [DOI: 10.1016/j.jcrs.2015.05.035] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 05/03/2015] [Accepted: 05/06/2015] [Indexed: 11/24/2022]
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Tychsen L. Refractive surgery for children: laser, implants, current results and future directions. EXPERT REVIEW OF OPHTHALMOLOGY 2014. [DOI: 10.1586/17469899.3.6.635] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Williams C, Northstone K, Borwick C, Gainsborough M, Roe J, Howard S, Rogers S, Amos J, Woodhouse JM. How to help children with neurodevelopmental and visual problems: a scoping review. Br J Ophthalmol 2013; 98:6-12. [PMID: 24158842 PMCID: PMC4030252 DOI: 10.1136/bjophthalmol-2013-304225] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Children with visual impairment and a condition affecting their neurodevelopment (children with VND) may require extensive and specialised help but evidence on the most effective strategies for visual improvement is lacking. We defined a PICO format (Population, Intervention, Comparator, Outcome) for a scoping review and systematically searched 13 databases. Two reviewers assessed the abstracts for inclusion and a third arbitrated in cases of disagreement. We abstracted data from included studies. We found 4450 abstracts from which we identified 107 papers for inclusion. Of these, 42 related to interventions involving a change in visual input or function: 5 controlled trials, 8 before and after studies and 29 case reports. The strongest evidence supported the provision of spectacles to improve distance or near vision and the use of ultraviolet light as environmental modification for training. Less strong but suggestive evidence supported training/practice routines to improve acuity or oculomotor control. Interventions exist to help children with VND and current recommendations that they are assessed by a vision specialist are supported by the evidence. More information is needed on the effectiveness of training/practice programmes which may promote improved function, and of environmental modifications to facilitate engagement of children with VND with the surroundings.
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Affiliation(s)
- C Williams
- School of Social and Community Medicine, University of Bristol, , Bristol, Somerset, UK
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Zafar SN, Siddiqui SN, Khan A. Effects of Artisan aphakic intraocular lens on central corneal thickness and intra ocular pressure in pediatric eyes with crystalline subluxated lenses. Oman J Ophthalmol 2013; 6:44-7. [PMID: 23772125 PMCID: PMC3678197 DOI: 10.4103/0974-620x.111914] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
PURPOSE To study effects of Artisan iris fixated intraocular lens (IOL) on central corneal thickness (CCT) and intraocular pressure (IOP) in pediatric eyes with crystalline subluxated lenses. MATERIALS AND METHODS The study included 17 eyes undergoing Artisan aphakic IOL implantation after lensectomy for subluxated crystalline lenses. CCT and IOP measurements were recorded pre-operatively and post-operatively taking the mean of 4 post-operative visits. Patients were divided into Group A (n = 8) including patients with lensectomy and iris fixation of Artisan IOL as a primary procedure and Group B (n = 9) including patients in which lensectomy was carried out as a primary surgery and Artisan IOL fixation as a secondary procedure. RESULTS Children ranged in age from 08 years to 16 years, mean 11.59 ± 2.96 years. Follow-up period ranged from 7 months to 16 months, mean 11.24 months ± 4.27. Mean pre-operative and post-operative IOP in Group A was 14.88 ± 2.80 and 14.16 ± 0.59 respectively (P = 0.528). In Group B it was 12.44 ± 2.79 and 14.44 ± 1.15 respectively (P = 0.080). Mean pre-operative and post-operative CCT in Group A was 529.13 ± 24.23 and 529.87 ± 17.46 respectively (P = 0.674). In Group B it was 567.33 ± 29.13 and 568.83 ± 25.69 respectively (P = 0.859). CONCLUSIONS Primary and secondary Artisan aphakic IOL implantation did not cause any significant changes in corneal thickness or IOP during the follow-up period.
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Affiliation(s)
- Saemah Nuzhat Zafar
- Department of Pediatric Ophthalmology and Strabismus, Al Shifa Trust Eye Hospital, Rawalpindi, Pakistan
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The role of phakic intraocular lens implants in treatment of high-refractive errors and amblyopia in children. Ophthalmol Ther 2013; 2:3-9. [PMID: 25135696 PMCID: PMC4108153 DOI: 10.1007/s40123-013-0013-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Indexed: 11/08/2022] Open
Abstract
Introduction This article aims to evaluate the role of phakic intraocular lens (pIOL) implants in the treatment of high-refractive errors and amblyopia in the pediatric setting. Methods A literature search of the PubMed database was conducted in December 2012 using the keywords: pIOL implants, amblyopia, pediatric refractive surgery and ametropia, and articles of high or medium clinical relevance were selected for review. Inclusion criteria were children aged 0–17 years who had undergone pIOL implantation for the treatment of refractive errors and/or amblyopia. Results Multiple studies have shown the relevancy and effectiveness of pIOL implantation as an alternative surgical management for highly significant pediatric ametropia in selective patients who are noncompliant with medical treatment. Conclusions In the management of clinically significant severe pediatric ametropic and/or anisometropic myopia or hyperopia and in the event of nonadherence to traditional medical treatment, phakic anterior chamber IOL implantation is currently considered an effective modality of treatment. Long-term follow-up of pediatric patients following pIOL implantation is necessary. Future clinical trials are needed to address the safety and efficacy of the type of and the best time for pIOL implantation in treatment and/or prevention of amblyopia in children.
