Pinhole Pupilloplasty for Higher Order Aberrations in Patients With Scarred Cornea

Purpose: To analyze the clinical outcomes of pinhole pupilloplasty (PPP) in eyes with higher order aberrations (HOAs) due to scarred cornea. Methods: In this prospective, interventional series, eyes with central or paracentral localized corneal opacity (partial or full thickness) with adjacent clear corneal zone with or without cataract were included. Phacoemulsification with posterior chamber intraocular lens (IOL) implantation was performed followed by PPP. HOAs were assessed with the Pentacam HR (Oculus Optikgeräte GmbH) and optimum pupil size was determined by placing the pinhole template and recording the pinhole size that enabled patients to see distinctly. Postoperative visual outcomes, patient satisfaction score, change in HOAs, and pupil size were documented. Results: Overall, 25 eyes of 24 patients underwent the procedure. The mean size of the corneal scar was 4.5 ± 2.4 mm (2 to 12 mm) (linear [n = 5] and non-linear [n = 20]) and the mean depth was 462.4 ± 108.6 μm (range: 158 to 600 μm). PPP was combined with phacoemulsification and posterior chamber IOL in 23 eyes and with glued IOL in 2 eyes. Postoperatively, there was significant improvement in uncorrected ( P < .001) and corrected ( P < .001) distance visual acuity. There was significant reduction in pupil size ( P < .001) and optimum pinhole ( P = .071) size was attained for all eyes. There was no significant difference in the postoperative period for HOA root mean square values ( P = .118) except one case that underwent corneal suture removal. No change in corneal topography ( P = .249) was observed. A negative correlation was observed between reduction of pupil size and improvement in corrected distance visual acuity; however, it was not statistically significant ( r = −0.136, P = .517). Seventy-five percent of the patients reported being highly satisfied (score 3) and 25% of the patients were satisfied (score 2) with the surgical outcomes. Conclusions: PPP leads to satisfactory visual outcomes and can be considered as an alternative in eyes with central or paracentral corneal scar with residual clear cornea.