Pediatric corneal surgery utilizing the excimer laser: advances in treatment and outcomes

Introduction Excimer laser surgery is an important yet underutilized intervention for treating pediatric refractive errors and corneal pathologies. While photorefractive keratectomy (PRK) and phototherapeutic keratectomy (PTK) are well-established in adults, their use in children requires specialized consideration due to unique anatomical, physiological, and behavioral factors. This review summarizes existing evidence and identifies future needs in pediatric excimer laser applications.Areas covered A systematic PubMed search was conducted using the terms ‘excimer laser,’ ‘pediatric,’ ‘PRK,’ ‘PTK,’ ‘amblyopia,’ and ‘corneal surgery,’ covering publications from 1988 to 2025. The review focuses on surgical outcomes, complications, patient selection, and long-term safety in children under 18 years.Expert opinion Evidence suggests that excimer laser surgery is a viable option for carefully selected pediatric patients, particularly those at high risk of amblyopia or unresponsive to conventional therapies. Future directions include combined approaches, such as PTK with collagen cross-linking for pediatric keratoconus. Broader adoption will require standardized surgical protocols, enhanced surgeon training, and multicenter controlled studies to establish definitive safety and efficacy. When integrated into structured care pathways, excimer laser surgery has the potential to reduce lifelong amblyopia, improve functional vision, and expand therapeutic options in pediatric corneal management.