Limbal Incision Research Articles

Cost-effectiveness of low-astigmatism correction with toric or spherical intraocular lenses combined with corneal incisions: an economic evaluation.

To assess the cost-effectiveness of the treatment of low corneal astigmatism (≤1.5 diopters) at the moment of cataract surgery. Qvision, Ophthalmology Department, VITHAS Almería Hospital, Spain. Economic evaluation. A decision tree was used to assess the cost-effectiveness of implanting spherical vs toric intraocular lenses (IOLs) or spherical lens combined with the following corneal incisions: limbal-relaxing incisions conducted manually (M-LRI) or assisted by femtosecond laser (F-LRI), arcuate keratotomies conducted manually (M-AK) or assisted by femtosecond laser (F-AK), and intrastromal arcuate keratotomies (F-iAK). Outcomes of cost were selected from a patient perspective considering the gross cost of each one of the surgeries at European centers, and the effectiveness variable was the probability of achieving a visual acuity of 20/20 postoperatively. A sensitivity analysis was conducted to assess the uncertainty considering the evidence retrieved from the transition probabilities of the model, effectiveness, and cost. F-AK or toric IOLs were the most effective treatments, increasing an 16% or 9%, respectively, in the percentage of eyes attaining 20/20 vision. The M-LRI, F-iAK, and F-LRI procedures were strongly dominated while the M-AK and toric IOL were weakly dominated by the F-AK. A patient with low corneal astigmatism would need to be willing to pay 360€ (95% CI, 231-1224) with F-AK and 472€ (95% CI, 149-4490) with toric IOLs for a 10% increase in the probability of achieving 20/20 vision. From patient perspective, F-AK was generally the most cost-effective treatment, although toric IOLs can dominate in some countries.

Билатеральная последовательная имплантация интраокулярной линзы специального дизайна с четырехточечной склерокорнеальной фланцевой фиксацией при афакии

Bilateral, sequential implantation of an intraocular lens of special design with four-point sclero-corneal flange fixation in aphakia A.F. Teshev, A.V. Malyshev, K.P. Telegin, R.Kh. Adzhiev Adygea Republican Clinical Hospital, Maykop, Republic of Adygea, Russian Federation Maykop State Technological University, Republic of Adygea, Russian Federation Research Institute – Regional Clinical Hospital No. 1 named after Professor S. V. Ochapovskii Krasnodar, Russian Federation City Hospital No. 40 of the Kurortnii district Sestroretsk, St. Petersburg, The article describes a clinical case with surgical treatment of bilateral aphakia in a patient who underwent cataract removal 50 years ago through a wide limbal incision. This case is interesting due to the approach to surgical treatment, namely the choice of intraocular lens, the method of fixing the intraocular lens in the absence of a capsular bag, and the results of visual acuity obtained. Key words: aphakia, sclerocorneal fixation of IOLs, intraocular lens, IOL stitching, Aquamarine nanocrystal model ACQ11.03IOL (Aquamarine TT)

Phacofragmentation of Posteriorly Dislocated Lens Fragments: Limbal versus Pars Plana Approach

ABSTRACT Purpose To assess intra-operative complications and feasibility of removing crystalline lens fragments from the vitreous cavity through a limbal incision compared to a pars plana approach. Design Retrospective cohort study. Subjects 16 eyes underwent phacofragmentation via a limbal approach (Group A) and 9 eyes through a pars plana approach (Group B) at an academic center over a 10-year period. Methods We collected pre-operative, intra-operative, and post-operative data. We compared rates of intraoperative complications, including corneal wound burn, iris or capsular damage, retinal tears, and hemorrhage, and recorded post-operative BCVA and IOP measurements at the one-month post-operative appointment. We also compared rates of post-operative complications, including corneal edema, choroidal detachment, or retinal detachment. Main Outcome Measures Primary outcomes of the study were the rates of intraoperative complications and the feasibility of crystalline lens removal with the limbal approach. We defined the latter outcome as the ability to complete lens removal without switching to the pars plana route. Results Mean BCVA for group A was 1.6, and for group B was 2.0 (p = .19). There was no significant difference between the two groups in the incidence of intraoperative complications, including corneal wound burn, iris damage, anterior capsular tear, iatrogenic retinal tear, or suprachoroidal hemorrhage (p > .99). There was no significant difference in the incidence of intra-operative vitreous hemorrhage (p = .36). Additionally, there was no significant difference in post-operative corneal edema (p = .27), choroidal detachment (p = .52), or retinal detachment (p > .99). The mean post-operative BCVA was 1.0 in group A and 1.0 in group B (p = .75). We completed all cases in group A using the limbal approach without switching to the pars plana route. Conclusion Phacofragmentation through a limbal incision provides a feasible option for dropped nuclear fragment removal and is not associated with a higher risk of complications than the pars plana route.

