Impact Of Pupil-Decentration On Visual And Refractive Outcomes In Myopic Patients Undergoing High Astigmatic Lasik Surgery

To compare the visual and refractive outcomes of myopic patients undergoing high astigmatic laser-assisted in situ keratomileusis (LASIK) surgery with and without pupillary decentration of treatment.

Care-Vision Laser Centers, Tel-Aviv, Israel.

We reviewed medical records of myopic patients who underwent LASIK surgery for high astigmatism (>3 diopters) between January 2013 and December 2023. The patients were divided into two groups based on whether the surgeon applied pupillary decentration during the surgery. Preoperative, intraoperative, and postoperative parameters were compared between the groups. Adjustments were made to account for differences in baseline characteristics and intraoperative parameters.

This retrospective study included 332 eyes from 250 patients, of which 89 eyes were treated with pupil-decentration. The pupil-decentered group had higher preoperative astigmatism (-3.99±0.77 D vs. -3.73±0.60 D, P=0.002), and had a more negative treated sphere (-1.69±1.48 D vs. 0.75±1.64 D, P<0.001), and a greater maximum ablation depth (79.98±19.05 μm vs. 64.42±16.55 μm, P<0.001). Postoperatively, there was no significant difference in uncorrected visual acuity (UCVA) (logMR 0.12±0.70 vs. 0.12± 0.70, P=0.916). Furthermore, there was no significant difference in postoperative subjective spherical equivalent (SEQ) (-0.32±0.57 D vs. -0.41±0.59 D, P=0.238) and efficacy index (0.98±0.31 vs. 1.01±0.29, P=0.464).

Our findings suggest that in myopic patients undergoing high-astigmatic LASIK surgery, pupil decentration does not lead to superior postoperative visual or refractive outcomes. This highlights that, in this scenario, surgeons will not compromise the efficacy or safety of the procedure if they choose not to apply pupil decentration.