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PubMed2004

Fourth and sixth cranial nerve injury after halo traction in children: a report of two cases.

BACKGROUND: Spinal traction is the application of a longitudinal force to the spinal column as a means of stabilizing a damaged or abnormal spine. Although not well documented in the ophthalmic literature, complications include cranial nerve palsies, with the sixth nerve being most commonly affected. Fourth nerve palsies have not previously been reported to our knowledge. We present 2 cases of combined fourth and sixth palsies after cervical traction. METHODS: Retrospectively, we reviewed the ophthalmic findings in 2 children with diplopia after spinal traction. RESULTS: Case 1 suffered a traumatic rotatory atlantoaxial subluxation and underwent halo traction. Case 2 required traction to correct a scoliosis secondary to osteogenesis imperfecta. In both cases, sixth nerve palsies were apparent soon after traction. Careful orthoptic examination revealed additional fourth nerve involvement. After 3 months, both cases showed partial resolution of the cranial nerve injuries. CONCLUSIONS: Cranial nerve injury may occur with spinal traction. Fourth nerve palsy may be underreported because of masking by a coinciding sixth nerve palsy.

Abducens Nerve Injury↗
PubMed2004

Negative predictive value of a vision screening program aimed at children aged 3 to 4 years old.

PURPOSE: Nova Scotia has a vision screening program which assesses children aged 4[1\2] to 5[1\2] years. However, its use in younger children proved impossible. This study will examine a modified screening protocol for the younger children (3 to 4 years old) and determine its negative predictive value and minimum age for reliable application. MATERIALS AND METHODS: Public health nurses administered the study protocol to 3- to 4-year-old children. One hundred seventy-eight children were screened over two summers. Medical and family history, external inspection, as well as measures of visual acuity with the Lea Hyvarinen symbols chart and stereoacuity with Frisby plates were recorded. Results were compared with a gold standard examination that included full orthoptic and ophthalmologic evaluations. One hundred forty-one (79%) children underwent the gold standard examination. Agreement between screening and gold standard examinations was studied. RESULTS: Data showed increased concordance between screening and gold standard examination results with increasing age up to 41 months. Negative predictive value (NPV) and specificity also improved when data were separated by this age. In children <41 months old, the screening test NPV was 90%, specificity, 68%, and sensitivity, 75%. In comparison, children >/=41 months old had screening test NPV of 96%, specificity, 95%, and sensitivity, 50%. Specificity was higher in the older age group ( P < 0.001). Sensitivity was lower ( P = 0.004). CONCLUSION: This study's vision screening protocol appears better suited for children 41 months and older. They had better pass/fail reproducibility than children <41 months. The test's simplicity allows easy use by non-eye-care professionals. It could potentially lower the reliable screening age of children by 13 months, from 54 months of age (4[1\2] years old) to 41 months. This screening may miss some refractive errors and microtropia/monofixation syndrome, despite normal visual acuity, stereoacuity, and external inspection.

Age Distribution↗
PubMed2005

Effects of ocular dominance on binocular summation after monocular reading adds.

PURPOSE: To investigate the relationship between ocular dominance and binocular summation with monocular reading adds. SETTING: Department of Orthoptics and Visual Science, School of Allied Health Sciences, Kitasato University, Sagamihara, Kanagawa, Japan. METHODS: Contrast sensitivities were measured by having subjects view contrast charts at spatial frequencies of 1.5, 3.0, 6.0, 12.0, and 18.0 cycles per degree after the addition of positive spherical lenses that ranged from +1.0 to +3.0 diopters (D). Through the use of a balance technique, the test group was quantitatively divided into 12 weak and 8 strong ocular dominance subjects on the basis of binocular rivalry. In study 1, binocular contrast sensitivity was measured in the weak and strong ocular dominances by adding a positive spherical lens in front of 1 eye, whereas the other eye was fixed at a corrected distance. RESULTS: In study 1, the binocular summation was observed only after adding positive spherical lenses in the nondominant eye. The differences in binocular contrast sensitivity that occurred after adding a positive spherical lens in the dominant eye versus that seen in the nondominant eye were statistically significant in the strong ocular dominance subjects who had +1.5 D and +2.0 D defocuses (P<.05; analysis of variance). CONCLUSIONS: Binocular summation was effectively maintained with reading adds in the nondominant eye and was significantly influenced by the magnitude of ocular dominance. Evaluating binocular summation after monocular reading adds seems to be a good method to evaluate adaptability to monovision.

