Pediatric refractive surgery in evolution

Refractive surgery as a treatment tool for strabismus: systematic review

The impact refractive surgery has on preoperative horizontal strabismus is rapidly evolving, and this knowledge can provide valuable clinical context when considering refractive surgery as a treatment for strabismus. 515 studies were identified, of which 26 met the inclusion criteria. Analysis indicated that refractive surgery resulted in an overall decrease in the mean uncorrected postoperative angle of deviation caused partially or fully due to refractive error and highlighted the varied outcome of refractive surgery on nonaccommodative horizontal strabismus with limited evidence to suggest refractive surgery for this type of strabismus. Efficacy of refractive surgery in reducing concomitant horizontal strabismus depends on several factors: type of horizontal ocular deviation, patient age, and extent of refractive error. Refractive surgery can be an effective treatment for refractive accommodative horizontal strabismus in patients with stable, mild to moderate myopia or hyperopia and should be considered with careful patient selection for optimum outcome.

Relative peripheral refraction across 4 meridians after orthokeratology and LASIK surgery

Background

To characterize the axial and off-axis refraction across four meridians of the retina in myopic eyes before and after Orthokeratology (OK) and LASIK surgery.

Methods

Sixty right eyes with a spherical equivalent (M) between − 0.75 to − 5.25 D (cylinder <− 1.00 D) underwent LASIK (n = 26) or OK (n = 34) to treat myopia. Axial and off-axis refraction were measured with an open-field autorefractometer before and after stabilized treatments. Off-axis measurements were obtained for the horizontal (35° nasal and temporal retina) and vertical (15° superior and inferior retina) meridians, and for two oblique directions (45–225° and 135–315°) up to 20° of eccentricity. The refractive profile was addressed as relative peripheral refractive error (RPRE).

Results

OK and LASIK post-treatment results showed an increase of myopic relative refraction at several eccentric locations. At the four meridians evaluated, the M component of the pre-treatment RPRE values was not statistically different (p > 0.05) from the post-treatment RPRE within 30° and 20° of the central visual field after LASIK and OK, respectively. These results demonstrated that the treatment zone warrants an optimal central field of vision.

Conclusions

The present study gives an overview of RPRE after refractive corneal reshaping treatments (OK and LASIK) across vertical, horizontal and two oblique meridians together. This allows a 3D representation of RPRE at the retina and shows that the myopic shift induced by both treatments is more relevant in horizontal directions.

The influence of compliance with the use of refractive correction in hyperopic children on accommodation

PURPOSE

To indicate the relationship between constant, correct use of hyperopic spectacles and relaxation of accommodation in children.

METHODS

After thorough ophthalmic examination (cycloplegia included), 52 children 2.5 to 9 years old were detected with hyperopia >3 D, out of all examined within a year. These children were fully or partially corrected, with hyperopic glasses, depending on whether accommodative esotropia was or was not present. Constant and correct use of spectacles was strongly suggested to all children. During follow-up 3 and 6 months later, the amount of manifest hyperopia was measured in each case by an autorefractometer (without the use of cycloplegic factor).

RESULTS

Out of the 52 children, 37 who participated in our study fully complied with hyperopic spectacle treatment, wearing their glasses constantly and correctly. The 15 others wore their glasses partially or not at all or made incorrect use of them. During follow-up 3 and 6 months later, refractive measurements of manifest hyperopia in the first group of children were identical or similar to the refractive power of their glasses. On the contrary, in the second group of children, strong accommodation did not allow the expression of hyperopia, and in a few cases myopic refractive measurements appeared (similar to those on the first examination, before spectacle treatment was prescribed).

CONCLUSIONS

Constant and correct use of hyperopic spectacles leads to relaxation of accommodation in children and is thus an accurate indicator of compliance.