Transcript Limbal relaxing incisions versus penetrating limbal relaxing

‫بسم اللة الرحمن الرحيم‬
Limbal relaxing incisions versus
penetrating limbal relaxing incisions
for the management of astigmatism
in cataract surgery
Sara Akram Azzam
M.B.B.ch
Goals of modern cataract
surgery
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Cataract removal
Total spherical correction
Cylinderical correction (Astigmatism)
Restoration of accomodation
Prevention of posterior capsular
opacification
Astigmatism and cataract
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An optical defect whereby vision is
blurred due to inability of the optics of
the eye to focus a point object into a
sharp focused image on the retina. This
may be due to an irregular or toric
curvature of the cornea or lens.
Surgical correction of
astigmatism with cataract
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Manipulation of cataract incision
Limbal relaxing incisions (LRIs)
Astigmatic keratotomy
Paired opposite clear corneal incision
Implantation of toric intraocular lenses
Penetrating limbal relaxing incisions (PLRIs)
Post-operative LASIK
AIM OF WORK
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The aim of this study is to compare
between limbal relaxing incisions (LRIs
technique) and penetrating limbal
relaxing incisions (PLRIs technique) as
regards the simplicity and efficacy in
the treatment of preexisting corneal
astigmatism at the time of cataract
surgery.
PATIENTS AND METHODS
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Group A:
LRIs
20 eyes
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Group B:
PLRIs
20 eyes
Kasr EL Aini, surgical unit
PREOPERATIVE EVALUATION
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History taking
Best corrected visual acuity (BCVA)
Refraction
Intraocular pressure (IOP)
Slit lamp examination
Fundoscopy using indirect
ophthalmoscope
Corneal topography
PATIENTS AND METHODS
Inclusion criteria:
 Age: 20-80 years
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Both sexes enrolled
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Topographic astigmatism: 1.0-4.0 diopters
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Clear cornea
Exclusion criteria:
 Preexisting ocular condition such as:
Corneal opacities
Keratoconus
Glaucoma, uveitis, retinal, optic nerve disease
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Topographic astigmatism <1.0 diopter or more than 4.0 diopters
LIMBAL RELAXING INCISIONS
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Two limbal incisions were performed
along the steepest meridian using
preset guarded stainless steel knives
with preset guards of 550 µm depth.
The length of the incision depended on
the degree of the astigmatism, and was
calculated using a “Limbal relaxing
incisions nomogram”.
AMO LRI Calculator
PENETRATING LIMBAL RELAXING
INCISIONS
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Two full thickness incisions were
performed using a keratome knife along
the steepest meridian, in addition to the
clear corneal stab incision of the
phacoemulsification.
Mackool Nomogram
FOLLOW- UP
Patients were evaluated 1 day
and 1 week postoperative for:
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Visual acuity
Corneal topography
Presence or absence of any
complications.
RESULTS
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In the LRI group, mean cylinder preoperative
was 1.8 D (SD range 0.636) however mean
cylinder postoperative was 0.62 D (SD range
0.421).
In the PLRI group, mean cylinder
preoperative was 1.6 D (SD range 0.619)
however mean cylinder postoperative was 1.7
D (SD range 0.798).
The average change in corneal cylinder
(∆change) was found to be 1.178 D, SD
0.338 in the LRI group and -0.095 D, SD
0.846 in the PLRI group.
RESULTS
RESULTS
A
B
Changes in corneal topography (LRI case)
A: preoperative, B: 1 week postoperative
RESULTS
A
B
Changes in corneal topography (PLRI case)
A: preoperative, B: 1week postoperative
CONCLUSION
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Limbal relaxing incisions are safe and
effective method in reducing preexisting
corneal astigmatism up to 4 diopters,
however penetrating limbal relaxing
incisions failed to achieve any
improvement in correcting preexisting
astigmatism.
Thank You