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 (118%) 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.