Manually performed limbal relaxing incisions versus femtosecond laser-guided astigmatic keratotomy for correction of corneal astigmatism after phacoemulsification

Purpose This study aimed to evaluate the safety and efficacy of manually performed limbal relaxing incisions (LRIs) compared with femtosecond laser-guided astigmatic keratotomy (FLAK) in the management of corneal astigmatism after phacoemulsification. Patients and methods This is a prospective, comparative, randomized, interventional study that was conducted from March 2018 to September 2022. It included 56 patients (74 eyes) who had corneal astigmatism after conventional phacoemulsification. They were classified into two groups. Group A included 34 patients (41 eyes) for whom manual LRIs using a diamond knife were performed and group B included 22 patients (33 eyes) for whom FLAK was performed. The preoperative evaluation included manifest refraction, uncorrected distance visual acuity, best corrected distance visual acuity, slit lamp examination of the cornea, intraocular pressure measurement, and fundus examination. Corneal astigmatism in diopters (D) was established by corneal tomography and Scheimpflug imaging (Pentacam). Postoperative follow-up visits were scheduled on the first day, at 1 week, 1 month, and 3 months after surgery. Postoperative evaluation included a slit lamp examination for the incisions, uncorrected distance visual acuity, manifest refraction, and Pentacam to evaluate corneal astigmatism. Results The mean topographic corneal astigmatism was reduced from 3.36±1.66 D to 1.07±1.11 D, 3 months postoperatively in the LRIs group with a statistically highly significant difference (P=0.000) and from 3.66±1.82 D to 1.19±1.26 D in the FLAK group with a statistically highly significant difference (P=0.000). The mean topographic corneal astigmatism 3 months postoperatively showed a statistically nonsignificant difference between the two groups (P=0.665). Although there was no statistically significant difference between the two groups, the mean arithmetic reduction of astigmatism was higher in the FLAK group (2.47 D) than in the LRIs group (2.29 D). The surgery was uneventful in 92.68% of the cases in group A with only 7.32% showing nonserious corneal perforation, while in group B, the surgery was uneventful in 97% of the cases with only 3% showing nonserious corneal perforation with a statistically nonsignificant difference between the two groups (P=0.431). Conclusion Both manually performed LRIs and FLAK were safe, predictable, and effective methods for correcting pre-existing or surgically induced corneal astigmatism after phacoemulsification with a nonsignificant difference in visual and corneal topographic outcomes between the two methods.

Predicting the impact of femtosecond-assisted arcuate keratotomy combined with tri-planar clear corneal incisions on astigmatism in implantable collamer lens surgery: one-year follow-up.

To investigate the factors associated with and impact on the femtosecond-assisted (FS-assisted) limbal relaxing incision (LRI) combined with the steep-meridian tri-planar clear corneal incision (TCCI) to reduce astigmatism in patients undergoing Implantable Collamer Lens (ICL) surgery. Retrospective case series. The study reviewed patients with ICL surgery combined with FS-assisted LRIs paired with steep-meridian TCCIs. Correlation analysis examined the relationship between independent variables, including preoperative characteristics (intraocular pressure, corneal thickness, axial length, et al.), TCCI, and LRI surgical parameters. The predictors of surgically induced astigmatism (SIA) were determined using individual-level analysis and accounting for inter-eye correlation with the generalized estimating equation (GEE). The study enrolled 69 patients, with 114 eyes (55 right and 59 left). The mean spherical equivalent (SEQ) was - 10.29 ± 2.99D and - 9.99 ± 2.72D for the right and left eye, respectively, while the mean preoperative corneal astigmatism was - 1.54 ± 0.47D and - 1.54 ± 0.46D for the right and left eyes, respectively. After 12 months of follow-up, univariate analysis revealed significant correlations between SIA and intraocular pressure (IOP), astigmatism type, TCCI position (degree), peripheral corneal thickness (PCT), LRI arc incision diameter, post depth (%), and angle, respectively (P = 0.046, 0.016, 0.039, 0.040, 0.009, 0.000, 0.000). Multivariate analysis using GEE demonstrated that axial length (AL), astigmatism type, LRI arc diameter, and angle were independent predictors of SIA (P = 0.000, 0.005, 0.029, 0.000). The type of astigmatism and axial length were independent factors that affected SIA when modifying the LRI arc diameter and angle through FS-assisted steep-meridian TCCI paired with LRI in ICL surgery.

