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    Refractive surgery for special needs children: The time is now

    For many, living in a visual blur promotes fearfulness, blunts social interactions


    Treatment strategy

    To treat myopia of –8 D or less, hyperopia of +5 D or less, and astigmatism of 2.5 D or less, he performs excimer laser PRK (608 patients in this study). In children with refractive errors above these limits, he prefers to implant a Visian or Ophtec-Artisan spherical or toric phakic IOL (174 patients in this study). In children with small anterior chambers less than 3.2 mm and small corneas under 11 mm, he performs lensectomy (58 patients in this study).

    The preoperative examination done to obtain precise measurements frequently must be carried out with the patients under brief general anesthesia, as are all surgeries, which are all outpatient procedures. The procedures are performed not only on children from the St. Louis region, but also nationally and inter-nationally.

    The refractions targeted in these patients vary by age, but Dr. Tychsen pointed out typically 1 D of overcorrection. He reported that regression after PRK can be up to 0.85 D annually in some children with high myopia, which is considered greater than 8 D. Applying mitomycin C intraoperatively can reduce the level of regression but does not eliminate it.

    “This is the reason that we prefer to implant phakic IOLs in children with high myopia and high hyperopia,” he commented.

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