Magraby Eye and Ear Centre - OMAN

 Difficulties with children and LA  Reports of NO2 interference with Laser function  Aim – compare propfol/fentanyl and ketamine/midazolam

     Prospective 30 patients Randomized to 2 groups Age 3 to 12 years Aniso/Amblyopia

 NBM overnight  Clear fluids till 4 hours before  LASIK or LASEK

 Heart rate  MABP  SaO2 O2 by nasal cannula if SaO2 ≤ 90%

 Matched for: age weight duration of anesthesia duration of surgery

   Time to recovery shorter in P/F group Opposite effects on BP and HR P/F group 3 patients needed O2   Post-op agitation and vomiting higher in K/M group Airway obstruction (needing jaw thrust) higher in P/F group

   Bells phenomenon Nystagmus Overall intra and post-op state   No significant difference (used suction ring for fixation)

    Propofol preferred Shorter acting Lower incidence of dysphoric effects Greater potential for airway compromise.

University of L’Aquila, Italy

       Prospective 18 consecutive patients Mean age 32.4 (range 21 to 52) Accommodative eso (normal AC/A) No suppression 8 – PRK (Group A) 10 – LASIK (Group B)

  ET’ 14.4

Without correction ∆ (10 to 19) ET 11.6

∆ (8 to 14)   ET’ 5 ET 2.4

∆ ∆ With correction (4 to 6) (2 to 4)  Mean 71.2 sec/arc

  2 ∆ 1.2

esophoria – near ∆ esophoria – distance  Refraction +4.6 D (mean) (range +3.50 to +6.00)  Mean BSCVA – 20/20

  ET’ 1.2

∆ 1 Year esophoria ET – orthophoric   ET’ 2 ∆ ET 0.4

∆ 2 Years esophoria

Without correction  ET’ 13.4

∆ (8 to 21)  ET 11.5

∆ (6 to 19) With correction   ET’ 5.4

ET 2.8

∆ ∆ (2 to 8) (orthophoria to 6)  Mean 81 sec/arc

  2.5

∆ 1.1

∆ esophoria – near esophoria – distance  Refraction +6.46 D (mean) (range +5.00 to +8.50)  Mean BSCVA – 20/20

  ET’ 1.7

∆ ET 0.2

∆ 1 Year esophoria esophoria 2 Years  No change

 Only 1 case of regression   Recurrence of ET

 Good binocular function  Good acuity  Careful selection of patients  ? Timing of surgery

 Possible application to older children and young adults?????

Review by L.Tychsen

 Corneal surface ablation  Phakic IOL  Clear Lens Exchange

 Anisometropia – spectacle non-compliant 2.0 D - hypermetropes 3.0 to 4.0 D - myopes  Intolerance of specs or CL  Neuro-behavioural disorders

   Iso-ametropia Spectacle non-compliant Amblyopia approaching 50%   Neuro-behavioural disorders Visual autism

 Other special needs Craniofacial deformities  High hyperopia and esotropia Poor spectacle compliance

 Baseline Repeated examinations EUA    Surface ablation +6.0 to -10.0 D ACD ≥ 3.2 mm Phakic IOL Remainder - Clear lens extraction

       Volatile induction Intravenous anaesthetic EUA LASEK or PTK/PRK BCL and goggles Epithelial healing as in adults Better tolerated

     Artisan iris enclaved Bilateral sequential – 1 month interval Absorbable sutures Limbal relaxing incisions Arm band restraints

       Above 20.0 D ACD ≤ 3.2 mm Lensectomy Posterior capsulectomy Anterior vitrectomy Acrylic IOL AL ≥ 29 mm - Prophylactic laser

 Improvement in UCVA  Best with bilateral ametropia  Modest with anisometropia

 Ametropia avg 7.1 D  UCVA 20/180 to 20/60 (mean)  If glasses worn - BCVA 2-fold improvement

 Ametropia – mean 15.0 D  UCVA 20/3400 to 20/57 (mean)  Similar results with CLE

 90% within 1.5 D of emmetropia  Variable improvement in UCVA and BCVA  No reported loss of acuity  50% improvement in fusion and stereopsis

 Low  Several years follow up  Small numbers

      260 eyes - 1998 to 2008 Negligible rate of sight-threatening complications LASIK – flap complications LASEK – thicker residual stroma Regression - 1.0 D/year ? Over-correction for myopes

 No regression  Corneal endothelium? Low rate of loss  ? Posterior chamber IOLs  ? Glaucoma/ Cataract

   Accomodation Multifocal IOLS?

RD risk – 3% long term

 Substantial benefits for selected patients  Need more information/scrutiny/disclosure