A novel custom bent 27G needle-guided suture snare technique for scleral fixation of posterior chamber intraocular lenses

PURPOSE: To describe a custom bent 27G needle-guided suture snare technique for scleral fixation of posterior chamber intraocular lenses (PCIOL). METHODS: An 8-0 polypropylene suture was threaded into the lumen of a custom bent 27G needle, and the needle tip was advanced into the eye from the IOL fixation point. The suture was threaded through the posterior limbal incision inside the IOL haptic loop and pulled out. The needle tip was advanced into the eye again, going around the IOL haptic loop through the same limbal incision. The suture was threaded in again, and the needle was withdrawn from the eye, completing fixation of the IOL haptic loop. The suture knot was buried in the stroma of the sclera. RESULTS: The technique was performed in 10 eyes of 10 patients, with a preoperative logarithm of the minimum resolution angle corrected visual acuity of 0.73 ± 0.55 (Snellen 20/107), improvement of 0.24 ± 0.27 (Snellen 20/35) at the final follow-up visit, and a mean postoperative PCIOL tilt of 2.78 ± 1.32°. There were no cases of pupillary capture or suture-related complications during follow-up. CONCLUSION: The curved needle-guided suture snare technique provides a simple minimally-invasive method of scleral suture fixation of PCIOL.

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

PurposeTo evaluate short-term visual and refractive outcomes after implantation of a diffractive trifocal intraocular lens (IOL) in cataract patients with phacoemulsification (PHACO) and femtosecond laser assisted cataract surgery (FLACS).SettingDepartment of Ophthalmology, Shanghai Aier Eye Hospital, China.DesignA retrospective, observational study.MethodsPatients who underwent cataract surgery combined with Acrysoft IQ PanOptix trifocal IOL implantation were enrolled and divided into three groups: PHACO group, LAstig-FLACS group (astigmatism less then 1D) and HAstig-FLACS group (astigmatism more than 1D). Logarithm of the minimum angle of resolution (logMAR) visual acuity of uncorrected distance (UDVA), intermediate (UIVA), near visual (UNVA), defocus curve, surgically induced astigmatism (SIA) were evaluated in 1 months postoperatively and wavefront aberrations were evaluated in 6 months.Results101 eyes of 60 patients were included with 31 eyes in PHACO group, 45 eyes in LAstig-FLACS group and 25 eyes in HAstig-FLACS group. Significant difference was found of internal Strehl Ratio (SR) between PHACO and LAstig-FLACS group (P = 0.026). In PHACO group, 79.31%, 86.21%, 72.41% of eyes gain visual acuity LogMAR 0.1 or more in UDVA, UIVA and UNVA, while 83.72%, 93.02%, 93.02% of those in LAstig-FLACS group and 92.00%, 84.00%, 76.00% in HAstig-FLACS group.ConclusionsPanoptix diffractive trifocal IOL provides satisfied visual outcome in no matter FLACS or PHACO. Besides, trifocal IOL implantation via FLACS can provide a better accumulative visual acuity outcome at all distance than PHACO in 1 month. Femtosecond laser assisted limbal relaxing incisions (FLLRIs) is an excellent way to reduce a patient’s corneal astigmatism.

