Bilateral implantation of a supplementary intraocular pinhole.

PURPOSE: To evaluate the safety and efficacy of bilateral implantation of a supplementary small-aperture device to treat irregular corneal astigmatism. SETTING: Private practice. DESIGN: Retrospective consecutive case series. METHODS: Patients with bilateral irregular corneal astigmatism secondary to multiple causes and consented for implantation of the XtraFocus intraocular pinhole (IOPH) were enrolled. The mean follow-up was 27 months (range 5 to 66 months). Patients were assessed in their scheduled follow-up visits and monocular and binocular uncorrected and corrected distance and near visual acuities were recorded. Assessment of darkening vision complaints was also performed after implantation in the first eye and repeated after second-eye surgery. RESULTS: Thirty-two eyes of 16 patients were analyzed. The mean monocular and binocular uncorrected distance visual acuities improved from logMAR 1.091 ± 0.208 and 1.078 ± 0.259 preoperatively to 0.342 ± 0.091 (P < .001) and 0.342 ± 0.147 (P = .001) 1 year postoperatively. Three patients were excluded because of darkening vision complaints after surgery in the first eye. No major complications were noted after implantation of the IOPH. CONCLUSIONS: Bilateral implantation of the XtraFocus IOPH is a safe technique in a selected group of patients. There was improvement in visual acuity sustained over the analyzed period. Postoperative darkening vision complaints vary between individuals and can limit the application of this approach in certain patients.

Long-term safety of in-the-bag implantation of a supplementary intraocular pinhole.

PURPOSE: To evaluate the long-term effectiveness and safety of the XtraFocus intraocular pinhole (IOPH) when it is implanted inside the capsular bag. SETTING: Private practice. DESIGN: Retrospective consecutive case series. METHODS: Patients who had an IOPH implanted in the capsular bag together with the primary intraocular lens (IOL) to treat irregular corneal astigmatism secondary to multiple causes were enrolled. The mean follow-up was 16 months (range 7 to 48 months). Patients were assessed in their scheduled follow-up visits. The uncorrected and corrected distance visual acuities were recorded at each visit. An infrared slitlamp photograph was captured and analyzed to verify the presence of interlenticular membrane formation. RESULTS: Sixty eyes of 58 patients were analyzed. The mean uncorrected and corrected distance visual acuities improved from logarithm of the minimum angle of resolution 1.34 ± 0.338 and 0.57 ± 0.145 preoperatively to 0.14 ± 0.012 (P < .001) and 0.12 ± 0.008 (P = .001) at 1 year postoperatively, respectively. A mild pinhole decentration was noted in 5 eyes (8.3%). Interlenticular opacification (ILO) was not noted in any patient. CONCLUSIONS: Implantation of the XtraFocus IOPH inside the capsular bag was a safe technique. Improvement observed in both uncorrected and corrected distance visual acuities was significant and sustained over time. ILO did not occur when this implant was positioned in the capsular bag together with a primary IOL.

Toric intraocular lens combined with a supplementary pinhole implant to treat irregular corneal astigmatism.

A case of refractive lens exchange with the implantation of a supplementary intraocular pinhole (IOPH) to treat a challenging case of keratoconus is presented. Four months after the initial procedure, an intraocular lens (IOL) exchange (under the IOPH) was performed to a toric implant to correct the residual manifest astigmatism. This significantly improved both distance and near acuities and demonstrates how a toric IOL and astigmatism correction in combination with a pinhole device could be used to treat selected cases of keratoconus.

Intraocular pinhole implantation for irregular astigmatism after planned and unplanned posterior capsule opening during cataract surgery.

We present two cases for which intraocular pinhole implants were used to treat irregular corneal astigmatism after planned and unplanned posterior capsule opening during cataract surgery. The first case had a fibrotic posterior capsule that was eliminated with a posterior capsulorhexis. After that, the intraocular lens (IOL) and pinhole were implanted in the capsular bag. In the second case, a posterior capsule tear after phacoemulsification was converted to a posterior capsulorhexis, allowing implantation of an IOL in the capsular bag and the intraocular pinhole in the ciliary sulcus. With this method, irregular astigmatism in both cases could be managed with the intraocular pinhole very effectively. The implants remained stable and well centered in both cases and no complications were noticed.

Spherical aberration and contrast sensitivity in eyes implanted with aspheric and spherical intraocular lenses: a comparative study.

PURPOSE: To determine whether implantation of an intraocular lens (IOL) with a modified anterior aspheric surface results in reduced spherical aberration and improved contrast sensitivity after cataract surgery. DESIGN: Prospective, comparative, interventional case series. METHODS: In an intraindividual randomized prospective study of 25 patients with bilateral cataract, an IOL with a modified anterior surface (Tecnis Z9001; Advanced Medical Optics, Santa Ana, California, USA; group 1) was compared with biconvex lens with spherical surfaces (ClariFlex; Advanced Medical Optics; group 2). Ocular aberrations for a 5.0-mm pupil and 6.0-mm pupil were measured with Hartmann-Shack aberrometer. Quality of vision was measured by visual acuity and contrast sensitivity under mesopic and photopic conditions. All patients were followed up for three months. RESULTS: No statistically significant difference in postoperative uncorrected and best-corrected distance vision acuity after a follow-up of three months existed between the groups. Postoperative contrast sensitivity testing revealed significant differences between the groups under photopic and mesopic conditions. These differences reached statistical significance under photopic conditions at three spatial frequencies and under mesopic conditions at all spatial frequencies. When analyzing higher-order aberrations, the difference between the groups was statistically significant at the 5.00-mm and 6.00-mm pupil diameters, with the group 1 inducing less higher-order aberration and also less spherical aberration compared with group 2. CONCLUSIONS: Results show the Tecnis Z9001 IOL with a modified anterior aspheric surface induced significantly less higher-order aberration and spherical aberration compared with the ClariFlex IOL. Contrast sensitivity revealed better values under photopic and mesopic conditions with the Tecnis Z9001 IOL.

