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• W3200438532 abstract "We were interested to read the recent publication by Narang et al., in which their new pinhole pupilloplasty (PPP) technique was applied to 6 eyes of 5 patients with previous radial keratotomy (RK).1 This category of patients may harbor severe, irregular, and unstable astigmatism, rendering spectacle correction impossible. To date, few effective therapeutic options have been available, aside from rigid contact lens wear (which may be unwelcome in individuals initially seeking refractive surgery) or corneal transplantation, which may carry significant potential long-term risks. As a result, if effective PPP would represent a major advance in the treatment of patients with post-RK corneal aberrations. Recently, we have also begun performing PPP in eyes with previous RK, similar to the technique originally described by Narang et al.2 In this article, we would like to contribute our data (thereby effectively doubling the pool of reported cases), which echoes and supports those in the study by Narang et al. and may bolster the validity of their results. Specifically, we have performed PPP for post-RK corneal abnormalities in 7 eyes of 4 patients (3 men, ages ranging 45–71 years). In 6 (86%) of these 7 operations, PPP was combined with phacoemulsification with intraocular lens implantation for visually significant cataract. The number of RK incisions ranged from 4 (3 eyes) to 8 (2 eyes) and 16 (2 eyes). Preoperatively, all patients manifested tomographically evident irregular corneal astigmatism and subjectively reported diurnally fluctuating visual acuity, rendering spectacle correction unsatisfactory. After PPP (combined with phacoemulsification and intraocular lens implantation, in most cases), 4 eyes (57%) achieved 20/20 (1.0) uncorrected distance visual acuity (UDVA), and all experienced an improvement of both uncorrected and corrected distance vision (Figure 1). No intraoperative or postoperative complications were observed, despite all operations occurring during a single surgeon's personal learning curve.Figure 1.: An eye with 16-cut radial keratotomy (A) after pinhole pupilloplasty (B) with a small, central pupil, resulting in 20/20 (1.0) UDVA.Reasoning from our experience, surgeons starting with PPP may wish to combine their initial cases with simultaneous cataract extraction, which might furnish the patient an additional visual benefit and decrease the need for a perfect PPP. In 3 (43%) of our 7 operated eyes, UDVA did not reach 20/20, and in each case, vision was noted to improve when tested through the pinhole occluder. This suggests that the PPP was likely too large, too small, or decentered, compared with the patient's visual axis—despite dutiful efforts intraoperatively to size the PPP to 1.5 mm, centered on the first Purkinje image, as recommended by Narang et al.3 It is possible that these underperforming eyes can be attributed to our surgical learning curve, or otherwise, it may be that some eyes need a larger/smaller PPP or that some centration landmark aside from the first Purkinje image may be warranted. Overall, however, we have been pleased with PPP to provide clinically meaningful improvements in UDVA to patients with previous RK and few other therapeutic options. Hopefully, this operation will be further refined and applied to other conditions of corneal optical abnormality (eg, advanced keratoconus)." @default.
• W3200438532 created "2021-09-27" @default.
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• W3200438532 date "2021-10-01" @default.
• W3200438532 modified "2023-10-14" @default.
• W3200438532 title "Comment on: Pinhole pupilloplasty after previous radial keratotomy" @default.
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• W3200438532 doi "https://doi.org/10.1097/j.jcrs.0000000000000797" @default.
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