The Effect of Limbal Relaxing Incisions on 1-Week Postoperative K1 and K2 Values

Abstract
 Introduction & Objectives : Limbal Relaxing Incisions (LRI) is a surgical technique used to correct astigmatism during cataract surgery. This technique used to reduce the steepness of the corneal curvature in a particular meridian. LRI can be performed alone or in combination with phacoemulsification.
 Methods : This prospective study aimed to investigate the effect of Limbal Relaxing Incisions (LRI) on corneal astigmatism in patients who underwent phacoemulsification cataract surgery. Five patients were included in this study, and preoperative and 1-week postoperative keratometry values (K1 and K2) were measured using the IOL Master. Paired t-test analysis was used to compare the changes in K1 and K2 values before and after LRI
 Results : Five eyes of Five patients with the mean age 39.8 years (range : 22 to 76 years) and corneal astigmatism 3.12 D (range : 2.25 to 4.66 D) were underwent LRI and cataract surgery. The mean preoperative K1 and K2 values were 42.12 D and 46.44 D, respectively, while the mean 1-week postoperative K1 and K2 values were 42.60 D and 45.80 D, respectively. Paired t-test analysis showed a statistically significant decrease in K2 values (p = 0.025) but no significant change in K1 values (p = 0.329).
 Conclusion : This study showed there were no significant difference between pre and postoperative of K1 and showed a significant decrease in K2 on IOL Master examination. The wide age range of the included patients, may have influenced the effectiveness of LRI in reducing astigmatism. Further study with more subject are required.

THE EFFECT OF LIMBAL RELAXING INCISIONS ON 1-WEEK POSTOPERATIVE IN K1 AND K2 VALUES

Introduction: Limbal Relaxing Incisions (LRI) is a surgical technique used to correct astigmatism during cataract surgery. This technique used to reduce the steepness of the corneal curvature in a particular meridian. LRI can be performed alone or in combination with phacoemulsification. Methods: This prospective study aimed to investigate the effect of Limbal Relaxing Incisions (LRI) on corneal astigmatism in patients who underwent phacoemulsification cataract surgery. Five patients were included in this study, and preoperative and 1-week postoperative keratometry values (K1=flat keratometry and K2=steep keratometry) were measured using the IOL Master. Paired t-test analysis was used to compare the changes in K1 and K2 values before and after LRI. Results: Five patients with the mean age 39.8 years (range: 22 to 76 years) and corneal astigmatism 3.12 D (range: 2.25 to 4.66 D) were underwent LRI and cataract surgery. The mean preoperative K1 and K2 values were 42.12 D and 46.44 D, respectively, while the mean 1-week postoperative K1 and K2 values were 42.60 D and 45.80 D, respectively. Paired t-test analysis showed a statistically significant decrease in K2 values (p = 0.025) but no significant change in K1 values (p = 0.329). Conclusion: This study showed there were no significant difference between pre and postoperative of K1 and showed a significant decrease in K2 on IOL Master examination. The wide age range of the included patients may have influenced the effectiveness of LRI in reducing astigmatism. Further study with more subjects are required.

REFRACTIVE OUTCOMES COMPARISON IN LIMBAL RELAXING INCISION BASED ON INCISION DEPTH IN MANAGING CORNEAL ASTIGMATISM DURING CATARACT SURGERY

Abstract
 Introduction & Objectives : Introduction: Prevalence of clinically significant astigmatism of more than 1D can be found in 20 to 50% population those undergo cataract surgery. During phacoemulsification surgery, astigmatism could be corrected by toric intraocular lens (IOL) or incisional technique such as limbal relaxing incision (LRI). LRI are safe and inexpensive procedures thus results in satisfying outcomes with surgeon’s precise phacoemulsification incision and accurate LRI arc position, which most appropriate treatment choice for surgeons in rural area that has problematic access towards IOL supply. Objectives: To compare refractive outcomes of LRI technique with incision depth of 500um and 600um using diamond knife corresponding with phacoemulsification cataract removal.
 Methods : Prospective cumulative interventional case study included 30 eyes of consecutive cataract corneal astigmatic patients power >1.0D those undergoing LRI and phacoemulsification. Length, numbers, and arc position of LRI were calculated on LRI Calc application to obtain best results in minimal astigmatism residual. Uncorrected visual acuity, intraocular pressure, and keratometric cylinder were also analysed before surgery, Day-1, Day-7, and 1-Month post-operation.
 Results : Day-1 follow-up keratometry shown that corneal astigmatism was 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 was better in 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 in day-7 and 1-Month post-LRI, which may due to more stable corneal surface.

