Study Of Visual And Refractive Outcomes In Patients Undergoing Limbal Relaxing Incision During Clear Corneal Phacoemulsification Surgery With Foldable Intra Ocular Lens

Background:Phacoemulsification requires a smaller incision, few or no stitches are needed and the patient's recovery time is usually shorter when using a foldable IOL.Limbal Relaxing Incisions, or LRIs, are partial thickness corneal incisions strategically placed to reduce or eliminate pre-existing astigmatism duringcataractsurgeryorrefractivelensexchangesurgery. Present study was aimed to evaluate the visual and refractive outcome in patients undergoing limbal relaxing incision during clear corneal phacoemulsification surgery with foldable intra ocular lens.Material And Methods:Present study was single-center, prospective, observational study, conducted in patients of age more than 18-75 years, with clear cornea and regular astigmatism on keratometry, with preoperative astigmatism more than or equal to 0.5D on keratometry, fit for phacoemulsification cataract surgery with foldable IOL.Result:A total of 44 eyes of 44 patients who for cataract phacoemulsification surgery, mean age of the patient was 56.98 ± 05.98 years. Refractive acceptance preoperatively was 0.50 D to 2.0 D.Onslit lamp examination showed most common Cataract Nucleus grade is NS 3 with PSC preoperatively. We observed improved diopteric difference by automated keratometry on postoperative 90th day as compared to preoperative values. Majority of patients had Preop Keratometric Difference (K1-K2) of 1.5 D, all required LRI Incisions length of 4 clock hours (60°).The difference between the visual acuity preoperatively and post operatively was found to be statistically significant with a p<0.01 by employing the statistical test Analysis of Variance (ANOVA). Visual outcome a change after limb relaxing incisions statistically significant. Keratometry changes preop and postop is statistically significant with p value <0.001.Conclusion:Visual and refractive outcome changes as improved best corrected visual acuity (BCVA), decrease in Corneal Astigmatism was noted in patients undergoing limbal relaxing incision during clear corneal phacoemulsification surgery with foldable intra ocular lens

Study Of Change In Vision And Astigmatic Refractive Error Postoperatively In Patients Undergoing Clear Corneal Phacoemulsification Surgery With Foldable Intra Ocular Lens

Background:Surgically induced astigmatism (SIA) is astigmatism that is created by incisions in cataract surgery; change in both the power and to a lesser degree, orientation of the principal meridians following a corneal incision. Prese nt study was aimed to study change in vision and astigmatic refractive error postoperativelyin patientsundergoing clear corneal phacoemulsificationsurgerywithfoldableintraocularlens.Material And Methods:Present study was hospital based, prospective, observational study, conducted in patients posted for phacoemulsification cataract surgery with foldable IOL with clear cornea and regular astigmatism on keratometry, with preoperative astigmatism more than or equal to 0.5D on keratometry, willing to participate in study.Result:In present study,44 eyes of 44 patients were considered for study. Mean age of the patient is 56.98 ± 5.98 years. There were 29 males and 15 females. Right eye surgery was done in 18 eyes and left eye surgery was done in 26 eyes. Refractive acceptance preoperatively was 0.50 D to 2.0 D. Mean IOL power was 22.7 ± 0.801. Preoperatively mainly eyes had best visual activity between 6/24 to 6/18 while visual activity range from 6/60 to 6/12. Improved vision postoperatively day 90th where vision was 6/6 unaided in 24 eyes out of44 eyes and 6/9 in 14 eyes respectively. Majority of patients had Preop Keratometric Difference (K1-K2) of 1.5 D, all required LRI Incisions length of 4 cloc k hours (60°). On postoperative 90th day, improved dioptric difference by automated keratometry ascompared to preoperative values. LRI was slightly more effective in patients above 50 years as compared to in patients below 50 years.Conclusion:In patientsundergoing clearcornealphacoemulsification surgery with foldable intra-ocular lens, postoperatively improved vision and reduced astigmatic refractive error is noted.

