Limbal Relaxing Incisions Group Research Articles

A randomised, prospective study of 'off-the-shelf' use of toric intraocular lenses for cataract patients with pre-existing corneal astigmatism in the NHS.

To compare visual and refractive outcomes of monofocal intraocular lenses (IOLs) with limbal relaxing incisions (LRI) with 'off-the-shelf' use of toric IOLs (TIOLs), with a fixed 2-dioptre cylinder (DC) correction, for cataract patients with pre-existing corneal astigmatism in a public-sector setting. Seventy-seven patients (77 eyes, first treated eye) with visually significant cataract and pre-operative corneal astigmatism ≥2.00 DC were randomised to receive either 'off-the-shelf' TIOLs, with a fixed 2.00 DC cylinder correction (39 eyes), or monofocal IOLs (38 eyes) with LRIs. The concept of fixing the cylindrical correction was to minimise costs, allow a full TIOL bank to be available and eliminate the need for individual TIOL ordering. Outcome measures were uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA) and refraction. Astigmatic changes were evaluated using the Alpins vector method. Mean UDVA improved from logMAR 0.88 (SD 0.56)[~20/150] pre-operatively to 0.18 (SD 0.19)[~20/30] post-operatively in TIOL group, versus 0.82 (SD 0.55)[~20/130] to 0.27 (SD 0.15)[~20/40] in monofocal/LRI group (P = 0.02; 95% CI: -0.17, -0.01). Mean CDVA improved from logMAR 0.40 (SD 0.26)[~20/50] to 0.01 (SD 0.12)[~20/20] in TIOL group, and 0.41 (SD 0.38)[~20/40] to 0.06 (SD 0.12)[~20/25] in LRI group (P = 0.07; 95% CI: -0.11, 0.01). Average post-operative refractive cylinder in TIOL group was 1.35 DC (SD 0.84 DC) and in LRI group 1.91 DC (SD 1.07 DC) (P = 0.01; 95% CI: -1, -0.12). Mean difference vector magnitude was 1.92 DC (SD 1.08 DC) in LRI group and 1.37 DC (SD 0.84 DC) in TIOL group (P = 0.02; 95% CI: 0.11, 0.99). TIOLs with a fixed 2.00 DC correction during cataract surgery may improve UDVA, reduce post-operative cylinder and result in a more reliable astigmatic correction compared with monofocal IOLs with LRIs.

Comparison of Toric intraocular lenses and corneal incisional procedures for correction of low and moderate astigmatism during cataract surgery: A meta-analysis

Objective: To systematically compare the effects of Toric intraocular lens (IOL) implantation and corneal incisional procedures on the correction of astigmatism during cataract surgery. Methods: A peer-reviewed literature search was implemented in MEDLINE, EMBASE, EBSCO, ScienceDirect, Trip Database, Ovid, and the Chinese databases including CNKI and Wanfang Data. The inclusion criteria were randomized controlled trials (RCTs) that compared the Toric IOL implantation and the corneal incisional procedures to correct low and moderate astigmatism during cataract surgery. The mean difference (MD) and the relative risk were respectively used to describe the effect sizes of continuous data and nominal data with a confidence interval (CI) of 95%. The random effects model was applied to pool the data including postoperative uncorrected visual acuity, residual astigmatism and surgical complications by Review Manager 5.3. Results: A total of 12 RCTs were included in this study, including 330 eyes implanted with Toric IOLs and 336 eyes with non-Toric IOLs combined with corneal incisional procedures to correct astigmatism. According to the types of corneal incisions, the included RCTs were divided into three groups: limbal relaxing incision group, opposite clear corneal incision group, and astigmatic keratotomy group. Meta-analysis showed that postoperative logarithm of the minimum angle of resolution uncorrected visual acuity was significantly better in eyes implanted with Toric IOLs than those with corneal incisional procedures (MD, -0.05; 95% CI, -0.08 to -0.02; P<0.01), and the residual astigmatism was significantly lower in eyes implanted with Toric IOLs (MD, -0.33 D; 95% CI, -0.48 to -0.18 D; P<0.01). There was no significant difference in the risk of surgical complications between the Toric IOL implantation and the corneal incision correction for astigmatism (relative risk, 0.45; 95% CI, 0.07 to 2.95; P=0.40). Conclusions: The current evidence suggests that Toric IOL implantation is more effective in correcting astigmatism than corneal incisional procedures during cataract surgery and shows better postoperative visual acuity. However, they are similar in the risk of postoperative complications. (Chin J Ophthalmol, 2019, 55: 522-530).

