Peripheral Corneal Relaxing Incisions Correct Post-Cataract Residual Astigmatism

Peripheral corneal relaxing incisions correct residual astigmatism post-cataract surgery.

Peripheral corneal relaxing incisions (PCRI) created after cataract surgery can effectively correct residual astigmatism, a study published in the Journal of Cataract and Refractive Surgery found. The technique had previously been found to effectively correct postoperative residual astigmatism following refractive surgery and has also been used prior to cataract surgery.

Researchers included 111 eyes of 6 patients (mean age, 70±8 years) who underwent cataract surgery at Baylor College of Medicine between 2014 and 2022 in the study. The subset of patients who were dissatisfied with their uncorrected distance VA, had a refractive cylinder of 0.5 diopter (D) or greater, and underwent peripheral corneal relaxing incisions at least 4 months post-cataract surgery were evaluated for the change in visual acuity and refractive astigmatism before and after receiving PCRI.

Participants received an intraocular lens (IOL) with a power of 19±4 D, and the time between peripheral corneal relaxing incisions and postoperative refraction ranged from 1 to 12 months.

Significant improvements to uncorrected VA (mean, 0.22 vs 0.10 logMAR; P <.05), refractive cylinder (mean, 1.10 vs 0.30 D; P <.05), and centroid value (mean, 0.34 D @ 166° vs 0.10 D @ 156°; P <.05) were observed from before and after the creation of peripheral corneal relaxing incisions, respectively. In addition, best-corrected visual acuity changed from 0.01 to -0.01 logMAR and spherical equivalent from -0.19 to -0.18 D, respectively.

PCRI incision length is the main factor manipulated in controlling the degree of astigmatic correction.

Among the entire group, 48 eyes had oblique, 48 had against-the-rule (ATR), and 15 had with-the-rule (WTR) refractive astigmatism. The correction for oblique and ATR eyes were 2 incisions at 35° for eyes with a 0.75 to 1.00 D astigmatism, 1 incision at 40° for asymptomatic eyes, and 2 incisions at 40° for eyes with a 1.01 to 1.25 D astigmatism. For the WTR group, eyes with 0.75 to 1.00 D astigmatism received 2 PCRIs at 45° or 35°, and eyes with 1.01 to 1.50 D astigmatism received 2 PCRIs at 50° or 45°.

Stratified by refractive astigmatism, 79% of the oblique eyes, 63% of the ATR eyes, and 80% of the WTR eyes achieved an astigmatism of 0.50 diopters or less post-PCRI.

The researchers report that peripheral corneal relaxing incisions significantly improved [uncorrected] visual acuities and decreased refractive astigmatism. “PCRI incision length is the main factor manipulated in controlling the degree of astigmatic correction,” the researchers report.

This study was limited by its short follow-up duration. Additional study is needed to evaluate long-term outcomes.

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.


Wang L, Koch DD. Outcomes of peripheral corneal relaxing incisions for residual astigmatism in patients after cataract surgery. J Cataract Refract Surg. Published online April 24, 2023. doi:10.1097/j.jcrs.0000000000001208