Sharma Vijay K, Divyashree G N, Ambiya Vikas, Kumar Ashok, Khullar Srishti, Rana Vipin
Department of Ophthalmology, Armed Forces Medical College, Pune, Maharashtra, India.
Department of Ophthalmology, Command Hospital (Eastern Command), Kolkata, West Bengal, India.
Indian J Ophthalmol. 2025 Jan 1;73(1):73-76. doi: 10.4103/IJO.IJO_3346_23. Epub 2024 Sep 10.
To describe the role of wavefront-guided pupilloplasty in improving visual quality and wavefront parameters in post-keratoplasty patients with pathologically irregular, mydriatic pupils.
A total of 13 eyes of post-penetrating keratoplasty patients with pathologically irregular mydriatic pupil were included in this prospective interventional study. Preoperative wavefront analysis was done with the actual pupil size, and predicted wavefront values were analyzed by setting the postoperative pupil size to 2 mm. Patients showing significant improvement between preoperative and predicted postoperative wavefront values underwent single-pass four-throw pupilloplasty, and all wavefront parameters were again evaluated after 1 week. Preoperative and postoperative best corrected visual acuity (BCVA), pupil size, and wavefront parameters were analyzed.
Mean BCVA improved from a preoperative value of 1.03 ± 0.32 log of minimum angle of resolution (logMAR) units to 0.24 ± 0.09 logMAR units. Mean preoperative pupil size was 6.077 ± 0.787 mm, whereas the achieved postoperative pupil size after pupilloplasty was 2.538 ± 0.139 mm. Mean astigmatism root mean square (RMS) value improved from 4.169 ± 3.876 to 0.875 ± 0.926 µm ( P < 0.05), and mean coma value changed from 1.525 ± 1.962 to 0.128 ± 0.152 µm ( P < 0.05). Mean point spread function Stehl ratio value improved from 0.056 ± 0.032 to 0.223 ± 0.102. Mean RMS (optical path difference) value changed from 6.248 ± 4.721 to 0.943 ± 0.947 µm ( P < 0.001), Mean RMS (high orders) value changed from 3.788 ± 3.537 to 0.328 ± 0.256 µm ( P value 0.003), and the mean spherical aberration value changed from 0.646 ± 0.873 to 0.223 ± 0.102 µm ( P value 0.024). All postoperative wavefront parameters showed statistically significant improvement from the preoperative parameters.
Wavefront-guided pupilloplasty can predict and improve wavefront parameters and visual quality in post-keratoplasty patients with pathologically irregular mydriatic pupils.
描述波前引导瞳孔成形术在改善角膜移植术后病理性不规则、散瞳患者视觉质量和波前参数方面的作用。
本前瞻性干预研究纳入了13例穿透性角膜移植术后病理性不规则散瞳患者的眼睛。术前采用实际瞳孔大小进行波前分析，并将术后瞳孔大小设定为2mm来分析预测的波前值。术前与预测术后波前值显示有显著改善的患者接受单次四向瞳孔成形术，术后1周再次评估所有波前参数。分析术前和术后的最佳矫正视力（BCVA）、瞳孔大小和波前参数。
平均BCVA从术前的1.03±0.32最小分辨角对数（logMAR）单位提高到0.24±0.09 logMAR单位。术前平均瞳孔大小为6.077±0.787mm，而瞳孔成形术后达到的术后瞳孔大小为2.538±0.139mm。平均散光均方根（RMS）值从4.169±3.876改善到0.875±0.926µm（P<0.05），平均彗差从1.525±1.962变为0.128±0.152µm（P<0.05）。平均点扩散函数斯特列尔比值从0.056±0.032提高到0.223±0.102。平均RMS（光程差）值从6.248±4.721变为0.943±0.947µm（P<0.001），平均RMS（高阶）值从3.788±3.537变为0.328±0.256µm（P值0.003），平均球差从0.646±0.873变为0.223±0.102µm（P值0.024）。所有术后波前参数与术前参数相比均有统计学显著改善。
波前引导瞳孔成形术可以预测并改善角膜移植术后病理性不规则散瞳患者的波前参数和视觉质量。