Adult↗
PubMed2005

Role of hyaluronidase in diplopia after peribulbar anesthesia for cataract surgery.

OBJECTIVE: To determine the protective action of hyaluronidase on peribulbar anesthesia-related diplopia in patients undergoing cataract surgery. DESIGN: Single-center observational case series. PARTICIPANTS: All patients undergoing elective phacoemulsification and intraocular lens implantation under peribulbar anesthesia between February 2001 and January 2003. METHODS: We compared the incidence of postoperative diplopia between 2 periods--February 2001 to January 2002 (P1) and February 2002 to January 2003 (P2)--which differed by the presence (P1) or absence (P2) of hyaluronidase in the anesthetic solution. MAIN OUTCOME MEASURES: All patients were examined on the first and fifth postoperative days during both periods. When diplopia was diagnosed, we recorded the characteristics of the patient, peribulbar anesthesia, and diplopia (orthoptic examination, and magnetic resonance imaging in some cases). RESULTS: Seven thousand two hundred five patients were studied. During P1, 3582 patients received peribulbar anesthesia, and no cases of diplopia occurred. During P2, 3623 patients received peribulbar anesthesia, and 27 cases of diplopia occurred (incidence, 0.75%; P = 0.0002 vs. P1). Diplopia involved the inferior rectus (40%) and the external rectus (37%) muscles. Diplopia was persistent in 54% of the cases. CONCLUSIONS: Peribulbar anesthesia-related diplopia was significantly more frequent when hyaluronidase was not added to the anesthetic solution.

Aged↗
PubMed1996

Unilateral congenital ptosis with ipsilateral superior rectus muscle overaction.

PURPOSE: Congenital ptosis may be accompanied by weakness of the ipsilateral superior rectus muscle. We report the finding of a hypertropia of the ipsilateral eye in patients with isolated unilateral congenital ptosis that became manifest only in upgaze. METHODS: Seventy consecutive patients with congenital ptosis were recalled and 58 reexamined. Examination included assessment of visual acuities, palpebral apertures, levator muscle function, and an orthoptic examination. Particular attention was paid to the assessment of upgaze. RESULTS: Thirty-eight patients had an isolated unilateral congenital ptosis. Four patients had bilateral ptosis, six had upgaze deficits, and ten others had a variety of other syndromes associated with ptosis. Seventeen of the 38 patients with isolated unilateral congenital ptosis were found to have an ipsilateral hypertropia on upgaze. The size of the vertical deviation varied from 5 to 30 prism diopters and, in the more severe cases, produced a cosmetic problem that became more noticeable after successful ptosis surgery. In one of these patients, a superior rectus muscle posterior fixation suture was effective in reducing the hypertropia. CONCLUSION: Of a number of possible causes for the ipsilateral hypertropia in upgaze in patients with unilateral congenital ptosis that we observed either a misdirection syndrome within the superior division of the oculomotor nerve or an exaggerated Bell's reflex is the most likely.

Adolescent↗
PubMed1990

Accommodative convergence in hypermetropia.

