2020–2021 BCSC Basic and Clinical Science Course™
13 Refractive Surgery
Chapter 3: Incisional Corneal Surgery
Incisional Correction of Astigmatism
Ocular Surgery After Arcuate Keratotomy and Limbal Relaxing Incisions
AK and LRIs can be combined with or performed after cataract surgery, PRK, and LASIK surgery. Better predictability can be obtained if astigmatic correction is performed after refractive stability is achieved. Penetrating keratoplasty can be done after extensive AK, but the wounds may have to be sutured before trephination, as discussed earlier for RK. A prerequisite for combining LRIs with cataract surgery is the use of astigmatically predictable phacoemulsification.
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Bains KC, Hamill MB. Refractive enhancement of pseudophakic patients. Focal Points: Clinical Modules for Ophthalmologists. San Francisco: American Academy of Ophthalmology; 2014, module 11.
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Bayramlar HH, Dağlioğlu MC, Borazan M. Limbal relaxing incisions for primary mixed astigmatism and mixed astigmatism after cataract surgery. J Cataract Refract Surg. 2003; 29(4):723–728.
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Budak K, Yilmaz G, Aslan BS, Duman S. Limbal relaxing incisions in congenital astigmatism: 6 month follow-up. J Cataract Refract Surg. 2001;27(5):715–719.
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Dick HB, Gerste RD, Schultz T. Femtosecond laser-assisted cataract surgery. Focal Points: Clinical Modules for Ophthalmologists. San Francisco: American Academy of Ophthalmology; 2015, module 4.
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Gills JP. Treating astigmatism at the time of cataract surgery. Curr Opin Ophthalmol. 2002; 13(1):2–6.
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Nichamin LD. Astigmatism control. Ophthalmol Clin North Am. 2006;19(4):485–493.
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Rao SN, Konowal A, Murchison AE, Epstein RJ. Enlargement of the temporal clear corneal cataract incision to treat preexisting astigmatism. J Refract Surg. 2002;18(4):463–467.
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Rubenstein JB, Raciti M. Management of astigmatism: LRIs. Int Ophthalmol Clin. 2012;52(2): 31–40.
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Tejedor J, Murube J. Choosing the location of corneal incision based on preexisting astigmatism in phacoemulsification. Am J Ophthalmol. 2005;139(5):767–776.
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Yeu E, Rubenstein JB. Management of stigmatism in Lens-Based Surgery. Focal Points: Clinical Modules for Ophthalmologists. San Francisco: American Academy of Ophthalmology; 2008, module 2.
Excerpted from BCSC 2020-2021 series: Section 13 - Refractive Surgery. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.