REFRACTIVE OUTCOMES COMPARISON IN LIMBAL RELAXING INCISION BASED ON INCISION DEPTH IN MANAGING CORNEAL ASTIGMATISM DURING CATARACT SURGERY

Introduction & ObjectivesIntroduction: Prevalence of clinically significant astigmatism of more than 1D can be found in 20 to 50% population those undergo cataract surgery. During phacoemulsification surgery, astigmatism could be corrected by toric intraocular lens (IOL) or incisional technique such as limbal relaxing incision (LRI). LRI are safe and inexpensive procedures thus results in satisfying outcomes with surgeon’s precise phacoemulsification incision and accurate LRI arc position, which most appropriate treatment choice for surgeons in rural area that has problematic access towards IOL supply. Objectives: To compare refractive outcomes of LRI technique with incision depth of 500um and 600um using diamond knife corresponding with phacoemulsification cataract removal.
 Methods : Prospective cumulative interventional case study included 30 eyes of consecutive cataract corneal astigmatic patients power >1.0D those undergoing LRI and phacoemulsification. Length, numbers, and arc position of LRI were calculated on LRI Calc application to obtain best results in minimal astigmatism residual. Uncorrected visual acuity, intraocular pressure, and keratometric cylinder were also analysed before surgery, Day-1, Day-7, and 1-Month post-operation.
 Results : Day-1 follow-up keratometry shown that corneal astigmatism was 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 was better in 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 in day-7 and 1-Month post-LRI, which may due to more stable corneal surface.

Using Total Corneal Astigmatism With Femtosecond Laser Cataract Surgery and Arcuate Keratotomy(ies) to Treat Low Amounts of Astigmatism.

The aim of this study was to evaluate outcomes using total corneal astigmatism (TCA) to calculate arcuate keratotomy(ies) (AK) parameters performed with femtosecond laser-assisted cataract surgery to reduce low corneal astigmatism. Patients who had femtosecond laser-assisted cataract surgery and AK with 0.50 diopter (D) to 1.30 D of TCA were included. Exclusion criteria were intraoperative complications, preexisting corneal surgery, and comorbidities that might adversely affect outcomes. Corneal tomography (Galilei G4, Zeimer Ophthalmic Systems AG) was performed preoperatively and 1 month postoperatively. TCA was input into the Donnenfeld limbal relaxing incisions nomogram to calculate the AK parameters. Preoperative and postoperative tomographic and subjective refractive measurements were compared. The Alpins method for vector analysis evaluated results. Eighty-two eyes of 82 patients were included. Mean preoperative TCA was significantly reduced from 0.80 ± 0.19 D to 0.51 D ± 0.26 D ( P < 0.001). Preoperative posterior corneal astigmatism, -0.28 ± 0.13 D, was unchanged, postoperative posterior corneal astigmatism, -0.28 ± 0.14 D ( P = 0.653). Target-induced astigmatism arithmetic mean (0.82 ± 0.21 D) was greater than that of the surgically induced astigmatism (0.70 ± 0.40 D), resulting in an arithmetic mean difference vector of 0.51 ± 0.27 D with a summated mean at 0.16 D at 20 degrees. The correction index was 0.87, indicating undercorrection. Angle of error arithmetic mean, -1.27 ± 23.27 degrees, indicated good alignment. Inputting TCA for calculation of femtosecond laser AK parameters can reduce low amounts of preoperative corneal astigmatism, thereby improving uncorrected vision.

Single and dual limbal relaxing incisions in correcting corneal astigmatism during cataract surgery

Introduction: Correcting astigmatism during cataract surgery to achieve optimal visual outcomes is important. Various techniques, such as limbal relaxing incisions (LRIs), are used to correct astigmatism. LRIs are effective for mild to moderate astigmatism but have limitations in correcting larger astigmatism. This study aimed to review the effectiveness of single and dual LRI in correcting astigmatism during cataract surgery. Methods: This literature review utilized databases from 2010 until 2022. The keywords “corneal astigmatism”, “limbal relaxing incision”, and “cataract surgery” were used to collect 12 journals that had relevant topics. Results: LRIs are a form of partial-thickness keratotomy used to correct astigmatism during cataract surgery. The incisions for LRIs are made in the peripheral cornea, following a nomogram based on the patient's astigmatism, age, and the location of the steep axis of astigmatism. LRIs can be performed as single or dual incisions, with dual LRIs offering greater astigmatism correction. In the case of irregular astigmatism, LRIs can be adjusted to the topography of the cornea because the lengths of coupled incisions can vary. Conclusion: The effectiveness between single and dual LRIs was the same, but paired LRIs have a superior effect in correcting greater astigmatism. LRIs remain a valuable tool for cataract surgeons to manage astigmatism and improve visual outcomes in cataract surgery patients.

