Limbal Relaxing Incisions to Correct Corneal Astigmatism During Phacoemulsification

Abstract

PURPOSE: To evaluate the safety and efficacy of limbal relaxing incisions for the correction of corneal astigmatism during phacoemulsification. METHODS: Fifty eyes of 37 patients (mean age 66.5 years, range: 45 to 80 years) with cataract and coexisting topographic astigmatism were included in the study. Eyes were randomly divided into two groups: eyes that underwent cataract surgery with limbal relaxing incisions (cataract LRI group) and eyes that underwent cataract surgery only (control group). All limbal relaxing incisions were performed during phacoemulsification. Best spectacle-corrected visual acuity (BSCVA), uncorrected visual acuity (UCVA), and corneal topography were recorded preoperatively and 1, 3, and 6 months postoperatively. RESULTS: A statistically significant improvement in BSCVA was seen in the cataract LRI eyes from 0.9±0.7 preoperatively to 0.1±0.1 at l, 3, and 6 months postoperatively (P<.01). A statistically significant improvement in BSCVA was seen in control eyes from 0.8±0.6 before surgery to 0.2±0.2 at 1, 3, and 6 months after surgery (P<.01). No difference in postoperative BSCVA was noted between the groups. A statistically significant reduction in the mean topographic astigmatism was seen in the cataract LRI eyes from 1.93±0.58 diopters (D) preoperatively to 1.02±0.60 D 6 months postoperatively (P<.05). The control eyes did not show a statistically significant change in topographic astigmatism. CONCLUSIONS: Limbal relaxing incisions performed during phacoemulsification surgery appear to be a safe, effective, and stable procedure to reduce pre-existing corneal astigmatism. [J Refract Surg. 2007;23:499504.]

Long-term stability of keratometric astigmatism after limbal relaxing incisions

“…The undercorrection of the preexisting keratometric astigmatism by LRIs in our study is consistent with that in previous studies. [4][5][6][7] With regard to the stability of LRIs over time, we found that from 2 to 10 weeks after surgery, there was a statistically significant decrease in SIA overall (PZ.002) and in the WTR subgroup (PZ.004). In the ATR subgroup, there was also a decrease in SIA from 2 to 10 weeks, although it did not reach statistical significance (PZ.1).…”

“…Some studies found the effects of LRIs regress over time, 4,7,9,11,12 while others found the effects to be stable. 5,6,[13][14][15][16] Furthermore, in general, published studies of LRIs in cataract surgery had a mean follow-up of 1 year or less with the exception of 2, which had a mean follow-up of 17 months 4 and 3 years. 12 In both studies, the authors describe a mild regression of the effects of LRIs.…”

“…[1][2][3] Limbal relaxing incisions performed in conjunction with cataract surgery have been shown to be effective in reducing moderate amounts of preexisting keratometric astigmatism, albeit with a tendency toward undercorrection. [4][5][6][7] For correction of higher degrees of astigmatism, a combination of an LRI and toric IOL implantation during bimanual phacoemulsification has been shown to be promising. 8 Apart from being effective, LRIs are a popular method for reducing existing keratometric astigmatism in cataract surgery because they are simple to perform and low in cost.…”

Limbal relaxing incisions at the time of apodized diffractive multifocal intraocular lens implantation to reduce astigmatism with or without subsequent laser in situ keratomileusis

“…Previous studies [16][17][18][19] used different nomograms to correct astigmatism during cataract surgery, and they report frequent undercorrection. In our study, only 4 eyes (5.5%) had overcorrection and all were in women older than 70 years.…”

Expected effects of surgically induced astigmatism on AcrySof toric intraocular lens results

“…Moderate amounts (!2.0 D) of corneal astigmatism have traditionally been addressed through peripheral corneal relaxing incisions or judicious selection of incision site. [3][4][5] The introduction of the AcrySof toric IOL (Alcon Laboratories, Inc.) provided a new method for correcting corneal astigmatism in pseudophakic patients. 6 The IOL can be readily oriented in the eye and has shown excellent postoperative stability, with 95% of IOLs within 10 degrees of the intended axis of implantation 6 months after surgery.…”