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

PURPOSE: 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. SETTING: The Queen Elizabeth Hospital, Adelaide, South Australia, Australia. METHODS: 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 (OAls) 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. RESULTS: 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). CONCLUSION: 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.