Online intraocular lens calculation.

To showcase the majority of online intraocular lens (IOL) calculation tools and highlight some of their characteristics. Online tools are available for preoperative and postoperative IOL-related calculations, including IOL power and toricity selection for standard patients, patients who underwent prior refractive surgery, keratoconus, limbal relaxing incisions for astigmatism management, realignment of a misplaced or rotated toric IOL, surgical induced astigmatism (SIA), formulae comparison, and other tools. As there are new online developments and technology is advancing rapidly, we hope that this review will assist ophthalmologists in becoming acquainted with a large variety of online tools.

Characteristics of surgically induced astigmatism after standardized microincisional cataract surgery with a superior limbal incision.

To determine (1) if measurements of surgically induced astigmatism (SIA) as measured by keratometry (K) and total keratometry (TK) differ (2) if SIA affects the magnitude and/or meridian of keratometric astigmatism (3) if SIA evolves over time. Tertiary care center. Retrospective data analysis. A swept-source optical coherence tomography biometry dataset (IOLMaster700) consisting of 498 eyes (327 patients) from a tertiary care center was analyzed. For all eyes preoperative and postoperative biometric measurements at 1-month, 3-month, and 6-months postoperative visits were considered for vector analysis of SIA K and SIA TK . Centroids in right and left eyes were 0.26 diopters (D) @5 degrees/0.31 D @1 degree for SIA K and 0.27 D @4 degrees/0.34 D @1 degree for SIA TK . Centroids for difference vectors K-TK in right and left eyes were 0.02 D @ 176 degrees/0.03 D @6 degrees. The mean SIA magnitudes in right and left eyes were 0.48 ± 0.41 D and 0.50 ± 0.37 D for SIA K and 0.53 ± 0.42 D and 0.54 ± 0.40 D for SIA TK . In eyes with ATR astigmatism, an increase in postoperative astigmatism magnitude was more common than a decrease. More than 30% of eyes showed changes in the meridian of more than 15 degrees. Overall, we observed differences in K- and TK-derived SIA, and changes in SIA magnitude over time. For postsurgical interventions, postoperative astigmatism meridian values should be measured to base treatments. Astigmatism magnitude showed a tendency to decrease for steep-meridian incisions and to increase in flat-meridian incisions.

Is refractive enhancement a safer option for post laser in situ keratomileusis and small incision lenticule extraction regression - How far we have come?

Is refractive enhancement a safer option for post laser in situ keratomileusis and small incision lenticule extraction regression - How far we have come?

ByLimb: Development of a New Technique to Implant Intracorneal Ring-Segments from the Perilimbal Region.

A new technique that allows implanting intracorneal ring-segments (ICRS) from the limbal zone is described. Using a femtosecond laser (FSL), a 360° corneal tunnel is created with an internal diameter of 5.4 mm and an external diameter of 7.0 mm, with a wider area (0.2 mm inner and 0.2 mm outer) in the upper 60° of the tunnel (called landing zone). Next, a 4.36 mm-long corneal-limbal incision was created with the FSL, which connects to the bubbles created in the landing zone. The entire procedure was performed using intraoperative optical coherence tomography (OCT). Once the two incisions were connected using blunt-edged Mac Pherson forceps, the bubbles were released from the surgical plane. The programmed ICRS(s), 6 mm in diameter, are then placed in the corneal tunnel from the limbal incision with the aid of Sinskey forceps. Finally, when the ICRS is in place, the surgery is complete.

