{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T11:08:06Z","timestamp":1788865686096,"version":"build-2803163510"},"reference-count":21,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2025,3,27]],"date-time":"2025-03-27T00:00:00Z","timestamp":1743033600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.mdpi.com"],"crossmark-restriction":true},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background\/Objectives: To compare the visual and refractive outcomes of myopic patients undergoing high astigmatic photorefractive keratectomy (PRK) surgery with and without pupillary decentration of treatment. Methods: In this retrospective study, we reviewed the medical records of myopic patients who underwent PRK surgery for high astigmatism (&gt;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: Overall, the study included 575 eyes from 414 patients, of which 79 eyes were treated with pupil decentration. The pupil-decentered group exhibited significantly preoperative higher myopia (subjective spherical equivalent (SEQ) of \u22125.30 \u00b1 3.12 D vs. \u22124.26 \u00b1 2.45 D, p &lt; 0.001) and subjective sphere (\u22123.40 \u00b1 3.13 D vs. \u22122.31 \u00b1 2.49 D, p &lt; 0.001). Visual and refractive outcomes, including uncorrected visual acuity (UCVA) of logMAR 0.11 \u00b1 0.77 vs. 0.09 \u00b1 0.72 (p = 0.302), best-corrected visual acuity (BCVA) of 0.07 \u00b1 0.92 vs. 0.07 \u00b1 0.82 (p = 0.982), SEQ (\u22120.33 \u00b1 0.93 vs. \u22120.19 \u00b1 0.60D, p = 0.094), sphere (0.02 \u00b1 0.98 vs. 0.15 \u00b1 0.67 D, p = 0.142), cylinder (\u22120.71 \u00b1 0.48 vs. \u22120.70 \u00b1 0.55 D, p = 0.894), safety index (1.07 \u00b1 0.27 vs. 1.12 \u00b1 0.31, p = 0.236), and efficacy index (0.99 \u00b1 0.31 vs. 1.07 \u00b1 0.35, p = 0.065), showed no significant differences between the two groups. Postoperative outcomes remained comparable after adjusting for baseline and intraoperative parameters. 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 and safety of the procedure even without applying pupil decentration.<\/jats:p>","DOI":"10.3390\/jcm14072282","type":"journal-article","created":{"date-parts":[[2025,3,28]],"date-time":"2025-03-28T03:35:28Z","timestamp":1743132928000},"page":"2282","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Impact of Pupil-Decentration on Visual and Refractive Outcomes in Myopic Patients Undergoing High Astigmatic PRK Surgery"],"prefix":"10.3390","volume":"14","author":[{"given":"Adir","family":"Sommer","sequence":"first","affiliation":[{"name":"Department of Ophthalmology, Rambam Health Care Campus, Haifa 3109601, Israel"},{"name":"Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 32000, Israel"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1814-8316","authenticated-orcid":false,"given":"Margarita","family":"Safir","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Rabin Medical Center, Petah Tikva 4941492, Israel"},{"name":"Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"validation","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7382-1198","authenticated-orcid":false,"given":"Waseem","family":"Nasser","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Rambam Health Care Campus, Haifa 3109601, Israel"},{"name":"Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 32000, Israel"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"validation","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3213-3524","authenticated-orcid":false,"given":"Dror","family":"Ben Ephraim Noyman","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Rambam Health Care Campus, Haifa 3109601, Israel"},{"name":"Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 32000, Israel"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"validation","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"given":"Tzahi","family":"Sela","sequence":"additional","affiliation":[{"name":"Care-Vision Laser Center, Tel Aviv 6407810, Israel"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"validation","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"project-administration","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-0984-3736","authenticated-orcid":false,"given":"Gur","family":"Munzer","sequence":"additional","affiliation":[{"name":"Care-Vision Laser Center, Tel Aviv 6407810, Israel"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"validation","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"project-administration","vocabulary":"credit"}]},{"given":"Igor","family":"Kaiserman","sequence":"additional","affiliation":[{"name":"Care-Vision Laser Center, Tel Aviv 6407810, Israel"},{"name":"Department of Ophthalmology, Barzilai Medical Center, Ashkelon 7830604, Israel"},{"name":"Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva 8410501, 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3109601, Israel"},{"name":"Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 32000, Israel"},{"name":"Care-Vision Laser Center, Tel Aviv 6407810, Israel"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"methodology","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"}]}],"member":"1968","published-online":{"date-parts":[[2025,3,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"3555","DOI":"10.1007\/s10792-020-01506-1","article-title":"Clinical Outcomes of Corneal Refractive Surgery Comparing Centration on the Corneal Vertex with the Pupil Center: A Meta-Analysis","volume":"40","author":"Zhang","year":"2020","journal-title":"Int. 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