Impact Of Pupil-Decentration On Visual And Refractive Outcomes In Myopic Patients Undergoing High Astigmatic Prk Surgery
Published 2025 - 43rd Congress of the ESCRS
Reference: PO775 | Type: Free paper | DOI: 10.82333/b2t6-s294
Authors: Adir Sommer* 1 , Margarita Safir 2 , Waseem Nasser 1 , Dror Ben Ephraim Noyman 1 , Tzahi Sela 3 , Gur Munzer 3 , Igor Kaiserman 4 , Eyal Cohen 5 , Michael Mimouni 1
1Rambam Health Care Campus,Haifa,Israel, 2Rabin Medical Center,Petah Tikva,Israel, 3Care-Vision Laser Center,Tel Aviv,Israel, 4Barzilai Medical Center,Ashkelon,Israel, 5Tel Aviv Sourasky Medical Center,Tel Aviv,Israel
Purpose
To compare the visual and refractive outcomes of myopic patients undergoing high astigmatic photorefractive keratectomy (PRK) surgery with and without pupillary decentration of treatment.
Setting
Care-Vision Laser Centers, Tel-Aviv, Israel.
Methods
In this retrospective study, we reviewed the medical records of myopic patients who underwent PRK surgery for high astigmatism (>3 diopters [D]) between January 2013 and December 2023. The patients were divided into two groups based on whether the surgeon applied pupillary decentration during surgery. Preoperative, intraoperative, and postoperative parameters were compared between the groups. Adjustments were made to account for differences in baseline characteristics and intraoperative parameters.
Results
The study included 575 eyes from 414 patients, with 79 eyes treated using pupil decentration. The pupil-decentered group had higher preoperative myopia (SEQ -5.30±3.12D vs. -4.26±2.45D, P<0.001) and sphere (-3.40±3.13D vs. -2.31±2.49D, P<0.001). Postoperative outcomes, including UCVA (logMAR 0.11±0.77 vs. 0.09±0.72, P=0.302), BCVA (0.07±0.92 vs. 0.07±0.82, P=0.982), SEQ (-0.33±0.93 vs. -0.19±0.60D, P=0.094), sphere (0.02±0.98 vs. 0.15±0.67D, P=0.142), cylinder (-0.71±0.48 vs. -0.70±0.55D, P=0.894), safety index (1.07±0.27 vs. 1.12±0.31, P=0.236), and efficacy index (0.99±0.31 vs. 1.07±0.35, P=0.065), showed no significant differences. Adjusted analyses for baseline and intraoperative parameters confirmed comparable results.
Conclusions
Our findings suggest that, in myopic patients undergoing high-astigmatic PRK surgery, pupil decentration does not lead to superior postoperative visual and refractive outcomes. This highlights that, in this scenario, surgeons can preserve the efficacy or safety of the procedure even without applying pupil decentration.