Laser in situ keratomileusis for high hyperopia in awake, autofixating pediatric and adolescent patients with fully or partially accommodative esotropia

Purpose: To establish the safety and efficacy of laser in situ keratomileusis (LASIK) in pediatric and adolescent patients with bilateral visual acuity of 20/30 or better and accommodative or partially accommodative esotropia. Setting: Department of Ophthalmology and Visual Science, University of Texas-Houston Medical School, Houston, Texas, USA. Methods: The study comprised 30 eyes of 15 consecutive patients with accommodative or partially accommodative esotropia who met eligibility requirements and had bilateral LASIK using the Alcon Summit Autonomous LADARVision® excimer laser to correct a refractive error after January 2001. All patients were awake and autofixating during the procedure. Results: The mean age of the patients was 13.9 years (range 9.1 to 18.8 years) and the mean refractive error, +5.35 diopters (D) (range +3.75 to +8.50 D) with anisometropia of 2.0 D or less. The mean follow-up was 15.7 months (range 9.5 to 22.5 months). No intraoperative complications were encountered. The percentage of undercorrection {100% - [(treatment achieved/treatment attempted) × 100%]} [mean 34% ± 17% (SD), coefficient of variation (SD/mean) 0.50, range 5% to 58%] was higher than expected. Seven patients (47%) required enhancement due to undercorrection of hyperopia with diplopia (6 patients) or astigmatism with decreased visual acuity (1 patient). In this small series, no patient lost best corrected visual acuity or stereo acuity. Conclusion: Laser in situ keratomileusis can safely and effectively reduce refractive error in this group of patients; however, patient selection is extremely critical and enhancement was required in almost half the patients.