الفهرس 
• Anterior Segment AnatomyOnly 14 pages are availabe for public view
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Abstract
Refractive surgery in children is mainly performed when conventional treatment has failed. The primary indications are anisometropic amblyopia and bilateral high myopia. The major areas of concern are unstable refraction due to ongoing growth of the eye, and long-term implications.
Anisometropic amblyopia typical treatment includes refractive correction with glasses or contact lenses combined with occlusion or pharmacologic penalization as necessary. Unfortunately, treatment often fails when severe anisometropia of levels greater than 4 to 6 diopters is present.
Patients often are noncompliant with traditional therapy as aresult of aniseikonia, symptoms of eye fatigue or asthenopia, loss of contact lenses, and other reasons. Treatment success is correlated to the amount of anisometropia with decreasing success associated with increasing anisometropia. When more than 6 D of anisomyopia was present, only 25% of children had asuccessful visual outcome with conventional therapy. When 3 D to 6 D of anisomyopia or anisohyperopia was present, only 67% were successfully treated with conventional therapy.
Extensive investigation into surgical treatments for severe anisometropia associated with amblyopia and bilateral high myopia has been undertaken. Excimer refractive procedures, including PRK ,LASIK and LASEK have enjoyed some success .
However the excimer laser procedures in children are still experimental and not yet proven to be truly safe and effective in the long term, the same is eminently true for CLE with or without IOL implantation.
Clear lens extraction for extreme anisometropia in children is associated with increase risk of retinal detachment. We know that children with high anisometropic myopia, frequently axial in nature, are already at increased risk of retinal detachment.
Despite the growing knowledge on alternative treatments for severe anisometropia associated with amblyopia, including excimer laser procedures and now clear lensectomy, we do not know at this point whether there will be any adverse long-term complications and whether or not the best-corrected visual acuity improvements are significant.