Comparison of Efficacies in Treating Astigmatism between Toric Intraocular Lens Implantation and Limbal Relaxing Incision

PURPOSE: To compare the effectiveness of toric intraocular lens (IOL) implantation and monofocal IOL implantation with a limbal relaxing incision (LRI) for correcting astigmatism in the Korean population. METHODS: The medical records of 79 patients (100 eyes) with corneal astigmatism over 1.25 diopters (D) who underwent toric IOL implantation (toric group; 54 eyes), monofocal IOL implantation with a concurrent LRI (LRI group; 24 eyes), or monofocal IOL implantation without correcting astigmatism (control group; 22 eyes), were retrospectively reviewed. For subgroup analyses, the three groups were subdivided according to preoperative astigmatic severity under 2.5 D. Visual, refractive, and keratometric outcomes were compared 2 and 6 months postoperatively. RESULTS: The uncorrected distance visual acuity was at least 20/25 (0.1 logMAR) in 64.8%, 41.7%, and 27.3% of the toric, LRI, and control group eyes, respectively at 2 months after surgery. The toric group had the greatest refractive cylindrical error change (toric group, −2.48 ± 1.84 D to −0.98 ± 0.92 D; LRI group, −2.02 ± 1.03 D to −1.65 ± 0.86 D; control group, −1.69 ± 0.88 D to −1.49 ± 0.60 D; p < 0.001) and the LRI group showed the greatest mean corneal cylindrical error change (toric group, 2.40 ± 1.33 D to 2.23 ± 1.42 D; LRI group, 1.86 ± 0.44 D to 1.29 ± 0.55 D; control group, 1.60 ± 0.39 D to 1.35 ± 0.60 D; p = 0.025). The 85 eyes with moderate corneal astigmatism (between 1.25 D and 2.5 D) were under evaluation. The toric group showed the highest mean refractive cylindrical change (0.97 ± 0.66 D; p < 0.001), followed by the LRI group (0.53 ± 0.87 D; p = 0.046). CONCLUSIONS: Both surgical techniques significantly reduced astigmatism and had comparable visual outcomes. Toric IOL implantation was more reliable for correcting astigmatism than monofocal IOL implantation with a concurrent LRI regardless of the preoperative astigmatic severity. Both procedures were effective in reducing astigmatism in eyes with moderate corneal astigmatism.

Influence of phacoemulsification combined with limbal relaxing incisions for preoperative astigmatism on corneal high-order aberrations / 中华实验眼科杂志

Background phacoemulsification combined with limbal relaxing incision (LRI) is reported to be effective for the management of coexisting cataract astigmatism,but the influence of after phacoemulsification with LRI on corneal high-order aberration is still rarely reported.Objective This study was to evaluate the effect of cataract surgery with LRI for preoperative astigmatism or on corneal high-order aberration.Methods A selfcontrolled serial cases observational study was designed.A total of 35 cataractous eyes of 35 patients with astigmatism ≥ 1.0 D before cataract surgery were enrolled in Tianjin Medical University Eye Hospital from August 2014 to April 2015 under the informed consent of patients.LRIs were performed on the eyes during the phacoemulsification and IOL implantation.The uncorrected visual acuity (UCVA),BCVA and optometry were recorded before operation and 1 day,1 week,1 month,3 months after operation.Pentacam was employed to measure the maximal and minimal diopters,astigmatism and high-order aberrations within 3 mm of the anterior corneal surface at above-mentioned time points.All the results were compared among different time points.The optometry outcomes and the anterior corneal surface astigmatism change were analyzed using vector analysis method.Results The UCVA was 0.34 ±0.22,0.38 ± 0.25,0.43±0.27,0.42±0.28 in 1 day,1 week,1 month and 3 months after operation,which was significantly higher than 0.08 ±0.09 before operation;and the BCVA was 0.54 ± 0.27,0.64 ± 0.29,0.67 ± 0.29,0.71 ± 0.32 in 1 day,1 week,1 month and 3 months after operation,showing a significant increase in comparison with 0.22±0.51 before operation(F=54.457,P=0.000;F =62.653,P =0.000).The refractive cylindrical error and corneal astigmatism were significantly decreased after operation in comparison with before operation (F =31.061,P =0.000;F =113.043,P=0.000).High order aberrations (HOA) at postoperative 1 day,1 week,1 month,3 months were all higher than those in preoperation (F =11.189,P =0.000) under the 4 mm pupil diameter.Compared with preoperation,the vertical coma,secondary vertical coma and three leaf clover were significantly increased(all at P＜0.05),but the horizontal coma and primary spherical aberration were not significantly changed (all at P＞0.05) under the 6 mm pupil diameter.Conclusions Phacoemulsification combined with LRI can reduce the corneal astigmatism effectively and steadily,and the increase of corneal aberrations does not affect visual acuity.

