1. Magraby Eye and Ear Centre - OMAN

2.  Difficulties with children and LA  Reports of NO2 interference with Laser function  Aim – compare propfol/fentanyl and ketamine/midazolam

3.  Prospective  30 patients  Randomized to 2 groups  Age 3 to 12 years  Aniso/Amblyopia

4.  NBM overnight  Clear fluids till 4 hours before  LASIK or LASEK

5.  Heart rate  MABP  SaO2 O2 by nasal cannula if SaO2 ≤ 90%

6.  Matched for: age weight duration of anesthesia duration of surgery

7.  Time to recovery shorter in P/F group  Opposite effects on BP and HR  P/F group 3 patients needed O2  Post-op agitation and vomiting higher in K/M group  Airway obstruction (needing jaw thrust) higher in P/F group

8.  Bells phenomenon  Nystagmus  Overall intra and post-op state  No significant difference  (used suction ring for fixation)

9.  Propofol preferred  Shorter acting  Lower incidence of dysphoric effects  Greater potential for airway compromise.

10. University of L’Aquila, Italy

11.  Prospective  18 consecutive patients  Mean age 32.4 (range 21 to 52)  Accommodative eso (normal AC/A)  No suppression  8 – PRK (Group A)  10 – LASIK (Group B)

12. Without correction  ET’ 14.4 ∆ (10 to 19)  ET 11.6 ∆ (8 to 14) With correction  ET’ 5 ∆ (4 to 6)  ET 2.4 ∆ (2 to 4)  Mean 71.2 sec/arc

13.  2 ∆ esophoria – near  1.2 ∆ esophoria – distance  Refraction +4.6 D (mean) (range +3.50 to +6.00)  Mean BSCVA – 20/20

14. 1 Year  ET’ 1.2 ∆ esophoria  ET – orthophoric 2 Years  ET’ 2 ∆ esophoria  ET 0.4 ∆

15. Without correction  ET’ 13.4 ∆ (8 to 21)  ET 11.5 ∆ (6 to 19) With correction  ET’ 5.4 ∆ (2 to 8)  ET 2.8 ∆ (orthophoria to 6)  Mean 81 sec/arc

16.  2.5 ∆ esophoria – near  1.1 ∆ esophoria – distance  Refraction +6.46 D (mean) (range +5.00 to +8.50)  Mean BSCVA – 20/20

17. 1 Year  ET’ 1.7 ∆ esophoria  ET 0.2 ∆ esophoria 2 Years  No change

18.  Only 1 case of regression   Recurrence of ET

19.  Good binocular function  Good acuity  Careful selection of patients  ? Timing of surgery

20.  Possible application to older children and young adults?????

21. Review by L.Tychsen

22.  Corneal surface ablation  Phakic IOL  Clear Lens Exchange

23.  Anisometropia – spectacle non-compliant 2.0 D - hypermetropes 3.0 to 4.0 D - myopes  Intolerance of specs or CL  Neuro-behavioural disorders

24.  Iso-ametropia  Spectacle non-compliant  Amblyopia approaching 50%  Neuro-behavioural disorders  Visual autism

25.  Other special needs Craniofacial deformities  High hyperopia and esotropia Poor spectacle compliance

26.  Baseline Repeated examinations EUA  Surface ablation +6.0 to -10.0 D  ACD ≥ 3.2 mm Phakic IOL  Remainder - Clear lens extraction

27.  Volatile induction  Intravenous anaesthetic  EUA  LASEK or PTK/PRK  BCL and goggles  Epithelial healing as in adults  Better tolerated

28.  Artisan iris enclaved  Bilateral sequential – 1 month interval  Absorbable sutures  Limbal relaxing incisions  Arm band restraints

29.  Above 20.0 D  ACD ≤ 3.2 mm  Lensectomy  Posterior capsulectomy  Anterior vitrectomy  Acrylic IOL  AL ≥ 29 mm - Prophylactic laser

30.  Improvement in UCVA  Best with bilateral ametropia  Modest with anisometropia

31.  Ametropia avg 7.1 D  UCVA 20/180 to 20/60 (mean)  If glasses worn - BCVA 2-fold improvement

32.  Ametropia – mean 15.0 D  UCVA 20/3400 to 20/57 (mean)  Similar results with CLE

33.  90% within 1.5 D of emmetropia  Variable improvement in UCVA and BCVA  No reported loss of acuity  50% improvement in fusion and stereopsis

34.  Low  Several years follow up  Small numbers

35.  260 eyes - 1998 to 2008  Negligible rate of sight-threatening complications  LASIK – flap complications  LASEK – thicker residual stroma  Regression - 1.0 D/year  ? Over-correction for myopes

36.  No regression  Corneal endothelium? Low rate of loss  ? Posterior chamber IOLs  ? Glaucoma/ Cataract

37.  Accomodation  Multifocal IOLS?  RD risk – 3% long term

38.  Substantial benefits for selected patients  Need more information/scrutiny/disclosure