Phakic ICL Implantation to Correct Myopia in Children With Special Needs
American Journal of Ophthalmology, March 2017
Correcting high degrees of ametropia can be challenging in children with special needs, who may resist wearing glasses and may not be able to use contact lenses appropriately. Tychsen et al. prospectively studied a cohort of children with special needs and found that implantation of a phakic intraocular collamer lens (ICL) was safe and improved visual function.
Clinical course and outcome data were obtained for 40 implanted eyes (23 children aged 1-18 years). Before implantation of the Visian ICL device (Staar Surgical), myopia ranged from –3.0 D to –14.5 D (mean, –9.2 D). The correction goal range was plano to +1.0 D. The mean follow-up period was 15 months (range, 6-22 months).
Implantation of the lens resulted in correction within ±1.0 D of the refractive goal for 35 eyes (88%). The other 5 eyes were corrected to within 1.5 D. Uncorrected distance visual acuity improved markedly for all eyes, from a mean of 20/1,050 to a mean of 20/42. Of the 13 children with a neurobehavioral disorder (such as Down syndrome, cerebral palsy, or autism), 11 experienced enhanced attentiveness, visual awareness, or social interaction after the surgery.
Of the 23 children, 2 were returned to the operating room on the first postoperative day for alleviation of pupillary block caused by a nonpatent iridotomy. No other complications occurred, and no patient experienced worsening visual acuity during the follow-up period.
The authors emphasized that the surgical and perioperative management of children with special needs differs from that of myopic adults who undergo similar refractive surgery; recommendations are provided in the article.
The authors concluded that implantation of a phakic ICL into the ciliary sulcus appears to be effective and safe in children with special needs. Major advantages of this procedure include avoidance of marked refractive regression and corneal haze (concerns with excimer laser keratectomy of pediatric eyes) and reduction in the risk of accommodation loss and aphakic/pseudophakic retinal detachment (disadvantages of refractive lensectomy).
The original article can be found here.