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Subjective refractive outcomes of single limbal relaxing incisions during phacoemulsification surgery

Poster Details

First Author: H.Ziaei UK

Co Author(s):    C. Kanawati                    

Abstract Details


To analyse the effects of a single limbal relaxing incision created during phacoemulsification surgery on the subjective astigmatic outcome. The routine use of a fixed length and depth, single limbal relaxing incision at the meridian of highest corneal curvature (according to pre-operative keratometry) is proposed. The results are compared with a cohort of control patients undergoing surgery at the hands of the same surgeon.


July 2014 - January 2016 Ophthalmology Department Stepping Hill Hospital Poplar Grove, Hazel Grove, Stockport SK2 7JE United Kingdom


Patients with subjective pre-operative cylinder of 1 Dioptre or greater were randomised to an LRI group and a control group. The two arms employed 70 patients each. Clear corneal incision wound placement was fixed superiorly at 110 degrees for all patients. The LRI was performed with a 550um fixed depth blade. The length of the incision was 60 degrees of arc centered at the meridian of highest corneal curvature according to keratometry. Corneal sutures were not employed in any patient. The post-operative refraction was performed by the same optometrist.


The average reduction in post-operative cylinder was 1.15D for the LRI group and 0.73D for the control group. Cylinder reduction of 1D or greater was elicited in 47/70 LRI patients and 23/70 control patients. Average post-operative spherical equivalent was 0.48D for the LRIs and 0.5D for the controls. Spherical equivalent reduction was 2.78D for the LRIs and 2.3D for the controls. There was no change in cylinder for 2 LRI and 5 control patients. The cylinder increased by 0.25D for 4 patients in each group. There were no LRI related complications.


For surgeons undertaking fixed superior approach phacoemulsification surgey, the use of a single limbal relaxing incision of fixed length at the meridian of highest corneal dioptric power is safe and yields marked reduction in postoperative refractive astigmatism. The average cylinder reduction was 1.15D for the LRI and 0.73D for the control group indicating a 57% reduction in the LRI cohort. There were no LRI related complications. These results suggest that the routine use of a single LRI can be effective in improving postoperative refractive outcomes and reducing post-operatice spectacle dependence.

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