Refractive surgery may be appropriate for children with severe anisometropia or bilateral high ametropia

The authors of this literature review on the use of surgery to treat pediatric refractive errors concluded that it may be appropriate in children with severe anisometropia or bilateral high ametropia resistant to conventional therapy. But for patients at low risk of amblyopia in which traditional treatments work well, refractive surgery risks outweigh the benefits at least until the long-term safety and effectiveness of pediatric refractive surgery have been better studied, they said.

The authors found through their literature search that no multicenter, long-term controlled trials have been published on pediatric refractive surgery. However, the results of the other studies identified indicated that LASIK, PRK and LASEK show promise in children with refractive amblyopia. Corneal haze and myopic regression are the main complications, particularly in those with myopia greater than 12 D. The results of small studies suggest that in children with extremely high myopia, phakic IOL implantation or clear lens extraction with or without IOL implantation may be useful. But the authors noted that pediatric phakic IOL implantation remains controversial and patients may have a high risk of cataract and glaucoma due to their smaller anterior chamber size compared with adults and propensity for eye rubbing.

Based on their personal experience, the authors proposed use, when appropriate, of an excimer laser-assisted procedure for children with anisometropia or severe ametropia between -12 and 5D and IOL implantation for myopia of more than 12 D or hyperopia of more than 5 D.