K317

Lateral corneal cataract incisions in preoperative astigmatism with the rule can be followed by undesired increase of astigmatism. In comparison with superior corneal incisions we prefer principally lateral corneal incisions because of more distance from the corneal center and better handling in narrow lid configurations. Limbal relaxing incisons (LRI), first described by Gills 1997, seemed appropriate to us for prevention of the above mentioned astigmatic increase.

Patients: We applied one resp. two LRI of 6-8 mm length using an Akom diamond groover with 0.5 mm preset depth in 54 cataract patients with astigmatism with the rule after clear corneal stretch incision (outer opening 4.0 -4.1 mm, inner opening 6.5 - 7.0 mm), phacoemulsification and 5 mm PMMA lens implantation. 27 cataract patients on which we performed lateral corneal stretch incisions without LRI served as a control. Corneal topography using the Mastervue Humprey device was performed preoperatively, 3 days and 6 months respectively following surgery.

Results: Postoperative astigmatism following single LRI at 6 o’clock position in patients with preoperative astigmatism with the rule of 0.67 ± 0.11 (n = 18) was 1.14 ± 0.62 after 3 days and 0.95 ± 0.52 aker 6 months. The postoperative astigmatism following paired LRI at 6 o’clock and 12 o’clock in patients with preoperative astigmatism with the rule of 0.77 ± 0.23 (n = 36) was 0.84 ± 0.67 after 3 days and 0.66 ± 0.41 aker 6 months. Axis shifts were not observed in any patient. That means: The surgically induced astigmatism of 0.8 ± 0.7 (n = 27) following lateral corneal incision in the control group was prevented completely in patients with paired LRI on the vertical axis. Complications such as overcorrections, perforations or delayed healing following LRI was nat observed.

Conclusion: Paired limbal relaxing incisions (LRI) are appropriate for effective astigmatic reduction. The procedure leads to fast and almost invisible scar formation.

Augenklinik des Städtischen Klinikums, Moltkestr. 90, D-76133 Karlsruhe