We compared the clinical characteristics of esotropic, hypermetropic children whose strabismus was fully corrected with spectacles (refractive accommodative esotropia) with those who remained orthotropic (that is, had no manifest strabismus on the cover test) in the presence of uncorrected hypermetropia. In addition to a standard ophthalmologic and orthoptic examination, we determined the stimulus accommodative convergence/accommodation (AC/A) ratio by using the gradient method over a range of 6 diopters, the near point of accommodation, and random dot stereopsis. Hypermetropic patients without esotropia or significant esophoria were found to have a low AC/A ratio in contrast to those patients with refractive accommodative esotropia. This finding explains why esodeviations may be absent in some hypermetropic patients with uncorrected vision. We found a high prevalence of abnormally low near points of accommodation and defective or absent stereopsis in both groups of patients.

Accommodation, Ocular↗
PubMed1978

Efficacy of bifocals in the treatment of accommodative esotropia.

We treated 84 patients with a partially refractive accommodative esotropia with bifocals. Twelve patients were able to fuse without bifocals at the end of therapy; in 19, the bifocal power could be reduced and further improvement can be expected in the future. Thirty-nine remained dependent on bifocals; and in 14, fusion had deteriorated in spite of therapy. Patients with a high AC/A ratio and those receiving supportive orthoptic treatment seemed to fare best with bifocals. In those with a low AC/A ratio, fusion tended to deteriorate because of a slowly increasing esodeviation at near fixation.

Accommodation, Ocular↗
PubMed1998

Congenital corneal anesthesia in children with the VACTERL association.

PURPOSE: To describe ocular manifestations in patients with the VACTERL (vertebral, anal, cardiovascular, tracheoesophageal, renal, and limb defects) association. METHOD: We reviewed the medical records of patients with the VACTERL association who had undergone treatment for amblyopia at the orthoptic department. RESULTS: A striking similarity was found in three unrelated children, who, in addition to clinical manifestations of VACTERL association, showed total corneal anesthesia of one or both eyes that had resulted in recurrent corneal erosions, keratitis, and permanent corneal opacities. Other ocular manifestations included nonparalytic strabismus, anisometropia, and amblyopia. CONCLUSION: Congenital corneal anesthesia may be part of the VACTERL association.

Abnormalities, Multiple↗
PubMed2001

Vertical rectus muscle transposition and botulinum toxin for complete sixth nerve palsy.

BACKGROUND: Effective surgical treatment of complete unrecovered sixth nerve palsy must include the transfer of abducting power to the temporal aspect of the globe with release of medial rectus contracture nasally. We describe our experience in the treatment of five such patients who underwent full vertical rectus transposition combined with botulinum toxin chemodenervation of the ipsilateral medial rectus muscle. METHODS: The five patients all had primarily unilateral complete unrecovered sixth nerve palsy. They all underwent a complete preoperative and postoperative eye examination and an orthoptic assessment. Excursion into abduction was graded from -8 (globe immobilized in extreme adduction) to -4 (abduction as far as primary position) to 0 (full abduction). Abduction saccades and a forced muscle generation test confirmed the presence of complete unrecovered sixth nerve palsy, and forced duction testing measured the degree of medial rectus contracture. All patients received ipsilateral medial rectus injection of botulinum toxin in the preoperative (8 to 2 months before surgery) and perioperative periods, and underwent complete superior rectus-inferior rectus transposition temporally. RESULTS: The average length of follow-up was 21 (range 6 to 48) months. The average preoperative distance alignment was 52 (range 25 to 80) prism dioptres (PD). Vertical rectus transposition combined with botulinum toxin injection resulted in an average distance alignment change of 66 PD (range 50 PD to 82 PD) of exoshift. The average final deviation was 1 PD of esotropia (range 4 PD of esotropia to 6 PD of exotropia). Average abduction improved from -6 (range -3 to -8) preoperatively to -1.7 (range -1 to -2) postoperatively. Saccades averaged -4 preoperatively and improved to -2 postoperatively. Normal vertical eye movements were preserved in all patients. A total field of single binocular vision was created in all patients, which averaged 55 degrees (range 30 degrees to 75 degrees) in the horizontal meridian. The field of single binocular vision from primary position into abduction averaged 23 degrees (range 18 degrees to 28 degrees). INTERPRETATION: Temporal transposition of the vertical rectus muscles combined with perioperative botulinum toxin injection of the ipsilateral medial rectus muscle is a reliable and effective way of restoring functional binocular vision in patients with complete unrecovered sixth nerve palsy.