Refractive outcomes after limbal relaxing incisions or femtosecond laser arcuate keratotomy to manage corneal astigmatism at the time of cataract surgery

To compare the results of manual limbal relaxing incisions (LRIs) performed during conventional phacoemulsification surgery with those of nonpenetrating femtosecond laserarcuate keratotomies performed during femtosecond laser-assisted cataract surgery to manage corneal astigmatism. Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom. Randomized case-controlled trial. This was a secondary outcome of a randomized controlled trial comparing 400 patients treated with conventional phacoemulsification surgery or femtosecond laser-assisted cataract surgery. All patients with corneal astigmatism greater than 0.9 diopter (D) were offered LRIs or femtosecond laser arcuate keratotomy based on the original randomization. Visualacuity, postoperative refraction, and corneal topography were recorded 4weeks postoperatively. Vector analysis was performed using the Alpins method. Fifty-one eyes of 51 patients received LRIs, and 53 eyes of 53 patients received femtosecond arcuate keratotomies. The mean target induced astigmatism was 1.50 D and 1.38 D, respectively, with 1.02 D and 1.23 D surgically induced astigmatism (P=.21), resulting in the femtosecond arcuate keratotomy group having a smaller difference vector (1.17 D versus 0.89 D; P=.02) and a greater correction index (0.48 versus 0.73; P=.02). Forty-four percent of patients in the femtosecond arcuate keratotomy group and 20% in the LRI group attained a postoperative cylinder of less than 0.50 D (P=.01). The femtosecond arcuate keratotomy group achieved a higher correction index and a smaller difference vector. The femtosecond arcuate keratotomy patients showed less postoperative cylinder than LRI patients.

Effect of Limbal relaxing incisions during implantable collamer lens surgery

BackgroundThe limbal relaxing incisions (LRIs) technique is a safe and an inexpensive procedure, which is simple for experts to perform. It can effectively reduce astigmatism and result in a rapid visual rehabilitation. But there are few reports about reducing pre-existing corneal astigmatism by LRI in ICL surgery. Our research was aimed to study the effect of limbal relaxing inci sions during implantable collamer lens (ICL) surgery.MethodsA prospective analysis reviewing consecutive cases of corneal astigmatism that had either independent ICL surgery (control group) or combined with LRIs (LRIs group). The study population consisted of 45 patients, 85 eyes, with high myopia and regular corneal astigmatism more than 0.50 diopter (D) and less than 3.00 D. The first group received ICL surgery combined with LRIs (limbal relaxing incisions); the control group received only ICL surgery alone. The outcomes considered were uncorrected distance visual acuity (UDVA), best corrected distance visual acuity (BCVA), refraction, keratometry, slit lamp biomicroscopy, indirect ophthalmoscopy, corneal topography, corneal astigmatism, endothelial cell count, and patient satisfaction. The follow-up period covered 12 months.ResultsThe mean uncorrected distance visual acuity (UDVA) and the best corrected visual acuity (BCVA) demonstrated statistically significant improvement after surgery in both groups. At the end of the follow-up period, the UCVA was statistically better for the patients with LRIs compared with those underwent ICL surgery alone. The LRIs group showed significant reduction in the mean topographic astigmatism from 1.48 ± 0.35 D preoperatively to 0.37 ± 0.14 D postoperatively (P < .0001) after one month. The control eyes did not show a statistically significant change (P > 0.05). The mean magnitude of the surgically induced astigmatism (SIA) read 1.10 ± 0.35 D,1.13 ± 0.34D,1.13 ± 0.34D,1.11 ± 0.35D by the end of the 1st, the 3rd, the 6th and the 12th month postoperatively in LRIs group, which was slightly lower than the target-induced astigmatism (TIA). The difference in SIA between the LRI and the control group was statistically significant by the end of the 1st, the 3rd, the 6th and the 12th month postoperatively (P < 0.001). The mean correction index (CI) was less than 1, which indicated undercorrection effect of limbal relaxing incision. No difference was observed in the postoperative endothelial cell count between the two groups. There was no intraoperative and postoperative ocular or systemic complication.ConclusionLimbal relaxing incision is an effective method in reducing corneal astigmatism during implantable collamer lens surgery.Trial registrationThe trial was retrospectively registered in 14 April 2017. (NO:ChiCTR-ONR-17011147).

