Femtosecond-Laser Assited Limbal Relaxed Incisions And Cataract Surgery

To present a case of astigmatism correction using femtosecond laser–assisted limbal relaxing incisions (LRIs) performed simultaneously with cataract surgery.

The Dr Solomatin eye center, Riga, Latvia.

A 70-year-old male was referred to the clinic with complaints of decreased visual acuity in the left eye. Clinical examination revealed age-related cataract and corneal astigmatism of 2.50 diopters in the left eye, partially compensated by lenticular astigmatism.

Preoperative Examination

Visual Acuity:

• OD: 0.6 cc +0.25 D sph −1.25 D cyl × 25° = 0.6
• OS: 0.6 cc +0.75 D sph +0.75 D cyl × 90° = 0.7

Keratometry:

• OD:
  R1 44.50 D × 23°
  R2 45.50 D × 113°
  Cylinder: −1.00 D × 23°
• OS:
  R1 44.50 D × 179°
  R2 47.00 D × 89°
  Cylinder: −2.50 D × 179°

The patient was offered implantation of a toric intraocular lens (IOL); however, he declined this option for financial reasons. As an alternative, femtosecond laser–assisted limbal relaxing incisions were proposed, and informed consent was obtained.

Surgery was performed uneventfully in the left eye and included femtosecond laser–assisted LRIs followed by standard phacoemulsification and monofocal IOL implantation. The LRI parameters were calculated using a validated nomogram.

Postoperative Outcomes

Visual Acuity:

• OD: 0.7 cc +0.25 D sph −0.75 D cyl × 15° = 0.8
• OS: 0.8 cc +1.25 D cyl × 165° = 0.9–1.0

Keratometry (OS):

• R1 45.25 D × 2°
• R2 46.00 D × 171°
• Cylinder: −0.75 D × 171°

Postoperatively, corneal astigmatism in the left eye was reduced from 2.50 D to 0.75 D, with corresponding improvement in visual acuity.

Femtosecond laser–assisted limbal relaxing incisions represent a safe and predictable method for reducing corneal astigmatism when toric IOL implantation is not feasible. Careful preoperative diagnostics, appropriate nomogram selection, and thorough patient counseling are essential to minimize refractive surprises and achieve the intended refractive outcome.