The role of refractive surgery in the management of anisometropia in children

Aim This study aimed to correct anisometropia in children as a first step in the management of anisometropic amblyopia. Patients and methods This prospective study included 38 children, aged up to 10 years and suffering from anisometropia myopic or hypermetropic of 4 D or more. Refractive surgery, either laser in situ keratomileusis or small incision lenticular extraction, was performed in the more ametropic eye in order to reduce the difference in refraction between the two eyes, thus allowing spectacles fitting, than management of amblyopia by occlusion therapy of the better eye. Results The amount of anisometropia ranged from −4 to −12 D in myopic anisometropia, seen in 20 patients, and ranged from +4 to +7 D in the hypermetropic anisometropia, seen in 18 patients. Laser in situ keratomileusis was performed in 29 cases, and small incision lenticular extraction was performed in nine cases. Cases were considered corrected when postoperative anisometropia reached less than 3 D difference between the two eyes. All cases were corrected except one case of residual hypermetropic anisometropia. Conclusion Refractive surgery in the more ametropic eye has shown to have an important role in the start of management of anisometropic amblyopia, as a first step to allow proper glasses fitting, then allowing occlusion therapy.