About the correctness of laser refractive surgery in children

Disturbances of refraction are one of the most urgent problems of pediatric ophthalmology. Late and incomplete correction of refractive errors leads to the development of amblyopia, disturbances of binocular vision, the appearance of strabismus. Such complications reduce the quality of life, drastically limit the choice of professional child. Pediatric Ophthalmology always face a choice: many drugs and technologies are not approved for use in pediatric patients, practitioners are forced to use their «off-label», but such situations require great care and strict medical indications. For example, refractive surgery has worked well in adults, but its use remains controversial in children for security reasons and unpredictable effects. Several authors have described the use of laser refractive surgery in children under the age of 18 years, but there are no results of a multicenter, controlled study evaluating the safety, efficacy, and especially long-term results. In all the studies, the calculation was performed on adult nomograms ablation, while not proved how they are accurate for children. Long-term results and data on the endothelial cell density, corneal curvature changes in catamnesis are presented no longer than two years. Despite the fact that currently there is insufficient information about the results of remote application keratorefractive laser surgery in children, and there are no indication system and contraindications, modern achievements in medicine should be used in pediatric patients, and our successful track record proves it clearly. Undoubtedly, the positive experience of the laser surgery use in a child with clouding of the cornea in the outcome of herpetic keratitis, which provided a positive result: high visual acuity, binocular vision and lack of infection relapses for 2 years, requires study, evidence multicenter studies, and possibly expansion of indications for refractive laser surgery.

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