Limbal Relaxing Incisions at the Time of Apodized Diffractive Multifocal Intraocular Lens Implantation to Reduce Astigmatism with or Without Subsequent Laser in Situ Keratomileusis

Purpose: To evaluate the visual and refractive outcomes of limbal relaxing incisions (LRIs) to reduce astigmatism at the time of apodized diffractive multifocal intraocular lens (IOL) implantation.

Setting: University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, USA.

Methods: This retrospective review comprised consecutive patients who had LRIs at the time of lens extraction and AcrySof ReSTOR IOL implantation. A subgroup of patients had subsequent laser in situ keratomileusis (LASIK) for residual refractive error correction.

Results: The study evaluated 73 eyes (59 patients); 21 eyes (28.7%) of 59 patients had further LASIK (LRI+LASIK). The mean follow-up was 13.2 months +/- 6.4 (SD). The mean keratometric astigmatism decreased from 1.49 +/- 0.71 diopters (D) preoperatively to 0.56 +/- 0.57 D at the last follow-up (P<.001). Although the LRI+LASIK group had significantly greater corneal astigmatism than the LRI-only group preoperatively (P = .005) and 1 month (P = .030) and 6-months (P = .014) postoperatively, there was no statistically significant difference between the 2 groups at the last follow-up (P = .528). At the last follow-up, the uncorrected distance visual acuity was 20/25 or better and the uncorrected near visual acuity was J1 or better in 32 (76%) of 42 eyes in the LRI-only group and in 17 (81%) of 21 eyes in the LRI+LASIK group.

Conclusion: Limbal relaxing incisions at the time of apodized diffractive multifocal IOL implantation, with or without subsequent LASIK, were effective and safe in reducing astigmatism.