Implanting toric implantable collamer lens displays better astigmatism correction than implantable collamer lens combined with manually limbal relaxing incision

BackgroundThis retrospective study aimed to compare the outcomes of toric implantable collamer lens (TICL) surgery with those of implantable collamer lens (ICL) implantation combined with limbal relaxing incision (LRI) in patients with low myopia and astigmatism.MethodsA total of 40 eyes of 28 patients who underwent TICL implantation and 40 eyes of 27 patients who underwent ICL implantation combined with manually LRI between 2021 and 2022 were included. Primary outcomes were manifest sphere and cylinder, intraocular pressure, visual acuity, and astigmatism parameters at 1 day, 1 week, and 1, 3, and 6 months postoperatively.ResultsThe two surgeries showed comparable effects on manifest sphere and cylinder, intraocular pressure, and visual acuity (all p > 0.1). Surgery-induced astigmatism (SIA) was maintained as stable in the TICL group (1.73 to 1.68, p = 0.420), but was significantly reduced in the ICL/LRI group (1.74 to 1.17, p = 0.001) from preoperative to postoperative 6 months. The TICL group displayed significantly higher SIA and correction index at postoperative 1, 3, and 6 months than the ICL/LRI group (at 6 months: SIA, 1.68 (1.26, 1.96) vs., 1.17 (1.00, 1.64), p = 0.010; CI: 0.98 (0.78, 1.25) vs. 0.80 (0.61, 1.04), p = 0.018). No complications occurred during follow-up.ConclusionsThe effects of ICL/LRI are comparable to those of TICL in correcting myopia. TICL implantation displays better astigmatism correction than ICL/LRI.

Use of primary and piggyback toric intraocular lenses for treatment of high myopic astigmatism

Introduction: High myopic astigmatism often presents a challenge for cataract surgeons. Procedures such as limbal relaxation incisions may also be impossible in the setting of an extensive refractive surgical history. Patient and Clinical Findings: A 61-year-old woman for cataract surgery with a history of automated lamellar keratoplasty, 4-incision radial keratotomy, and arcuate incisions in the left eye. Astigmatism was 8.00 diopters (D) by manifest refraction, and on optical biometry, corneal topography, and auto keratometry, astigmatism was 9.01 D, 7.52 D, and 8.25 D, respectively. Diagnosis, Intervention, and Outcomes: A primary in-the-bag toric intraocular lens (IOL) and piggyback toric IOL with reverse optic capture were used. A surgically induced astigmatism of 6.59 D, magnitude of error of −1.41 D, angle of error 5.6 degrees, and correction index of 0.82 were achieved. Owing to limited potential improvement with IOL rotation, additional enhancement with photorefractive keratectomy (PRK) of −0.61 −1.78 × 69 degrees was performed to achieve desired results and high patient satisfaction. Preoperative corrected distance visual acuity was 20/50, and the uncorrected visual acuity achieved after cataract surgery and PRK enhancement was 20/25. Conclusions: The use of double toric IOLs for treating high astigmatism in patients with prior keratorefractive surgery is reported.

Small incision lenticule extraction and femtosecond-assisted laser in situ keratomileusis in patients with deep corneal opacity: case series.

To report the safety, efficacy, and accuracy of small-incision lenticule extraction (SMILE) or femtosecond-assisted laser in situ keratomileusis (FS-LASIK) for the correction of myopia or myopic astigmatism in patients with deep corneal opacity denoted by anterior segment optical coherence tomography (AS-OCT). Four patients with monocular corneal opacity (3 due to mechanical injury, 1 due to a firecracker wound) were recruited and treated with refractive surgery (3 for SMILE, 1 for FS-LASIK combined with limbal relaxing incision (LRI). Preoperative ocular manifestations, surgical details, postoperative visual outcomes, corneal opacity parameters, and corneal topography were analyzed. Preoperatively, spherical diopter ranged from -3.0 D to -4.75 D with cylinder ranging from -0.75 to -5.0 D, and corrected distance visual acuity (CDVA) ranging from 20/25 to 20/20. One eye's corneal opacity was located in the central zone and three were in the mid-peripheral optical zone. Three patients underwent uneventful SMILE in both eyes, whilst one patient underwent FS-LASIK for high astigmatism in both eyes and LRI in the right eye. CDVA of the eye with corneal opacity ranged from 20/22 to 20/20 one to six weeks postoperatively. Two patients achieved better CDVA and no patients lost Snellen lines. The postoperative diopter was within ±0.75 D for all eyes. Significant edema existed above the corneal opacity in one eye and dissipated soon. No eccentric corneal topography or morphological anomaly of the corneal cap or flap was observed. The cases demonstrate that SMILE or FS-LASIK is safe and effective to treat myopic astigmatism combined with deep corneal opacity lesions after comprehensive preoperative evaluation and appropriate candidate selection. FS-LASIK combined with LRI is also sufficient for correcting high astigmatism due to corneal scarring.