1. Refractive surgery in children: Treatment
options, Outcomes and Controversies
By
Hany EL-Defrawy
Pediatric fellow, Bristol
Eye hospital

2.  Medline Literature review (1950-2007)
 Cochrane library
 Cumulative index for nursing and allied health
literature
 English language articles using MeSH terms and key
words
Pediatric refractive errors & amblyopia, ansiometropia,
hyperopia, myopia, LASIK, PRK,excimer laser,
refractive intraocular lens

3. Alhazen (Ibn al-Haytham)
(965 – 1040)

4. Spectacles

5. Problems with high powered
spectacles

6. Contact lenses
 Myopia
 Hyperopia
 Anisometropia
 Monocular aphakia
 Astigmatism (Toric)

7. Contact lens problems

8. LASIK

9. PRK

10. LASEK

11. COMPLICATIONS OF REFRACTIVE
SURGERY
 Regression
 Flap related complications
 Interface deposits
 Infection
 Post LASIK Kerato-ectasia

12. Cornea refractive surgery for myopic
anisometropia

13. Refractive surgery in children
 IOL insertion in congenital cataract.
 Epikeratophakia

14. Refractive surgery in High myopia,
preliminary studies

15. Cornea refractive surgery for
hyperopic anisometropia

16. Artisan Iris Claw lens

17. Intraocular surgery studies for myopic
Anisometropia

18. Risks and benefits of phakic IOLs

19. ARE WE READY?

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. Discussion
 Small number
 Selection bias
 Healing in children
 Flap related complications
 Visual acuity affected by amblyopia
 Regression
 Haze

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