Clinical research of limbal relaxing incision during implantable collamer lens surgery / 国际眼科杂志(Guoji Yanke Zazhi)

To evaluate the efficacy and safety of limbal relaxing incision ( LRl) for correcting corneal astigmatism during implantable collamer lens ( lCL) surgery.METHODS:A total of 185 eyes of 105 patients with high myopia and corneal keratometric astigmatism were included in the study. lCL surgery with concomitant relaxing incision was performed in 105 eyes of 60 patients in LRls group ( Group A) . Eighty eyes of 45 patients only underwent lCL surgery were in control group ( Group B) . All patients undergone ophthalmic examination that included uncorrected visual acuity ( UCVA ) , best -corrected visual acuity ( BCVA ) , Pentacam analysis system to observe the changes of corneal astigmatism before and 1wk, 1 and 3mo after surgery.RESULTS: Respectively comparing UCVA between two groups in 1 and 3mo postoperatively, the P values were considered statistically significant ( P 0. 05 ). Preoperative corneal astigmatism was 1. 52 ± 0. 55D in group A and 1. 48 ± 0. 57D in group B, there was no statistically significant difference (P>0. 05). One week postoperatively, the astigmatism was 0. 55 ± 0. 41D in group A and 1. 20 ± 0. 48D in group B. One month postoperatively, the astigmatism was 0. 60 ± 0. 38D in group A and 0. 93 ± 0. 47D. Three months postoperatively, the astigmatism was 0. 51 ± 0. 32D in group A and 0. 96 ± 0. 40D in group B. The difference between the two groups were statistically significant ( P<0. 05 ). The difference value of corned astigmatism before surgery and 1wk, 1 and 3mo after surgery had statistical significance ( P<0. 05). ln LRls group, at preoperative and postoperative time points, the average corneal astigmatism changes were also considered statistically significant difference (P<0. 05). CONCLUSlON: LRls performed during lCL surgery appeared to be an effective and safer procedure to reduce pre-existing corneal astigmatism and improve UCVA as well as the visual quality.

A case of endophthalmitis associated with limbal relaxing incision.

Limbal relaxing incisions (LRIs) are considered a relatively safe procedure with rapid stabilization and absence of infectious complications. Do we need to readdress this last impression? We report a case of nocardia endophthalmitis associated with an exudate at the site of an LRI in a patient who underwent routine cataract surgery. This case, to the best of our knowledge, is the first report of its kind, stressing the need for a cautious approach to the adoption of this method of astigmatic correction.

The Short-Term Effect of Limbal Relaxing Incision and Compression Suture on Post-Penetrating Keratoplasty Astigmatism

PURPOSE: To investigate the short-term effect of limbal relaxing incisions accompanied by compression sutures on postoperative astigmatism in penetrating keratoplasty. METHODS: The medical records of patients who underwent penetrating keratoplasty, were followed-up for at least 18 months and had residual astigmatism greater than 4.0 diopters (D), were retrospectively analyzed. The patients had paired limbal relaxing incisions on the steep axis and compression sutures on the flat axis. The paired limbal relaxing incision was done for 2 clock hours each with a depth of 85% of the corneal thickness, and the compression sutures with an average of 3.2 bites were added with a Troutman operating keratometer guide. The visual acuities, corneal astigmatism and complications were evaluated at 1 month and 6 months. RESULTS: At 1 month after the surgery, the best corrected visual acuities (log MAR) improved from 0.840 to 0.674 (p = 0.037) except for 1 patient with immediate postoperative rejection and another patient with a pre-existing cataract. The mean corneal astigmatism was reduced from 9.118 +/- 3.158 D to 4.982 +/- 3.063 D (p = 0.021). At 6 months after the surgery, the mean corneal astigmatism increased to 5.489 +/- 2.670 D (p = 0.008), and the effect of surgery became statistically insignificant (p = 0.477). CONCLUSIONS: Paired limbal relaxing incisions and compression sutures were effective short-term on reducing residual corneal astigmatism and improving visual acuities in keratoplasty patients with high astigmatism, but became less effective on corneal astigmatism at 6 months.

