In children with high myopia and sufficient anterior chamber depth, he implants a Visian ICL (Staar Surgical Company). For high hyperopic and astigmatic errors, he implants an Artisan hyperopic or toric phakic IOL (Ophtec). These IOLs are enclaved to the iris at the 3 and 9 o’clock fixation points.
“The virtue of the phakic IOL is stable correction of extreme ametropia. The mean refractive error in this study population was 15 D,” he said. Patients implanted with a phakic IOL gained 13 lines of vision compared with preoperatively.
Another important finding in this patient group was that half of the children who underwent a refractive procedure gained some binocular fusion, ranging from level 1 (restoration of a positive prism vergence fusional response) to level 5 (100 arc sec stereopsis).
Induced corneal haze is the biggest concern with excimer laser keratectomy. In this group, the severities ranged from grade 0 (none) to grade 4 (severe). Dr. Tychsen reported that 83% had no haze, 8% had grade 1 haze, 5% grade 2 haze, and 2% each grades 3 and 4 haze. No child has developed corneal ectasia.