Effect of Limbal Relaxing Incisions on Corneal Aberrations.

To study the effect of limbal relaxing incisions on corneal aberrations after phacoemulsification with aspheric intraocular lens (IOL) implantation. Forty-five eyes underwent microincision cataract surgery with on-axis phacoemulsification incision. These eyes were divided into two groups: limbal relaxing incision group (23 eyes) and control group (22 eyes). In the limbal relaxing incision group, a single limbal relaxing incision was performed on the steepest meridian of corneal topography and the degrees of arc were determined using the DONO-Donnenfeld nomogram. The eyes in the control group were operated on by microincision cataract surgery without limbal relaxing incision. Corneal topography and wavefront analysis over 6-mm pupil size were performed preoperatively and 1 month postoperatively in both groups. Target induced astigmatism vector, surgically induced astigmatism vector, difference vector, magnitude of error, flattening effect, and torque were analyzed using the Alpins vectorial method. The limbal relaxing incision group showed significant reduction in topographic astigmatism by 51.87% of preoperative topographical astigmatism (P < .0001). The mean surgically induced astigmatism of limbal relaxing incision was 1.29 ± 0.71 diopters (D), which was close to the mean target induced astigmatism (1.33 ± 0.20 D), whereas the control group did not show a significant change in topographic astigmatism (0.17 ± 0.11 D; P = .73). Higher order aberrations of the cornea did not show significant change in either group except quatrefoil aberration, which significantly increased in the limbal relaxing incision group but not in the control group, with no significant difference between the two groups regarding corneal aberrations. Limbal relaxing incision is an effective method in reducing corneal astigmatism with neutral effect on corneal aberrations.

Correction of low corneal astigmatism in cataract surgery.

To evaluate and compare aspheric toric intraocular lens (IOL) implantation and aspheric monofocal IOL implantation with limbal relaxing incisions (LRI) to manage low corneal astigmatism (1.0-2.0 D) in cataract surgery. A prospective randomized comparative clinical study was performed. There were randomly recruited 102 eyes (102 patients) with cataracts associated with corneal astigmatism and divided into two groups. The first group received toric IOL implantation and the second one monofocal IOL implantation with peripheral corneal relaxing incisions. Outcomes considered were: visual acuity, postoperative residual astigmatism, endothelial cell count, the need for spectacles, and patient satisfaction. To determine the postoperative toric axis, all patients who underwent the toric IOL implantation were further evaluated using an OPD Scan III (Nidek Co, Japan). Follow-up lasted 6mo. The mean uncorrected distance visual acuity (UCVA) and the best corrected visual acuity (BCVA) demonstrated statistically significant improvement after surgery in both groups. At the end of the follow-up the UCVA was statistically better in the patients with toric IOL implants compared to those patients who underwent implantation of monofocal IOL plus LRI. The mean residual refractive astigmatism was of 0.4 D for the toric IOL group and 1.1 D for the LRI group (P<0.01). No difference was observed in the postoperative endothelial cell count between the two groups. The two surgical procedures demonstrated a significant decrease in refractive astigmatism. Toric IOL implantation was more effective and predictable compared to the limbal relaxing incision.

Comparative evaluation of aspheric toric intraocular lens implantation and limbal relaxing incisions in eyes with cataracts and ≤3 dioptres of astigmatism

PurposeTo compare the visual outcomes of aspheric toric intraocular lens (IOL) implantation and limbal relaxing incisions (LRI) for management of coexisting age-related cataracts and astigmatism.MethodsIn this prospective study, sixty eyes...

High-cylinder toric intraocular lens implantation versus combined surgery of low-cylinder intraocular lens implantation and limbal relaxing incision for high-astigmatism eyes.