The Short Term Effects of a Single Limbal Relaxing Incision Combined with Clear Corneal Incision

PURPOSE: To compare the effects of performing a single limbal relaxing incision (LRI) combined with a clear corneal incision on a corneal astigmatism with that of paired LRIs in cataract surgery. METHODS: Medical records for 25 eyes in 20 patients who had undergone LRIs during cataract operations for with-the-rule astigmatism of 1.5 diopters (D) or more in topography were retrospectively reviewed. Single or paired LRIs were assigned randomly and were performed on the steepest axis; the degrees of arc were determined using the modified Gills nomogram. A clear corneal wound was made on the steepest vertical axis. Uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), manifest refraction, and corneal astigmatism on topography were evaluated preoperatively and one month postoperatively. Naeser's polar value analysis was used to assess the efficacy of the LRIs. RESULTS: The mean depth of the LRIs and degrees of arc were 620+/-31 micrometer (87.1% of corneal thickness) and 56.84+/-19.68degrees, respectively. The mean postoperative UCVA and BCVA (log MAR) were significantly improved (0.51+/-0.37 and 0.09+/-0.12, respectively) (p<0.05). Average refractive and corneal astigmatisms were significantly reduced by 49.4 percent and 32.4 percent, respectively (p<0.05). The single LRI combined with clear corneal incision showed reduced efficacy in refractive astigmatism by 47 percent, which is similar to that of paired LRIs where a 48 percent reduction in efficacy was seen. CONCLUSIONS: The short-term effects of a single LRI combined with clear corneal incision on a corneal astigmatism appears to be as effective as performing paired LRIs when combined with cataract incision.

Limbal Relaxing Incision Combined with Cataract Surgery Reducing Preoperative Corneal Astigmatism

PURPOSE: Corneal astigmatic correction is necessary to improve best uncorrected visual acuity (BUVA) after cataract extraction. The purpose of the study is to know the effect and safety of limbal relaxing incision combined with cataract extraction to reduce preoperative astigmatism in patients whose corneal astigmatism was 1.0 diopter or more. METHODS: Eighten eyes from 16 patients had cataract with corneal astigmatism 1.0 diopter or more. We checked preoperative uncorrected visual acuity (UCVA), autokeratometry, manifest refraction, corneal topography and so on. We phacoemulsified and inserted intraocular lens in the bag. After that, we made limbal relaxing incision at the previously-determined axis with previously-determined length and depth. We followed up them with autokeratometry, manifest refraction and corneal topography at 1week, 4, 8 and 12 weeks after surgery. RESULTS: There was a statistically significant improvement of final UCVA transformed by log MAR (minimum angle of resolution) compared with preoperative UCVA. According the analysis of autokeratometric astigmatism with Naeser's polar value concept, astigmatic polar value (AKP) was 1.37+/-0.53 diopter before surgery, .0.17+/-0.30 diopter at 1week after surgery, .0.07+/-0.36 diopter at 4weeks, .0.13+/-0.30 diopter at 8weeks, .0.07+/-0.38 diopter at 12weeks. Over the whole follow-up period, there was a statistically significant decrease of AKP compared with preoperative one (p=0, 0, 0, 0.001). There was also a statistically significant decrease of AKP measured by manifest refraction compared with preoperative ones (p=0.007, 0.001, 0.002, 0.015). There was a statistically significant decrease of AKP checked by corneal topography compared with preoperative ones (p=0.001, 0, 0, 0.002). CONCLUSIONS: Twelve weeks follow up after cataract extraction with limbal relaxing incision showed a statistically significant improvement of final UCVA compared with preoperative UCVA and reduction of preoperative astigmatism checked by autokeratometry, manifest refraction and corneal topography. Limbal relaxing incision combined with cataract extraction was an effective procedure to reduce preoperative astigmatism.