Long-term Outcomes Of LASIK For Hyperopic Anisometropic Anblyopia In Children

Objective:To evaluate the long-term outcomes of LASIK for hyperopic anisometropic amblyopia in children;to investigate the long-term visual quality and the factors affecting long-term visual quality of hyperopic LASIK in children.Methods:40 eyes of 40 children(age 7 to 18 years),57 eyes of 57 children(8 to 17 years) and 10 eyes of 10 children(6 to 16years) with hyperopic anisometropic amblyopia were treated by LASIK,spectacles and contact lenses respectively. All the three groups were given the routine examination included UCVA, subjective manifest refraction and cycloplegic refraction,BCVA.Then all the three groups patched the dominant eyes,and the mean follow-up were 21.65±13.09m, 18.93±8.83m,21.50±13.68m respectively.In LASIK group,Humphry Atalas 995(Carl Zeiss Meditec) was used to measure corneal curvature K1/K2,Oculus Pentacam was used to measure corneal thickness,Hartmann- Shack aberrometer (WASCA,Carl Zeiss Meditec) was used to measure the overall wavefront aberrations in scotopic pupils and the data was analyzed in 5mm diameter,IOL Master(Carl Zeiss) was used to measure the length of axis.TAKAGI CGT-1000 was used to measure the contrast sensitivity and glare sensitivity in LASIK group after the correction of refractive errors 2 weeks later.Titmus Stereo Tests was used to measure the stereopsis in LASIK group and spectacles group with the correction of refractive errors 2 weeks later.Stata 10.0 was used to analyze the data of cycloplegic refraction,BCVA,high order aberration,contrast and glare sensitivity,and stereopsis.Results:The mean postoperative SE refraction,SE anisometropia and LogMAR BCVA of the treated eyes in LASIK group were 1.22±1.34(D),1.80±1.07(D) and 0.37±0.23 respectively.All the changes postoperative were statistically significant(P＜0.05). Mean postoperative SE refraction,BCVA of the treated eyes in spectacles group and contact lenses group were 5.39±1.24(D),0.40±0.32 and 5.17±1.43(D),0.30± 0.19 respectively.The mean corneal curvature K decreased 2.09±1.20D by the latest follow up.87.5%of all LASIK eyes were within±1.00 D(including±1.00 D) of the attempt SE refraction.When preoperative central corneal thickness was not more than 522um,when optic diameter was less than 6.5mm,when the ablation depth was not less than 116um,and when the postoperative corneal curvature was not less than 46.56D,the correct assessment percent of that achieved SE was beyond±1.00 D of attempt SE refraction were 81.40%,65.12%,55.81%,67.44%respectively.The percent of stereopsis less than 60 seconds of arc was 0%preoperatively and 23.5% postoperatively.Contrast sensitivity were increased statistically significant in 0.7°,1°,1.6°and glare sensitivity were increased statistically significant in 0.7°,1°,4°(P＜0.05).The differences of Zerike coefficient Z(4,0),RMSh,RMS3, RJVIS4 and RMS5 between postoperative and preoperative were statistically significant.(P＜0.05),but all those differences were not related to age,preoperative central corneal thickness,preoperative refraction,optic diameter and the ablation depth.The difference of increased LogMAR BCVA between LASIK group and spectacles group was not statistically significant(P＞0.05).But the increased LogMAR BCVA was lager in LASIK group than in RGP group(P＜0.05).No intraoperative and postoperative complication was observed.Conclusions:LASIK for hyperopic anisometropic amblyopia in Children was safe, effective,and predictable;individual design would improved the outcomes of LASIK for hyperopic anisometropic amblyopia in Children;LASIK was alternative treatment in children with moderate and severe hyperopic anisometropic amblyopia who were unable to tolerate or failed with conventional methods of treatment;the changes of high order aberrations,contrast sensitivity and glare sensitivity after hyperopic LASIK need further research.