Abducens Nerve Diseases↗
PubMed2003

Masked bilateral superior oblique palsy.

BACKGROUND: A diagnosis of masked bilateral superior oblique palsy (MBSOP) is established when signs of SOP appear in the normal eye of a patient after strabismus surgery for SOP in the contralateral eye. Despite the absence of signs of bilaterality before surgery, a palsy will develop in the previously unaffected eye in 10% or more of the patients undergoing surgery. This paper examines the clinical profiles and results of surgical management of 14 patients with MBSOP. METHODS: We retrospectively analysed the records of all 14 patients with the clinical criteria for MBSOP in the clinical strabismus database of patients treated by the second author between 1979 and 2001. We extracted the history and data from the pre- and postoperative ophthalmic and orthoptic examinations, recorded the surgical procedures and tabulated the postoperative results. The surgical outcome was considered successful if normal head posture was restored, diplopia was eliminated in functional positions of gaze, and ocular alignment was improved to within 5 prism dioptres (PD) of orthotropia. RESULTS: All 14 patients had presented with seemingly unilateral SOP. The average primary-position hypertropia preoperatively was 17 (range 4-30) PD. The mean excyclotorsion was 5 degrees (n = 12). Most patients (93%) had a head tilt, mild V pattern, moderate inferior oblique overaction and mild superior oblique underaction. Initial surgery consisted of ipsilateral inferior oblique weakening with or without contralateral inferior rectus recession. The average primary-position hypertropia after the first operation (n = 14) was 8 (range 0-15) PD. In the previously masked eye inferior oblique overaction averaged +1.8 and superior oblique underaction -1.1. The average interval from initial surgery to involvement of the contralateral side was 14.9 (range 0.2-52) weeks. The average primary-position hypertropia after the second operation (n = 10) was 1.6 (range 0-10) PD; follow-up averaged 15 (range 0-120) months. Postoperative alignment was excellent (within 6 PD of orthotropia) and binocular vision restored in 9 of the 10 patients. INTERPRETATION: Masked superior oblique palsy is difficult to detect before surgical correction of the initially manifest palsy. However, the possibility of an occult contralateral palsy should be considered in all patients undergoing surgery for unilateral SOP. Patients should be informed preoperatively of the possibility of this outcome. When the masked palsy becomes evident, a successful surgical outcome can usually be expected.

Adolescent↗
PubMed1999

Gaze-shift dynamics in subjects with and without symptoms of convergence insufficiency: influence of monocular preference and the effect of training.

We studied gaze-shift dynamics during several gaze-shift tasks and during reading, in five subjects with convergence insufficiency (C.I., a diminished ability to converge), and in ten subjects without C.I. Furthermore, we studied the effect of vergence training in order to verify previous claims that orthoptic exercises can improve vergence performance. We recorded binocular eye movements with the scleral coil technique. Subjects switched fixation between nearby and distant light emitting diodes (LEDs) arranged in isovergence arrays (distances 35 and 130 cm) in a dimly lit room. In both the C.I. and non-C.I. group, two classes of subjects occurred: vergence responders and saccadic responders. During pure vergence tasks, saccadic responders made saccades with no or little vergence; vergence responders made vergence movements with no or small saccadic components. In saccadic responders, fixation of nearby targets was monocular. Subjects with a preferred eye, according to our determination, used the preferred eye. The five C.I. subjects showed idiosyncratic responses with insufficient vergence during most trials. They all had a tendency to alternate fixation between the left and right eye. Vergence-version tasks always elicited larger vergence components than pure vergence tasks. During a reading task, vergence angles were more accurate than during gaze-shifts between LEDs. After the pre-training sessions, nine subjects (one of which had C.I.) practised a pure vergence task three times a day for at least 2 weeks. Vergence amplitudes of four of these subjects were larger after training. We conclude that vergence training can change oculomotor performance. Although C.I. is often associated with abnormal vergence dynamics, there are no typical C.I. vergence dynamics. Unstable monocular preferences may play a role in the aetiology of C.I.