Clinical outcomes were compared between high-cylinder toric intraocular lens (IOL) implantation and the combined surgery of low-cylinder toric IOL implantation and limbal relaxing incision (LRI) for correcting preexisting high-amplitude corneal astigmatism. Fifty-seven eyes with preexisting corneal astigmatism of 2.5 diopter (D) or greater were divided into the following two groups: (1) eyes that underwent Alcon AcrySof® IQ Toric T6, T7, T8, or T9 IOL implantation (toric group); and (2) eyes that underwent the combined surgery of AcrySof® IQ Toric T5 IOL implantation and LRI (LRI group). Uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), manifest, refractive and corneal cylinder (MC, RC, CC), were compared postoperatively. Corneal and ocular higher-order aberrations (HOA) were also compared. At 1 day postoperative, UCVA was significantly better and MC and RC were significantly less in the toric group, however, at 1 and 6 months postoperative, there was no significant difference in those parameters. Postoperative corneal and ocular HOA were significantly greater in the LRI Group. For correcting astigmatism in eyes with a high amount of preexisting astigmatism, high-cylinder toric IOL implantation achieves better clinical outcomes, especially in the early postoperative period, than the combined procedure of moderate-cylinder toric IOL implantation and LRI.

Treatment of astigmatism during phacoemulsification.

To compare the effectiveness of limbal relaxing incisions (LRI) with that of toric intraocular lens (IOL) implantation for the treatment of astigmatism during phacoemulsification using nonvectorial (predictability, safety, and efficacy) and vectorial analyses. This longitudinal observational case series assessed 62 eyes of 31 consecutive cataract patients with preoperative corneal astigmatism of 0.75-2.50 diopters (D) in both eyes. Patients were randomly assigned to 2 groups: a toric IOL group, which received toric IOLs in both eyes, and an LRI group, which received spherical IOLs associated with LRI placement in both eyes. All patients were evaluated at 1, 3, and 6 months after surgery, when refractive astigmatism analysis was performed using both nonvectorial and Alpins vectorial methods. Outcomes were assessed within each group and compared between groups. The proportion of eyes within ±0.50 D of the intended correction at 3 and 6 months after surgery was 75% and 71.88%, respectively, in the LRI group and 40% and 66.67%, respectively, in the toric IOL group. In the remaining period, the proportion was greater in the toric IOL group. The safety index showed no difference at any time point. The efficacy index at 1 and 3 months after surgery was significantly higher in the toric IOL group (0.43 and 0.44, respectively) than in the LRI group (0.31 and 0.36, respectively). At 6 months after surgery, the status of eyes in the LRI group was as follows: 53.13% were undercorrected, 43.74% achieved the intended correction, and 3.13% were overcorrected. In the toric IOL group, 16.76% eyes were undercorrected, 76.67% achieved the intended correction, and 6.67% were overcorrected. The success rates for astigmatic surgery, astigmatism reduction at the intended axis, and astigmatism corrected were 43%, 62%, and 64%, respectively, in the LRI group and 57%, 81%, and 94%, respectively, in the toric IOL group. Our results suggest that the use of toric IOLs may be advantageous over the use of LRIs for the treatment of astigmatism during phacoemulsification. Although such advantages seem subtle in nonvectorial analyses, they are highlighted in vectorial analyses.

Comparison of clinical outcomes between limbal relaxing incisions and toric intraocular lenses in eyes with astigmatic corneas

Objective: To compare refractive and vectorial outcomes of limbal relaxing incisions (LRI) versus toric intraocular lenses (IOL) in the treatment of preexisting corneal astigmatism at the time of phacoemulsification. Methods: This longitudinal observational case series assessed 62 eyes of 31 consecutive cataract patients with preoperative corneal astigmatism between 0.75 and 2.50 diopters in both eyes. Patients were randomly assorted in two groups: one assigned to receive AcrySof Toric™ IOL in both eyes, and another one assigned to have AcrySof Natural™ IOL associated with LRI, also in both eyes. All patients were re-evaluated, postoperatively, at 1, 3 and 6 months, when refractive astigmatism analysis was performed using vectorial methods proposed by Thibos. Variability of outcomes within each group and between groups were assessed and compared. Results: Manifest refractive cylinder, in diopters (D), as means ± standard deviation, in the LRI group for 1-month, 3-month and 6-month re-evalutions were respectively -0.66 ± 0.30; -0.70 ± 0.21 and -0.74 ± 0.26 when compared to -0.58 ± 0.24; -0.63 ± 0.20, and -0.62 ± 0.17 in the toric IOL group. (p value ≥ 0.06). Vectorial analysis evidenced greater astigmatism reduction in the toric IOL group in the 6th postoperative month, when postoperative mean astigmatic power vector was 0.31 D, when compared to 0.37 D in the LRI group (p value = 0.00). Conclusions: A trend of slightly better refractive outcomes favoring toric IOL group was seen, although such a trend was not statistically significant. Vectorial analysis, however, suggests that the use of toric IOL may constitute a more advantageous approach in the treatment of pre-existing corneal astigmatism, simultaneously with phacoemulsification.

