Refractive Outcomes Comparison in Limbal Relaxing Incision Based on Incision Depth in Managing Corneal Astigmatism During Cataract Surgery
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Introduction: Prevalence of clinically significant astigmatism of more than 1D can be found in 20 to 50% of the population who undergo cataract surgery. During phacoemulsification surgery, astigmatism could be corrected by a toric intraocular lens (IOL) or incisional technique such as a limbal relaxing incision (LRI). LRI are safe and inexpensive procedures thus resulting in satisfying outcomes with the surgeon’s precise phacoemulsification incision and accurate LRI arc position, which most appropriate treatment choice for surgeons in rural areas that have problematic access to IOL supply. Objectives: To compare refractive outcomes of the LRI technique with incision depths of 500um and 600um using a diamond knife corresponding with phacoemulsification cataract removal. Methods: A prospective cumulative interventional case study included 30 eyes of consecutive cataract corneal astigmatic patients with power 1.0D undergoing LRI and phacoemulsification. Length, numbers, and arc position of LRI were calculated on the LRI Calc application to obtain the best results in minimal astigmatism residual. Uncorrected visual acuity, intraocular pressure, and keratometry cylinder were also analyzed before surgery, Day 1, Day 7, and 1-Month post-operation. Results: Day-1 follow-up keratometry showed that corneal astigmatism still fluctuated, day-7 follow-up was even better with significant improvement in visual acuity. 1-Month post-operation has reached target correction. Moreover, visual acuity and residual astigmatism were better at 600um incision depth. Conclusion: When toric IOLs are not available or contraindicated, LRI could be a good option in correcting astigmatism with better refractive outcomes trend in 600um incision depth. LRI results better be evaluated on day 7 and 1 month post-LRI, which may be due to a more stable corneal surface.
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