Adult↗
PubMed2000

Visual impairment and eye diseases in elderly institutionalized Australians.

OBJECTIVE: To study the prevalence and distribution of visual impairment and eye diseases by age and gender in an urban institutionalized population. DESIGN: Cross-sectional study. PARTICIPANTS: Four hundred three residents of nursing homes and hostels. METHODS: Fourteen nursing homes were randomly selected from 104 nursing homes and hostels located within a 5-km radius of each of nine clusters studied in the Visual Impairment Project (VIP) urban cohort. Participants completed a standardized orthoptic and dilated ophthalmic examination, including measurement of visual acuity and visual fields. The major cause of vision loss was identified for participants with visual impairment. MAIN OUTCOME MEASURES: Presenting visual acuity and ophthalmic diagnoses. RESULTS: The participants' mean age was 82 years (standard deviation, 9.24), with an age range of 46 years to 101 years. Women outnumbered men by 318 to 85. Seventy-one (22%) of 318 women had bilateral profound visual impairment (blindness), defined as best-corrected visual acuity <3/60 and/or visual field constriction <5 degrees compared with 10 (12%) of 85 men. However, this difference is not significant when age-standardized. Age-related macular degeneration was the principal diagnosis of vision loss in the better eye of 74 (44%) of the 167 participants with bilateral low vision (<6/18 and/or visual field constriction to <20 degrees radius). The age-adjusted rate of blindness or profound visual impairment in the VIP institutional cohort of 5.2% (95% confidence interval [CI], 1.8, 8.6) was significantly greater than in the VIP urban and rural cohorts of 0.13% (95% CI, 0, 0.25) and 0.29% (95% CI, 0, 0.57), respectively. CONCLUSIONS: Underestimation of visual impairment may occur in residential population-based studies that exclude institutional or residential nursing homes and hostels for the aged citizens. Expanded methods are required for visual assessment in institutional populations.

Age Distribution↗
PubMed2003

Management of strabismus in nanophthalmic patients: a long-term follow-up report.

PURPOSE: The purpose of this study is to identify the characteristics of strabismus that coexist with nanophthalmos and to report the results of strabismus surgery performed on these small eyes. DESIGN: Retrospective, consecutive, noncomparative interventional case series. PARTICIPANTS: Fifteen bilateral nanophthalmic patients, of whom five underwent horizontal muscle surgery, were included in this study. METHODS: Chart review. The clinical examination included visual acuity assessments using the linear Snellen and the Lea charts, slit-lamp and fundus examinations, intraocular pressure, and axial length measurements. The orthoptic examination consisted of measurements of ocular deviations using the prism cover test with an accommodative target at both near and distance with and without refractive correction, assessment of ocular motility with ductions and versions, binocularity with Worth's four-dot test, and the Titmus test. Amblyopia was treated with part-time occlusion. Surgery for the correction of esotropia included bilateral medial rectus recessions or recess-resect procedures. MAIN OUTCOME MEASURES: Magnitude of strabismic deviation, best-corrected visual acuity, and the level of binocular vision achieved were monitored. RESULTS: The average age of enrollment in the study was 4.7 (range, 1-12) years. The patients were followed for an average of 7.0 (range, 4-14) years. The mean axial length was determined as 18.4 mm (range, 15.5-20.7). The mean refractive error in spherical equivalents was measured as +9.9 and ranged between +4.0 and +15.0 diopters. Five patients (33%) had nonaccommodative esotropia, four (27%) had partially refractive esotropia, four (27%) had microesotropia, and two (13%) had exotropia. Five patients, all having nonaccommodative esotropia, underwent surgery for the correction of ocular misalignment. Diminishing the surgical dose in these small eyes resulted in undercorrections. Despite patching, 3 patients (20%) had unilateral and 12 patients (80%) had bilateral amblyopia at the conclusion of the study. CONCLUSIONS: Strabismus in nanophthalmos usually manifests as nonaccommodative and partially refractive esotropia. Medial rectus recession should be applied with care to prevent adduction deficit and convergence insufficiency. Otherwise, there seems to be no need for decreasing the surgical dose with regard to the smaller axial length. Amblyopia tends to be persistent in these patients.