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Refractive surgery for accommodative esotropia: past, present, and future. Eur J Ophthalmol 2012; 22:871-7. [PMID: 23097019 DOI: 10.5301/ejo.5000210] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2012] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Refractive surgery has the potential to be a definitive treatment for accommodative esotropia, yet it has not been widely embraced. This article reviews the current literature on refractive surgery to treat accommodative esotropia. METHODS A literature search was performed using the following terms: refractive surgery, photorefractive keratectomy, laser-assisted keratomileusis, intraocular lens, hyperopia, accommodative esotropia, children, pediatric. RESULTS Fifteen series of patients treated with refractive surgery for accommodative esotropia were identified and summarized. CONCLUSIONS Refractive surgery holds promise for the treatment of accommodative esotropia, although treatment risks are present and additional investigation is needed.
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Ryan A, Hartnett C, Lanigan B, O'Keefe M. Foldable iris-fixated intraocular lens implantation in children. Acta Ophthalmol 2012; 90:e458-62. [PMID: 22394414 DOI: 10.1111/j.1755-3768.2011.02367.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To describe the results of foldable iris-fixated intraocular lens (IOL) implantation in children. METHODS Children with high bilateral or unilateral myopia who were intolerant of spectacle or contact lens correction were implanted with an iris-fixated foldable IOL and prospectively followed. We measured pre- and postoperative visual acuity, refraction, endothelial cell density (ECD) and National Eye Institute Visual Functioning Questionnaire-25. RESULTS Eleven eyes of six children were implanted. Indications were high bilateral myopia in children with comorbid neurobehavioural disorders, high anisometropia and high myopic astigmatism. Mean preoperative spherical equivalent (SE) refraction was -14.6 dioptres (D)±4.2 SD. Mean follow-up was 15 months. Postoperative SE refraction was -2.40 D±2.40 SD. Corrected distance visual acuity (CDVA) improved from mean logMAR 0.84±0.4 SD to postoperative 0.67±0.34 SD (p=0.005). CDVA was reduced because of coexistent ocular disorders and amblyopia. Vision-related quality of life (QOL) measures improved significantly. There were no intraoperative or postoperative serious complications. CONCLUSION Foldable iris-fixated IOL insertion can give a significant improvement in vision and in vision-related QOL in a subset of paediatric patients with special refractive needs who are intolerant to conventional treatment. Long-term follow-up is required for monitoring of ECD.
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Affiliation(s)
- Andrea Ryan
- Department of Ophthalmology, Children's University Hospital, Dublin, Ireland
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Paysse EA, Tychsen L, Stahl E. Pediatric refractive surgery: corneal and intraocular techniques and beyond. J AAPOS 2012; 16:291-7. [PMID: 22681949 DOI: 10.1016/j.jaapos.2012.01.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2011] [Revised: 12/01/2011] [Accepted: 01/29/2012] [Indexed: 11/16/2022]
Abstract
Refractive surgery has now been used successfully to treat severe anisometropia and isoametropia associated with amblyopia in children who cannot wear standard spectacles or contact lenses. Extraocular techniques include photorefractive keratectomy, laser-assisted subepithelial keratomileusis, and laser-assisted in situ keratomileusis. Intraocular techniques include refractive lensectomy and phakic intraocular lenses and are still being investigated in children for refractive errors outside the treatment dose capabilities of the excimer laser. This workshop discusses the various techniques, how and when to use each, and their risks and benefits. Newer techniques currently being used in adults that may someday be used in children are also introduced.
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Affiliation(s)
- Evelyn A Paysse
- Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA.
