Relative mydriasis after photorefractive keratectomy

Gerd Geerling*, Birte Neppert, Christopher Wirbelauer, Horst Laqua

*Corresponding author for this work
6 Citations (Scopus)


PURPOSE: To report the incidence of anisocoria after unilateral excimer laser photorefractive keratectomy (PRK) for myopia and subsequent corticosteroid therapy in a retrospective and prospective study and to explore possible etiologies. METHODS: The horizontal pupil diameter was determined in 6 patients (6 eyes) at 21.8 12.6 months after unilateral wide- field excimer laser PRK (retrospective group) as well as in 8 consecutive patients (8 eyes) before and 3.4 ± 2.9 months after unilateral PRK (prospective group). The Sehwind-Keratom wide-field excimer laser was used. Measurements were done in an examination room using Rosenbaum card comparison pupillometry and with a Goldmann perimeter at 31.5 asb. In the prospective group, the effect of fitting a hard contact lens of zero diopter power and the application of 0.1% pilocarpine were evaluated. RESULTS: Relative mydriasis was present in all treated eyes and the difference in pupil diameter between the two eyes measured 0.25 to 1.75 mm (retrospective group: +0.56 ± 0.82 mm; prospective group: +0.72 ± 0.29 mm). At the time of pupil measurement, the retrospective group had a significantly longer mean postoperative follow-up (21 mo) than the prospective group (3.4 mo) and significantly more eyes still received topical corticosteroid treatment (retrospective group, 1 of 6 eyes; prospective group, 7 of 8 eyes). The amount of anisocoria did not correlate with the applied laser energy, ablation depth, or refractive change, but showed a negative correlation with increasing time after PRK. Neither hard contact lens fitting nor pilocarpine 0.1% reduced the amount of anisocoria significantly. CONCLUSION: Unilateral PRK with wide-field excimer laser ablation and subsequent application of topical corticosteroids regularly resulted in a relative pupillary mydriasis. Neither an altered corneal profile nor parasympathetic denervation is responsible for this. Weakening of the pupillary sphincter of the treated eye may cause this phenomenon.

Original languageEnglish
JournalJournal of Refractive Surgery
Issue number1
Pages (from-to)69-74
Number of pages6
Publication statusPublished - 01.2000


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