Risk Benefit Analysis Of Photorefractive Keratectomy (Prk) And Refractive Lens Exchange (Rle) In Children With Developmental Delay And High Refractive Errors: A 2-Year Follow-Up Study
Published 2023 - 41st Congress of the ESCRS
Reference: PO0932 | Type: Free paper | DOI: 10.82333/sheb-nv20
Authors: Aditya Sethi* 1 , Reena Sethi 2 , Sahebaan Sabharwal Sethi 3 , Arun Sethi 4
1Pediatric Ophthalmology, Cataract and Refractive Surgery,Arunodaya Deseret Eye Hospital,Gurgaon,India;Comprehensive,Dr Sethi's Eye Center,Delhi,India, 2Cataract and IOL Department,Arunodaya Deseret Eye Hospital,Gurgaon,India;Comprehensive,Dr Sethi's Eye Center,Delhi,India, 3Glaucoma, Cataract and IOL Services,Arunodaya Deseret Eye Hospital,Gurgaon,India;Glaucoma, Cataract and IOL Services,Dr Sethi's Eye Center,Delhi,India, 4Refractive Laser Surgery ,Arunodaya Deseret Eye Hospital,Gurgaon,India;Cornea and Refractive Surgery,Dr Sethi's Eye Center,Delhi,India
Purpose
Children with developmental delay often present with uncorrected refractive errors (URE) of high degree and often anisometropia, leading to the development of dense amblyopia. This study aims to evaluate the indications and long-term outcomes of PRK and RLE for the correction of URE in these children.
Setting
The study was conducted at a tertiary eye care center in the National Capital Region, Delhi, India, over a period of 2 years. A detailed necessary and comprehensive consent was taken from the parents and guardians after a detailed discussion on all possible interventions, the pros and cons of doing any procedure.
Methods
A retrospective analysis was performed on eight patients aged between 8-16 years with developmental delay and amblyopia who were intolerant to conventional therapy and had URE. The patients underwent excimer laser PRK or RLE, and their follow-up was documented for more than 2 years. Indicators of measurement included refractive correction, regression, visual acuity, intraocular pressure (IOP), and corneal status. A comparison was made with patients of similar diagnosis who were on conventional therapies.
Results
The preop refractive errors(RE) were -13.50 ± 4.77 diopters (D) for the myopic group and +4.75 ± 2.33 D for the hypermetropic group. The mean postop RE at the 24-month follow-up were -2.75 ± 3.54 D for the myopic group & +1.25 ± 0.75 D for the hypermetropic group that underwent PRK. The RLE group had very high myopia (-12.50 ± 0.75 Ds) patients, with a postoperative RE at -0.75 ± 0.75 Ds. The refractive regression was 0.37D in the myopic & 0.72D in the hyperopic groups. 75% of patients showed significant improvement in visual acuity within 6 weeks of the procedure, and 84% by 24 months. Subepithelial corneal haze remained negligible. The mean final refractive error rate was significantly better than the control group at the final follow-up.
Conclusions
PRK and RLE are viable refractive surgical options for children with developmental delay, high refractive error, and dense amblyopia who are intolerant to conventional therapy. The risk-benefit analysis shows favorable outcomes in terms of visual acuity improvement and refractive error correction, with negligible complications. Financial disclosure of all authors: None.