Skip to main content Skip to main navigation menu Skip to site footer

Single and dual limbal relaxing incisions in correcting corneal astigmatism during cataract surgery

  • Annisa Ikhsaniah Ariffin ,
  • Muhammad Abrar Ismail ,
  • Hasnah Eka ,


Introduction: Correcting astigmatism during cataract surgery to achieve optimal visual outcomes is important. Various techniques, such as limbal relaxing incisions (LRIs), are used to correct astigmatism. LRIs are effective for mild to moderate astigmatism but have limitations in correcting larger astigmatism. This study aimed to review the effectiveness of single and dual LRI in correcting astigmatism during cataract surgery.

Methods: This literature review utilized databases from 2010 until 2022. The keywords “corneal astigmatism”, “limbal relaxing incision”, and “cataract surgery” were used to collect 12 journals that had relevant topics.

Results: LRIs are a form of partial-thickness keratotomy used to correct astigmatism during cataract surgery. The incisions for LRIs are made in the peripheral cornea, following a nomogram based on the patient's astigmatism, age, and the location of the steep axis of astigmatism. LRIs can be performed as single or dual incisions, with dual LRIs offering greater astigmatism correction. In the case of irregular astigmatism, LRIs can be adjusted to the topography of the cornea because the lengths of coupled incisions can vary.

Conclusion: The effectiveness between single and dual LRIs was the same, but paired LRIs have a superior effect in correcting greater astigmatism. LRIs remain a valuable tool for cataract surgeons to manage astigmatism and improve visual outcomes in cataract surgery patients.


  1. Ilyas S, Yulianti SR. Ilmu penyakit mata. 5th Ed. Jakarta: Fakultas Kedokteran Universitas Indonesia; 2018.
  2. Shankar S, Bobier WR. Corneal and lenticular components of total astigmatism in a preschool sample. Optom Vis Sci. 2004;81(7):536–42.
  3. Prasetyo K, Pasaribu U, Riyanto S, Hutauruk J. Vector Analysis of Anticipated Residual Astigmatism and Actual Residual Astigmatism in Toric IOL Implantation using Callisto-Eye. Ophthalmologica Indonesiana. 2019;43(1):87.
  4. Anderson DF, Dhariwal M, Bouchet C, Keith MS. Global prevalence and economic and humanistic burden of astigmatism in cataract patients: a systematic literature review. Clin Ophthalmol. 2018;12:439–52.
  5. Sigireddi RR, Weikert MP. How much astigmatism to treat in cataract surgery. Curr Opin Ophthalmol. 2020;31(1):10–4.
  6. Mingo-Botín D, Muñoz-Negrete FJ, Won Kim HR, Morcillo-Laiz R, Rebolleda G, Oblanca N. Comparison of toric intraocular lenses and peripheral corneal relaxing incisions to treat astigmatism during cataract surgery. J Cataract Refract Surg. 2010;36(10):1700–8.
  7. Freitas G de O, Boteon JE, Carvalho MJ, Pinto R de MC. Comparison of clinical outcomes between limbal relaxing incisions and toric intraocular lenses in eyes with astigmatic corneas. Rev Bras Oftalmol. 2014;73(1).
  8. Bhalla JS, Rani M, Gupta S. Evaluation of Opposite Clear Corneal Incision in Controlling Astigmatism in Cataract Patients Undergoing Phacoemulsification Surgery. Delhi Journal of Ophthalmology. 2016;26(4):241–5.
  9. Khokhar S, Lohiya P, Murugiesan V, Panda A. Corneal astigmatism correction with opposite clear corneal incisions or single clear corneal incision: comparative analysis. J Cataract Refract Surg. 2006;32(9):1432–7.
  10. Rubenstein JB, Raciti M. Approaches to corneal astigmatism in cataract surgery. Curr Opin Ophthalmol. 2013;24(1):30–4.
  11. Lake JC, Victor G, Clare G, Porfírio GJ, Kernohan A, Evans JR. Toric intraocular lens versus limbal relaxing incisions for corneal astigmatism after phacoemulsification. Cochrane Database Syst Rev. 2019;12(12):CD012801.
  12. Agarwal A, Jacob S. Current and effective advantages of femto phacoemulsification. Curr Opin Ophthalmol. 2017;28(1):49–57.
  13. Donnefeld N. LRI calculator [Internet]. Johnson and Johnson Surgical Vision. 2021. Available from:
  14. Abu-Ain MS, Al-latayfeh MM, Khan MI. Do limbal relaxing incisions during cataract surgery still have a role? BMC Ophthalmol. 2022;22(1):102.
  15. Taneri S, Braunstein R, Azar D. Radial and Astigmatic Keratotomy. In: Azar D, editor. Refractive surgery. Elsevier Inc; 2020. p. 356–68.
  16. Núñez MX, Henriquez MA, Escaf LJ, Ventura B V, Srur M, Newball L, et al. Consensus on the management of astigmatism in cataract surgery. Clin Ophthalmol. 2019;13:311–24.
  17. Mohammad-Rabei H, Mohammad-Rabei E, Espandar G, Javadi MA, Jafarinasab MR, Hashemian SJ, et al. Three Methods for Correction of Astigmatism during Phacoemulsification. J Ophthalmic Vis Res. 2016;11(2):162–7.
  18. Hirnschall N, Gangwani V, Crnej A, Koshy J, Maurino V, Findl O. Correction of moderate corneal astigmatism during cataract surgery: toric intraocular lens versus peripheral corneal relaxing incisions. J Cataract Refract Surg. 2014;40(3):354–61.
  19. Lee J, Lee H, Kang DSY, Choi JY, Kim EK, Kim TI. Comparison of Toric Foldable Iris-Fixated Phakic Intraocular Lens Implantation and Limbal Relaxing Incisions for Moderate-to-High Myopic Astigmatism. Yonsei Med J. 2016;57(6):1475–81.
  20. Gangwani V, Hirnschall N, Findl O, Maurino V. Multifocal toric intraocular lenses versus multifocal intraocular lenses combined with peripheral corneal relaxing incisions to correct moderate astigmatism. J Cataract Refract Surg. 2014;40(10):1625–32.
  21. Nanavaty MA, Bedi KK, Ali S, Holmes M, Rajak S. Toric Intraocular Lenses Versus Peripheral Corneal Relaxing Incisions for Astigmatism Between 0.75 and 2.5 Diopters During Cataract Surgery. Am J Ophthalmol. 2017;180:165–77.
  22. Kim DH, Wee WR, Lee JH, Kim MK. The short term effects of a single limbal relaxing incision combined with clear corneal incision. Korean J Ophthalmol. 2010;24(2):78–82.
  23. Brinton JP, Oetting TA. Phacoemulsification: Considerations for Astigmatism Management [Internet]. The University of Iowa, Department of Ophthalmology and Visual Sciences. 2011. Available from:
  24. Brar V. Basic and Clinical Science Course, Section 13: Refractive Surgery. In: 2020-2021 Basic and Clinical Science Course. American Academy of Ophthalmology; 2020.

How to Cite

Ariffin, A. I., Ismail, M. A., & Eka, H. (2023). Single and dual limbal relaxing incisions in correcting corneal astigmatism during cataract surgery. Bali Medical Journal, 13(1), 235–240.




Search Panel

Annisa Ikhsaniah Ariffin
Google Scholar
BMJ Journal

Muhammad Abrar Ismail
Google Scholar
BMJ Journal

Hasnah Eka
Google Scholar
BMJ Journal