Do limbal relaxing incisions during cataract surgery still have a role?

Abstract

Background Though Limbal Relaxing Incisions (LRI) were used widely to correct pre-existing corneal astigmatism during cataract surgery, they have been replaced recently with the more expensive methods like the use of toric Intra Ocular Lenses (IOL) and femtosecond during cataract surgery. We conducted our study to re-evaluate the role of (LRI) in correcting pre-existing moderate corneal astigmatism during cataract surgery in settings where other options are neither available nor affordable. Methods Retrospective analysis of all consecutive cases of LRI performed by a single surgeon at the time of cataract surgery to correct moderate corneal astigmatism (1.5-3D) in a community hospital over a period of 6 months. Corneal astigmatism, uncorrected distance visual acuity (UDVA) and best corrected distance visual acuity (CDVA) were recorded pre-operatively, 4 weeks and 3 months post-operatively. Data on age, intraocular lens (IOL) power, predictive refraction and post-operative spherical equivalent was also collected and analyzed. The number and position of LRI was determined based on the pre-existing corneal astigmatism using online calculator. Results 29 eyes of 25 patients with the mean age of 73.6 years (range: 46 to 90 years) and corneal astigmatism between 1.5 to 3D were included. Statistically significant reduction in the mean corneal astigmatism was recorded from 2.05 ± 0.45D preoperatively to 0.85 ± 0.56D postoperatively (P < 0.0001). All eyes showed reduction in astigmatism; 83% of eyes had < 1.0D post-operatively and 66% of eyes had < 0.75D. UDVA of 6/9 or better was recorded in 80% of eyes post-operatively (CDVA of 6/9 or better in 100%). The spherical equivalent was within 1.0D of the predictive refraction postoperatively in nearly all eyes (97%) and within 0.5D in 86% of the eyes. There were no peri-operative or post-operative complications were recorded in any case. Conclusion Combining LRI and cataract surgery to address moderate degrees of corneal astigmatism is a safe, reliable and predictable option especially in areas where more expensive methods such as toric IOL or excimer laser are not available or affordable. LRI has no significant effect on the spherical equivalent and is an excellent tool in reducing patient’s spectacle dependence.

Comparison of short-term clinical outcomes of a diffractive trifocal intraocular lens with phacoemulsification and femtosecond laser assisted cataract surgery

“…Several studies have shown that FLLRIs provides a higher correction index and a smaller variance vector than manual LRI [ 44 , 49 ]. Therefore, we believe that FLLRIs is an excellent way to reduce astigmatism in patients, which is similar to the conclusions of the existing literature [ 50 ].…”

Residual refractive errors in pseudophakic eyes and related factors: a population-based study

“…The mean corneal astigmatism was 1.2 D in the present study and part of the observed residual SE is related to this astigmatism. The refractive error will not be completely corrected when there is significant corneal astigmatism not corrected by a toric IOL [36] or relaxed incision [37] or if an implanted toric IOL rotates over time [38] . Achieving the postoperative SE near Plano is the basis for calculating spherical IOL power by most IOL power calculation formulas if astigmatism correction is not planned.…”

Refractive surprise of irregular astigmatism following cataract surgery in two patients with neglected subclinical corneal ectasia: two case reports

“…Due to the limitations of astigmatism-correcting steep-axis incisions, other options for correction of corneal astigmatism should be taken into account. There are multiple procedures to correct astigmatism in patients with cataract, including toric intraocular lenses (IOLs) [ 30 ], keratotomy [ 31 , 32 ], limbal relaxing incisions (LRI) [ 33 ], excimer laser in situ keratomileusis [ 34 ], etc. Like relaxing incisions from the steep axis, toric IOLs have been widely applied in the correction of astigmatism, especially moderate to severe astigmatism, in cataract surgeries [ 35 ].…”