Corneal rim release dissection for astigmatism

       With the advent of the era of refractive IOL surgery, cataract surgery has shifted from traditional rejuvenation surgery to modern refractive cataract surgery. Despite significant developments in surgical methods, biometry, and IOL calculation formulas, corneal astigmatism remains an important factor in residual refractive error after cataract surgery. Approximately 15-20% of general population cataract patients have a combined greater than 1.5D, astigmatism. It is commonly believed that even an astigmatism of only 0.75D can cause patients to feel blurred vision, double vision, and halos, affecting naked eye vision and visual function; at the same time, it affects the effect of refractive IOL implantation such as multifocal and aspheric. Therefore, successful correction of preoperative corneal astigmatism has become a necessary requirement for modern cataract surgery. In order to obtain good postoperative naked eye vision, preoperative astigmatism should be reduced to a minimum. Zhang Jian, Ophthalmology Department, Xuanwu Hospital, Capital Medical University Astigmatism refers to the refraction of parallel light through the eye, which is not a focal point, but two focal lines and the smallest dispersion circle between focal lines at different locations in space. The purpose of astigmatism correction is to shorten the distance between the two focal lines and eventually become a focal point. It is generally accepted that astigmatism in the eye is a combined effect caused by changes in multiple factors. These include: inconsistent surface curvature of the refractive surface, inconsistent curvature of the retinal surface, inconsistent refractive index of the refractive element, and optical center deviation. Among these influencing factors, corneal astigmatism has the greatest impact on visual quality. There are many surgical methods to correct corneal astigmatism, which include choosing the location of the cataract incision, corneal release incision, corneal limbal release incision, excimer laser keratomileusis, and complex curved IOL implantation.       Limbal relaxing incisions (LRIs), or Peripheral corneal relaxing incisions (PCRIs), are single or paired relaxing incisions performed on the steepest corneal astigmatism axis within the vascular arch of the limbus and outside the central cornea. Non-penetrating incisions were first proposed by Dutch ophthalmologist L.J. Lans in 1898 to correct astigmatism by placing a non-penetrating incision at the corneal limbus. LRIs are effective for low, moderate and even high astigmatism, and can be seen by corneal topography to be more effective than corneal release incisions and arcuate keratotomy, rarely causes overcorrection, especially in low astigmatism, and rarely causes corneal distortion and irregularity. Patients recover their vision quickly after surgery and are less likely to experience glare and discomfort.       Compared with other methods of astigmatism correction, such as TORIC toric toric IOL implantation and LASIK surgery, LRIs have the advantages of relatively simple operation, low incidence of postoperative astigmatic axis shift, and low cost. They can also be performed as a method of correcting astigmatism in a healthy population.