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Brown SM. Appropriate research design for studies of refractive surgery in children. J Cataract Refract Surg 2011; 37:1379-81. [PMID: 21782082 DOI: 10.1016/j.jcrs.2011.06.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Alió JL, Toffaha BT, Laria C, Piñero DP. Phakic Intraocular Lens Implantation for Treatment of Anisometropia and Amblyopia in Children: 5-year Follow-up. J Refract Surg 2011; 27:494-501. [DOI: 10.3928/1081597x-20110120-01] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2010] [Accepted: 11/19/2010] [Indexed: 11/20/2022]
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Pirouzian A, Ip KC. Anterior chamber phakic intraocular lens implantation in children to treat severe anisometropic myopia and amblyopia: 3-year clinical results. J Cataract Refract Surg 2010; 36:1486-93. [DOI: 10.1016/j.jcrs.2010.03.041] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2009] [Revised: 03/21/2010] [Accepted: 03/24/2010] [Indexed: 10/19/2022]
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Trivedi RH, Wilson ME. Refractive lens exchange with intraocular lens implantation in hyperopic eyes of a patient with Angelman syndrome. J Cataract Refract Surg 2010; 36:1432-4. [PMID: 20656169 PMCID: PMC2911455 DOI: 10.1016/j.jcrs.2010.05.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2010] [Revised: 02/11/2010] [Accepted: 02/19/2010] [Indexed: 11/19/2022]
Abstract
UNLABELLED We describe a patient with Angelman syndrome with severe developmental delay who was visually impaired by uncorrected high hyperopia and poor control of accommodation. Refractive lens exchange with intraocular lens implantation was performed in both eyes when the patient was 22 years of age. Satisfactory anatomical and functional outcomes were achieved and maintained during 3 years of follow-up. Refractive lens exchange can be useful in patients with severe neurobehavioral disorders in the presence of high refractive error and poor accommodative control. FINANCIAL DISCLOSURE Neither author has a financial or proprietary interest in any material or method mentioned.
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Affiliation(s)
- Rupal H Trivedi
- Miles Center for Pediatric Ophthalmology, Storm Eye Institute, Department of Ophthalmology, Medical University of South Carolina, Charleston, South Carolina 29425-5536, USA.
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Pehere NK, Ramappa RM. Refractive surgery in children: treatment options, outcomes, and controversies. Am J Ophthalmol 2010; 149:870-1; author reply 871. [PMID: 20399936 DOI: 10.1016/j.ajo.2010.01.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2009] [Revised: 12/03/2009] [Accepted: 01/25/2010] [Indexed: 11/17/2022]
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Health- and Vision-Related Quality of Life in Intellectually Disabled Children. Optom Vis Sci 2010; 87:37-44. [DOI: 10.1097/opx.0b013e3181c1d533] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Pirouzian A, Ip KC, O'Halloran HS. Phakic anterior chamber intraocular lens (Verisyse) implantation in children for treatment of severe ansiometropia myopia and amblyopia: Six-month pilot clincial trial and review of literature. Clin Ophthalmol 2009; 3:367-71. [PMID: 19668592 PMCID: PMC2709036 DOI: 10.2147/opth.s5710] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2009] [Indexed: 11/23/2022] Open
Abstract
Purpose: The current study aims to evaluate both safety and efficacy of Verisyse™ (AMO, Irvine, CA) phakic anterior chamber intraocular lens (IOL) in the reduction of clinically significant (>−8 D) myopic anisometropia in children who are noncompliant to traditional medical treatment including spectacle correction or contact lenses. Design: Retrospective interventional case series. Methods: Six anisometropic myopic pediatric patients in one practice were identified through chart-review. None of the patients were compliant with specatacle correction or contact lens wear and as a result had dense amblyopia of less than 20/400 by Snellen or Allen visual acuity (mean <20/400). All patients underwent Verisyse™ phakic IOL implantation in the more myopic eye by one surgeon (AP). Pre- and post-operative visual acuity, anterior/posterior segment examination, stereoacuity, axial biometry measurements, cycloplegic refraction, and endothelial cell counts were performed in all patients whenever feasible. Results: The age of patients ranged from 5–11 years. The mean post-operative follow-up time was six months from the time of IOL insertion. Improvement in visual acuity >6 lines was achieved in four patients (mean visual acuity of 20/70 at six months). Improvement in stereoacuity was noted in all six patients (from total mean zero seconds-arc to six-months post-operative mean of 500 seconds-arc by randot stereoacuity testing). Improvement of >2 lines of visual acuity lines was achieved in the other two patients. No patient lost any lines of visual acuity. Enhanced physical activity, coordination, and improved social interaction were noted in patients and were reported by the parents. No intra/post-operative complications were noted. Discussion: Irreversible or intractable amblyopia secondary to severe anisometropic myopia is a serious medical concern in the pediatric population. Failure of compliance with contact lens therapy consistently leads to visual loss. Anterior chamber phakic IOLs may provide a safe alternative in treatment of noncompliant anisometropic myopic patients who do not accept spectacle wear or contact lens therapy. Conclusion: To reduce or eliminate highly significant anisometropic myopia in children who are noncompliant with traditional medical treatment, phakic anterior chamber IOL implantation may be considered as an alternative modality of treatment.
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