Accommodation, Ocular↗
PubMed1999

Ocular abnormalities in Alagille syndrome.

OBJECTIVE: To assess the type and frequency of ocular abnormalities occurring in Alagille syndrome (AS) in a large group of affected patients and their parents and the potential pathogenetic role of fat-soluble vitamin deficiency. DESIGN: Observational case series. PARTICIPANTS: Twenty-two children with AS and 23 of their parents participated. MAIN OUTCOME MEASURES: Participants underwent full ophthalmic examination, including refraction, orthoptic examination, keratometry, slit-lamp examination, and funduscopy. Corneal diameter measurement was performed in a subset of nine and fluorescein angiography in a subset of six. Serum levels of vitamins A and E and cholesterol were measured. RESULTS: The most common ocular abnormalities in patients with AS were posterior embryotoxon (95%), iris abnormalities (45%), diffuse fundus hypopigmentation (57%, a previously unreported finding), speckling of the retinal pigment epithelium (33%), and optic disc anomalies (76%). Microcornea was not associated with large refractive errors, and visual acuity was not significantly affected by these ocular changes. Vitamin levels were normal. Ocular abnormalities including posterior embryotoxon, iris abnormalities, and optic disc or fundus pigmentary changes were detected in one parent in 36% of cases. CONCLUSIONS: Alagille syndrome is associated with a characteristic group of ocular findings without apparent serious functional significance and probably unrelated to fat-soluble vitamin deficiency. Simple ophthalmic examination of children with neonatal cholestatic jaundice and their parents should allow early diagnosis of AS, eliminating the need for extensive and invasive investigations.

Abnormalities, Drug-Induced↗
PubMed2003

Epstein-Barr virus-related post-transplant lymphoproliferative disorder with t(9;14)(p11-12;q32).

The immunoglobulin heavy chain gene locus on 14q32 is known to be involved in translocations that are associated with B-lymphoproliferative disorders, typically Burkitt lymphoma and B-cell acute lymphoblastic leukemia. Several cytogenetic abnormalities have been described in post-transplant lymphoproliferatve disease (PTLD), some of which include this locus. To our knowledge, we report the first case of translocation t(9;14)(p11-12;q32) in a PTLD that developed after orthoptic liver transplantation.

Biliary Atresia↗
PubMed1993

Effect of hypothermic storage in liver allograft preservation solutions on vasoactivity and prostacyclin synthesis by the rabbit aorta, in vitro.

Primary graft dysfunction following orthoptic liver transplantation has been ascribed to thrombotic and ischemic complications in a high proportion of cases. It has been suggested that hypothermic storage of livers in preservation solutions elicits damage to the vascular endothelium. Since the endothelium controls vasoactivity and hemostasis via release of endothelium derived relaxing factor (EDRF) and prostacyclin (PGI2), storage injury to the endothelium may predispose the allograft to thrombosis, ischemia and impaired perfusion. In order to test this, the effect of long-term hypothermic storage in modified University of Wisconsin solution (UW), kidney perfusion solution (KPS) and minimum essential medium (MEM) on phenylephrine (PE)-stimulated contraction and acetylcholine (ACh)-stimulated relaxation, as well as PGI2 release by rabbit aortic rings was investigated. Following cold storage for 24, 48 and 72 h, PE and ACh dose response curves were unaffected by storage in MEM, UW or KPS. Following hypothermic storage for 24 h and 48 h, PGI2 release (stimulated with PE, ACh, arachidonate, fluoride, calcium ionophore and phorbol ester) was not significantly altered from zero time responses. These results demonstrate that hypothermic storage of rabbit aortic rings in both UW and KPS do not influence two key endothelial functions (the release of EDRF or PGI2) which in turn indicates that endothelial damage associated with reperfusion following hypothermic storage is not causally related to alterations in EDRF and PGI2 release.

