UT Southwestern Medical Center at Dallas Department of Ophthalmology

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UT Southwestern Medical Center at
DallasDepartment of Ophthalmology
OUTCOMES OF LIMBAL RELAXING INCISIONS
WITH RESTOR IMPLANTATION
Claire Y. Chu, Orkun Muftuoglu, V. Vinod
Mootha, Steven M. Verity, R. Wayne Bowman, H.
Dwight Cavanagh, James P. McCulley
Drs. Bowman, Verity, and McCulley receive
consultant reimbursement from Alcon.Dr.
Cavanaugh receives research reimbursements from
Ciba and Menion.None of the authors have
financial interest in the subject matter of this
poster.
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INTRODUCTION

• Multifocal IOLs were introduced to provide
  spectacle free distance and near vision.
• Early models offered limited near correction
  and/or were often associated with glare and halos
• This phenomenon is especially apparent with
  increased corneal astigmatism
• Recent models are reported to provide better near
  correction with less unwanted visual phenomena.
• ReStor AcrySof apodized diffractive IOL (Alcon
  Laboratories Inc., Fort Worth, Texas)
• Good biocompatibility with high refractive index
• The diffractive steps gradually reduce in height
  and spacing from the lens center to the edge
• Add power of 4.0 Diopters (D)

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Purpose

• To evaluate visual and refractive outcomes of LRI
  for the correction of cylindrical errors after
  (Restor) multifocal IOL implantation.

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METHODS

• Retrospective IRB approved study at UT
  Southwestern Medical Center
• 322 eyes of 176 consecutive patients underwent
  phacoemulsification surgery with AcrySof Restor
  SN60D3 implantation between December 2005 and
  June 2008 at the University of Texas Southwestern
  Medical Center.
• 57 eyes of 34 patients who had Limbal Relaxing
  Incision concurrently with Restor IOL
  implantation were included in the study
• Preoperative, postoperative month 1, 6, and final
  visit refraction and keratometry , requirement
  for Lasik
• Limbal relaxing incisions
• Corneal pachymetry performed preoperatively
• Length and number of incisions determined based
  upon the Gills and Gayton nomogram
• 600 mm or 650 mm incisions created for corneas lt
  625 mm and gt650 mm respectively
• Statistical analysis
• The vectorial method proposed by Thibos and
  Horner was used to convert any spherocylindrical
  refractive error S (sphere), C (cylinder) x f
  (axis) into a set of 3 dioptric powers SE, J0,
  J45, using the following formulas
• SE (spherical equivalent) S C/2 J0 (-C/2)
  cos (2f) J45 (-C/2) sin (2f)

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REFRACTIVE STABILITY
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CYLINDER STABILITY (VECTORS)
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VISUAL STABILITY
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UCVA
100
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UCNVA
10
CONCURRENT UCVA / UCNVA
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Results and Conclusions

• 22 (38) eyes of 13 (39) patients underwent
  LASIK enhancement
• 19 (33) eyes of 15 pts underwent NdYAG Laser
  capsulotomy
• 13 eyes of 10 pts in LRILASIK group
• 6 eyes of 5 pts in only LRI group
• 19 (33) eyes of 13 patients developed dry eye
• 10 eyes of 8 pts developed mild, 1 eye of 1 pt
  developed moderate dry eye in the LRI group
• 7 eyes of 4 pts develope mild, 1 eye of 1 pt
  developed moderate dry eye in the LRILASIK group

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Conclusions

• LRI is an effective and safe procedure for
  concurrent astigmatic correction with Restor
  SN60D3 implantation
• Astigmatic correction with LRI maintains
  stability as measured by cylinder vectors and
  visual acuity
• Best results are achieved with lt1.00 D cylinder
• Despite LRIs effectiveness, about 1/3 of pts
  required LASIK enhancement, particularly for
  gt1.00 D of residual astigmatism
• LRI seems to be associated with postoperative dry
  eye, therefore vigorous preoperative screening
  may be important