Limbal relaxing incision for correcting corneal astigmatism during phacoemulsification

Objective To evaluate the efficacy of limbal relaxing incisions (LRIs) for the correction of corneal astigmatism during phacoemulsification.Methods 66 eyes of 60 patients with senile cataract and coexisting keratometric astigmatism were included in the study.Phacoemulsification with concomitant relaxing incisions was performed in 40 eyes of 35 patients in LRIs group.26 eyes of 25 patients only underwent phacoemulsification with intraocular lens implantation were in control group.All patients underwent ophthalmic examination that included uncorrected visual acuity (UCVA),best-corrected visual acuity (BCVA)and corneal topography preoperatively,1 month and 3 months postoperatively.Results Respectively comparing UCVA of two groups 1 and 3 months postoperatively,the P values were considered statistically significant(P ＜ 0.05).At preoperative and postoperative time points,the average corneal astigmatism changes were also significantly different between the two groups.(P ＜ 0.05).Conclusion LRIs performed during phacoemulsification surgery appear to be an effective procedure to reduce pre-existing corneal astigmatism and improve UCVA as well as the visual quality. Key words: Limbal relaxing incisions; Phacoemulsification; Cataract; Corneal astigmatism; Topography

Limbal Relaxing Incisions Using a Reference Point and Corneal Topography for Intraoperative Identification of the Steepest Meridian

To examine the efficacy and safety of topography-based limbal relaxing incision (LRI) surgery. Forty-four eyes of 36 consecutive patients who underwent cataract surgery more than 1 month previously, had refractive against-the-rule astigmatism of ≥2.00 diopters (D), and were scheduled to undergo LRI surgery were enrolled in the study. Patients were randomized into two groups-a topography-based LRI group (19 eyes of 14 patients) and a conventional LRI group (25 eyes of 22 patients). The topography-based LRI procedure comprised 3 steps: placing a mark on the cornea and conjunctiva, identifying this mark in the topographic image, and performing LRI based on the location of the mark. In the conventional LRI group, the horizontal meridian was marked under a slit lamp and LRIs were made based on the position of the horizontal mark. Corneal astigmatism in the topography-based LRI group before and 1 month after surgery was 2.03±0.92 D and 1.33±0.69 D, respectively (P=.014). Corneal astigmatism in the conventional LRI group before and 1 month after surgery was 2.36±0.77 D and 0.93±0.70 D, respectively (P<.0001). Fourier harmonic analysis of the topography data demonstrated that regular astigmatism was significantly decreased in the two groups. The mean regular astigmatism was not significantly different before and after LRI between groups, whereas the variances (mean of the deviation squared from its mean) of regular astigmatism were significantly different between groups 1 month after LRI. Compared with conventional LRI surgery, a topography-based procedure may reduce the deviation of the effect of LRIs.

Limbal relaxing incision during cataract extraction versus photoastigmatic keratectomy after cataract extraction in controlling pre-existing corneal astigmatism

