Pinhole pupilloplasty has been documented to improve visual performance in cases with higher-order aberrations. The importance of performing an iris reconstruction and PPP around the Purkinje 1 reflex has been clearly demonstrated.
We came across a case in the postoperative period with an eccentrically positioned pinhole pupilloplasty (PPP) that required repositioning and recentration. We realized that the exact pupil size that achieves the best visual performance is unique to each patient depending on their specific aberrations. A multiple pinhole gauge was developed to find the optimal