Limbal Relaxing Incisions (LRI)
Limbal relaxing incisions have gained widespread acceptance amongst cataract surgeons where it is often combined with the cataract operation to reduce pre-existing astigmatism. This results in better post-operative vision without glasses. The procedure can also be used in individuals whose primary refractive error is astigmatism.
If an eye has more than a minimal amount of corneal astigmatism, the vision without glasses after cataract surgery will not be as clear as in an eye without astigmatism. We can fix up to a moderate amount of astigmatism at the time of cataract surgery by making precision incisions in the corneal limbus, the part right next to the white of the eye, with an adjustable depth diamond blade. The decision as to where to place the incisions, the depth of the blade, the number of incisions and how long they should be is determined by using the data we get from a corneal topographer (Orbscan) and a nomogram.
An older version of LRI is called astigmatic keratotomy (AK). In AK the incisions are made in the cornea closer to the center of the pupil. While AK gives good results, LRI's seem to give somewhat better vision and are probably a little safer, although medical complications of AK's and LRI's are very rare.
Limbal Relaxing Incisions (LRI) are similar to AK incisions. The primary difference is in their placement on the cornea. Although they are still in the steeper axis, LRI incisions are placed much closer to the sclera (white part of the eye) on the part of the cornea called the limbus.
Incisional correction of astigmatism with AK and LRI is generally performed along with other types of surgery such as cataract surgery.
They are also used to fine tune other surgeries in an effort to reduce or eliminate one's dependence on glasses or contact lenses.
LRI's are incisions that are placed on the far peripheral aspect of the cornea (the limbus) resulting in a cornea that is more round. The astigmatism is thus reduced and uncorrected vision is improved.
The procedure can be completed in a few seconds after numbing the eye with anesthetic drops. There is usually little if any post-operative discomfort. The procedure is extraordinarily safe and is not associated with glare or starburst, as often occurs with true corneal incisions (RK and AK). Furthermore, the cornea is usually stable within a week, indicating that visual fluctuations have typically resolved by that time interval.
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