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The use of phacoemulsification and limbal relaxing incision in case of high surgically induced astigmatism: case report

Poster Details

First Author: A.Zilfyan ARMENIA

Co Author(s):    S. Harutyunyan              

Abstract Details


Regardless of the developments in the technologies of ophthalmic surgery, post surgery induced astigmatism is still a major problem in ophthalmology. Current methods of astigmatism treatment do not always allow to treat the high induced astigmatism, which is why in some cases, in order to get good results, it is necessary to combine various methods. However, in cases with patients suffering from cataract and astigmatism, it is preferable to use the method of phacoemulsification with toric intraocular lens implantation. Although trabeculectomy is the golden standard in glaucoma surgery, in some cases refractional rehabilitation of the patients is not always predictable. This is due to the fact that sometimes an uncontrollable suture tension and its further shred can take place during suture adaptation of the scleral trim, which can further lead to a change of shape of the cornea in the form of inverse or direct astigmatism.


Artashes Zilfyan MD, Sona Harutyunyan MD “Shengavit” Medical Center, Yerevan, Armenia. A patient with surgically induced high astigmatism was operated at “Shengacit ”MC using microcoaxial phacoemulsification (MICS) with posterior chamber IOL implantation and libmal relaxing incision (LRI)


Patient with low and blurred vision of the left eye, lack of binocular vision, diplopia, which forces the patient to close the left eye. The left eye vision is 0.09 with correction sph (-)2.75, cyl(-) 8.0 ax 160 = 0.3, IOP 10 mm. Hg. The patient has previously undergone a trabeculectomy with basal iridectomy because of primary open-angle glaucoma I-b. A biomicroscopy exam of the eye shows a cystic conjunctival filtration pad with insufficient scleral flap, transparent cornea, anterior chamber of medium depth, iris subathrophic, posterior synechiae and lens– opacity in all layers (++ by Burato). The results of Auto Ref-Keratometer - 176o-39.80D, 86o-47.20D, astigmatism- 7.40D . An ?S surgery has been applied in order to improve the eyesight function and correct the induced high astigmatism: phacoemulsification with toric intraocular lens implantation and limbal relaxing incisions (LRI). Intraocular toric lens was calculated using AcrysofToricIOL ?n-line calculator, and the LRI was calculated using ?n-line AMO LRI calculator (Abbott Medical Optics LRI calculator) by means of NAPA alignment chart (refers to the Nichaminage and pachymetry adjusted nomogram). A 24D AcrysofIQToricSN6AT9 lens has been implanted with cylindrical power of 6.0D, two 60? cornea incisions have been made at relevant meridians.


Early postoperative period was smooth, no complications registered. On the second day, after medical pupil dilatation, the location of the IOL evaluated. The IOL location was correct, condition of incisions – satisfactory, edges – clear. Left eye sision is 1.0, IOP 10mm Hg. Binocular vision recovered, no aesthenopic complaints registered. Further patient exam is scheduled on the second day, in one week, one month and three months periods after the surgery.


Based on obtained data it has been revealed that phacoemulsification with toric intraocular lens implantation and application of relaxing incisions (LRI) for a patient with a cataract and high induced astigmatism are the most preferred methods, which can improve both visual functions of the patient and topography of the cornea.

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