Animals↗
PubMed2000

Incidence of ocular misalignment and diplopia after uneventful cataract surgery.

PURPOSE: To evaluate the incidence of ocular misalignment and diplopia after uneventful cataract surgery. SETTING: An outpatient private practice eye institute. METHODS: One hundred thirty-eight patients referred to 1 cataract surgeon were prospectively evaluated. Orthoptic evaluations were performed within 1 month before and then 1 day, 1 week, and 1 month after cataract surgery. Anesthesia was by retrobulbar injection, and cataract extraction was done by phacoemulsification. RESULTS: Cataract surgery was performed in 118 patients. Preoperatively, 16 patients had ocular misalignment; 10 were phoric, 4 were intermittently tropic, and 2 were tropic. Follow-up evaluation was obtained for 101 patients (86%) at 1 day, 91 (77%) at 1 week, and 88 (75%) at 1 month. A change in ocular alignment occurred in 22 of 101 patients (22%) at 1 day, 9 of 91 (10%) at 1 week, and 6 of 88 (7%) at 1 month. Only 1 patient who had a change in alignment at 1 month was symptomatic. CONCLUSIONS: A persistent change in ocular alignment after uneventful cataract surgery occurred in 7% of patients. However, symptomatic diplopia was uncommon (1 in 118; 0.85%) in this relatively small series.

Aged↗
PubMed2003

Clinical results of excimer laser photorefractive keratectomy for high myopic anisometropia in children: four-year follow-up.

PURPOSE: To evaluate the visual and refractive results of multizonal photorefractive keratectomy (PRK) for high myopic anisometropia and contact-lens intolerance in children. SETTING: Department of Ophthalmology, Masaryk University Hospital, Brno, Czech Republic. METHODS: Twenty-one patients aged 7 to 15 years with high myopic anisometropia had multizonal PRK in the more myopic eye and were retrospectively analyzed. The scanning-slit Nidek EC-5000 excimer laser was used. Postoperatively, patients were reviewed at 1 and 3 days, 1 week, and 1, 3, 6, 12, 18, 24, 36, and 48 months. The examination included cycloplegic refraction, uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), biomicroscopy, grading of postoperative haze, corneal topography, pachymetry, intraocular pressure, biometry, orthoptic status, binocular vision (BV), and fundus evaluation. The safety, efficacy, predictability, and stability of the procedure were evaluated. Long-term binocular vision outcome was analyzed. All patients completed a 4-year follow-up. RESULTS: The mean preoperative spherical equivalent (SE) refraction was 8.93 diopters (D) +/- 1.39 (SD) (range -6.75 to -11.75 D) and the mean postoperative SE, -1.66 +/- 0.68 D (range -0.50 to -2.75 D) (P <.05). The mean preoperative UCVA of 0.034 +/- 0.016 increased to 0.35 +/- 0.15 (P <.05) postoperatively. The mean preoperative BSCVA was 0.53 +/- 0.19 and changed to 0.64 +/- 0.16 postoperatively. The safety index was 1.21. No eye lost a line of BSCVA; 9 eyes gained 1 line, and 5 eyes gained 2 lines. The efficacy index was 0.66. The postoperative uncorrected and best spectacle-corrected BV were the same or improved. No eye had +3 haze. There were no significant complications. CONCLUSIONS: Photorefractive keratectomy was safe and effective in correcting high myopic anisometropia in children who were contact-lens intolerant. It provided good visual results and preserved or improved BV over the 4-year follow-up.

Adolescent↗