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SMILE in children

Children with ametropic and anisometropic amblyopia can undergo refractive surgery if spectacle or contact lens intolerant for any reason

Colin Kerr

Posted: Sunday, December 3, 2017

Dr Soosan Jacob

Children with ametropic and anisometropic amblyopia can undergo refractive surgery if spectacle or contact lens intolerant for any reason. Photorefractive keratectomy (PRK) is conventionally preferred over LASIK in children as there is no flap to be worried about intra or post-operatively. Dr Soosan Jacob presented her results of small incision lenticule extraction (SMILE) and enumerated its advantages over other forms of pediatric refractive surgery at the World Congress of Paediatric Ophthalmology and Strabismus, Hyderabad.

Pain, delayed visual recovery, haze and regression seen in PRK are less in SMILE as is need for long term steroids and frequent intra-ocular pressure checks. An immobile cap, less chances of intra or post-operative flap related complications, rapid visual recovery, less pain, dry eye and less effect on corneal biomechanics are other advantages. Environmental factors affect femtosecond lasers less than it affects excimer laser and this is an advantage as also the fact that there is no need to shift the child between machines. Challenges however include need for general anaesthesia, lack of fixation by the child during the procedure, difficulty in centration etc.

SMILE is a good option for reversing amblyopia. It provides full time correction of refractive error that is not dependent on compliance. It avoids difficulties, challenges and risks associated with contact lens wear. It is safer than PRK and combines advantages of both PRK and LASIK while avoiding their disadvantages. However, follow up for residual refractive error, occlusion therapy and close follow-ups are required. Currently, hypermetropia cannot be treated.