The techniques of limbal relaxing incision (LRI) and photoastigmatic keratectomy (PAK) are both effective methods for correcting pre-existing astigmatism with cataract extraction, but no previous study has directly compared them. To compare the effects of limbal relaxing incision (LRI) and photoastigmatic keratectomy (PAK) on preoperative astigmatism and higher-order aberrations (HOAs) in eyes undergoing cataract surgery. Kitasato University Hospital, Japan. A retrospective study of eyes which had undergone phacoemulsification and intraocular lens implantation through an astigmatically neutral incision either accompanied by LRI (LRI group, 20 eyes) or followed after 3 months by PAK (PAK group, 27 eyes), to control pre-existing corneal astigmatism. Among eyes that underwent LRI, manifest astigmatism (corrected to the corneal plane) averaged -1.72 +/- 0.95 D preoperatively and -0.98 +/- 0.58 D postoperatively. Corneal astigmatism averaged 2.03 +/- 0.49 D preoperatively and 1.34 +/- 0.60 D postoperatively. Among eyes that underwent PAK, manifest astigmatism averaged -2.02 +/- 0.64 D preoperatively and -0.70 +/- 0.58 D postoperatively. Corneal astigmatism averaged 2.30 +/- 0.81 D preoperatively and 1.05 +/- 0.36 D postoperatively. With regard to HOAs, in the LRI group, corneal HOAs averaged 0.172 +/- 0.051 microm (total aberrations for 4 mm pupil diameter) and 0.681 +/- 0.433 microm (total, 6 mm) preoperatively, but 0.172 +/- 0.053 microm (total, 4 mm) and 0.651 +/- 0.187 microm (total, 6 mm) postoperatively. In the PAK group, the corneal HOAs averaged 0.179 +/- 0.073 microm (total, 4 mm) and 0.679 +/- 0.314 microm (total, 6 mm) preoperatively, but 0.206 +/- 0.095 microm (total, 4 mm) and 0.816 +/- 0.380 microm (6 mm, total) postoperatively. The only statistically significant differences in the postoperative HOAs between LRI and PAK groups were in the S4 and S6 (spherical and spherical-like aberrations being bigger in the PAK group ).There were no vision-threatening complications in either group. PAK is more effective than LRI in the control of pre-existing manifest astigmatism. LRI causes less accentuation of the spherical HOAs than PAK.

Prospective Randomized Trial of Limbal Relaxing Incisions Combined with Microincision Cataract Surgery

To evaluate clinical outcomes of limbal relaxing incision (LRI) combined with bimanual phacoemulsification and insertion of an intraocular lens (IOL) developed for bimanual microincision cataract surgery (MICS). In a prospective, single-center study, eyes with > or = 0.75 diopters (D) of keratometric astigmatism were randomly assigned to two surgical techniques: 1) bimanual MICS (non-LRI group) or 2) LRI combined with bimanual MICS (LRI group). Postoperative uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), postoperative refractive error, corneal topography, and vector analysis of keratometric change between pre- and postoperative eyes were compared. In all cases of astigmatism in the LRI group, incisions for phacoemulsification and IOL insertion did not overlap or affect the LRIs. Uncorrected distance visual acuity was significantly higher in the LRI group (mean: 0.94) than in the non-LRI group (mean: 0.71, P = .009), although no difference was seen in CDVA in either group. Postoperative cylindrical error was significantly lower in the LRI group than in the non-LRI group (0.56 D and 1.51 D, respectively, P = .0004). Cravy analysis showed that the vector change in cylinder was 1.44 D in the LRI group and 0.18 D in the non-LRI group (P = .0007). Limbal relaxing incision with bimanual MICS is an easy-to-follow combined surgery to correct preexisting astigmatism with predictable accuracy.

Limbal relaxing incisions versus on-axis incisions to reduce corneal astigmatism at the time of cataract surgery

To compare limbal relaxing incisions (LRIs) with placement of the corneal cataract incision on the steepest keratometric axis for the reduction of preexisting corneal astigmatism at the time of cataract surgery. The Queen Elizabeth Hospital, Adelaide, South Australia, Australia. In a prospective single center study, patients having 1.5 diopters (D) or more of keratometric astigmatism were randomly assigned to 2 surgical techniques: on-axis incisions (OAIs) consisting of a single clear corneal cataract incision centered on the steepest corneal meridian or LRIs consisting of 2 arcuate incisions straddling the steepest corneal meridian and a temporal clear corneal incision. Vector analysis of the target axis flattening effect was used to assess the efficacy of treatment. Seventy-one eyes of 71 patients were evaluated, 33 in the OAI group and 38 in the LRI group. Six weeks postoperatively, the flattening effect was 0.41 D (median and interquartile range 0.15 to 0.78 D) in the OAI group and 1.21 D (range 0.43 to 2.25 D) in the LRI group (P = .002). After 6 months, the flattening effect was 0.35 D (range 0.00 to 0.96 D) and 1.10 D (range 0.25 to 1.79 D), respectively (P = .004). The amount of astigmatism reduction achieved at the intended meridian was significantly more favorable with the LRI technique, which remained consistent throughout the follow-up period.