Efficacy of image-guided accurate limbal relaxing incisions for astigmatism correction during cataract surgery

To investigate the efficacy of image-guided accurate limbal relaxing incisions (LRIs) for astigmatism correction during cataract surgery.

Consecutive cataract patients with regular corneal astigmatism ranging from 0.75 to 2.50 D, intended for cataract surgery with image-guided LRIs, were recruited in this prospective cohort study. The efficacy of astigmatism correction was evaluated 3 months after surgery, and compared among eyes with preoperative corneal with-the-rule (WTR), against-the-rule (ATR) and oblique astigmatism. Higher-order aberrations and visual quality indices obtained with iTrace were further compared between eyes with single and paired LRIs.

Totally, 108 eyes of 108 patients were analyzed. The mean total surgical induced astigmatism (tSIA) vector of all participants was 0.76 ​± ​0.38 D (range: 0.11-1.79 D, preoperative vs. postoperative astigmatism: 1.46 ​± ​0.41 vs. 0.78 ​± ​0.44 D, P ​< ​0.001). Eyes with WTR astigmatism showed higher tSIA (0.89 ​± ​0.32 D vs. 0.42 ​± ​0.21 D vs. 0.48 ​± ​0.36 D, respectively, P ​< ​0.001), as well as higher correction index and lower difference vector and index of success than ATR and oblique astigmatism groups (all P ​< ​0.05). Eyes with paired LRIs exhibited better corneal average height of modulation transfer function, a better corneal performance index and a better quality of vision index than those with single LRI (all P ​< ​0.05).

Image-guided LRIs can effectively correct low-to-moderate corneal astigmatism during cataract surgery, especially in eyes with WTR astigmatism.