Phacoemulsification with intraocular pinhole implantation associated with Descemet membrane endothelial keratoplasty to treat failed full-thickness graft with dense cataract.

We present a case in which a different approach was used to treat an eye with dense cataract associated with an irregular failed full-thickness corneal graft. After cataract surgery, a foldable intraocular pinhole was implanted in the capsular bag to treat the irregular corneal astigmatism. Next, a Descemet membrane endothelial keratoplasty graft was used to improve transparency in the failed penetrating keratoplasty. This approach addressed the cataract, irregular cornea, and failed graft through a standard 2.2 mm clear corneal phacoemulsification incision, thus avoiding open-sky surgical time and expediting visual rehabilitation.

Ocular aberrations and contrast sensitivity after cataract surgery with AcrySof IQ intraocular lens implantation Clinical comparative study.

PURPOSE: To determine whether implantation of an intraocular lens (IOL) with a modified posterior aspherical surface (AcrySof IQ, Alcon Surgical Laboratories) results in reduced ocular aberrations (spherical aberration) and improved contrast sensitivity after cataract surgery. SETTING: Brasilia Ophthalmologic Hospital, Brasilia, and Sao Geraldo Eye Hospital, Federal University of Minas Gerais, Belo Horizonte, Brazil. METHODS: In an intraindividual randomized prospective study of 25 patients with bilateral cataract, an IOL with a modified posterior surface (AcrySof IQ) was compared with a biconvex IOL with spherical surfaces (AcrySof Natural, Alcon). Ocular aberrations with a 5.0 mm and 6.0 mm pupil were measured with a Hartmann-Shack aberrometer. Quality of vision was measured by visual acuity and contrast sensitivity under mesopic and photopic conditions. All patients were followed for 3 months. RESULTS: There were no statistically significant differences between eyes in postoperative uncorrected and best corrected distance visual acuities after a follow-up of 1 month and 3 months. Postoperatively, there was a statistically significant between-group difference in contrast sensitivity under photopic conditions without glare at 18 cycles per degree (cpd) (P = .04) and under mesopic conditions without glare at all spatial frequencies (3 cpd, 6 cpd, 12 cpd, and 18 cpd; P = .03, P = .009, P = .003, and P = .003, respectively) and with glare at 3 cpd and 6 cpd (P = .001 and P = .02, respectively). The difference in higher-order aberration (HOA) values between groups was statistically significant with a 5.0 mm and 6.0 mm pupil, with the AcrySof IQ IOL inducing less HOA than the AcrySof Natural IOL. Eyes with an AcrySof IQ IOL also had statistically significant less spherical aberration than eyes with an AcrySof Natural IOL with both pupil diameters (P<.001). CONCLUSIONS: The AcrySof IQ IOL with a modified posterior surface induced significantly less HOA and spherical aberration than the AcrySof Natural IOL. Contrast sensitivity was better under mesopic conditions with the AcrySof IQ IOL.

Outcomes of radiofrequency in advanced keratoconus.

PURPOSE: To evaluate the use of radiofrequency energy to correct advanced keratoconus. SETTING: Universidade Federal de Minas Gerais, Belo Horizonte, and Universidade de Ciências da Saúde de Alagoas, Maceió, Brazil. METHODS: In this prospective comparative study, radiofrequency was applied to 25 eyes of 21 consecutive patients. One group comprised patients with a K-reading between 54.0 diopters (D) and 58.0 D; 8 thermal spots were placed at the 4.0 mm optical zone. The other group comprised patients with a K-reading greater than 58.0 D; 16 spots were applied at the 4.0 mm and 5.0 mm optical zones. The minimum follow-up was 18 months in all patients. Differences between preoperative and postoperative uncorrected visual acuity, best spectacle-corrected visual acuity (BSCVA), manifest refraction, and K-readings were clinically and statistically evaluated. RESULTS: At end of the 18-month follow-up, the mean BSCVA in the 8-spot group improved from 20/100 (0.71+/-0.25 logMAR) preoperatively to 20/40 (0.32+/-0.11 logMAR) and in the 16-spot group, from 20/200 (1.03+/-0.30 logMAR) to 20/60 (0.62+/-0.22 logMAR). The mean manifest refractive spherical equivalent (MRSE) improved from -7.70 D+/-5.20 (SD) preoperatively to -6.82+/-4.41 D after 18 months in the 8-spot group and from -11.33+/-6.70 to -8.38+/-5.12 D, respectively, in the 16-spot group. The mean best contact lens-corrected visual acuity was 20/30 (0.18+/-0.24 logMAR) in the 8-spot group and 20/40 (0.31+/-0.19 logMAR) in the 16-spot group. A dense corneal scar was seen in 1 patient in the 16-spot group at the 6-month follow-up. CONCLUSIONS: Radiofrequency appeared safe for the treatment of advanced keratoconus. Contact lens fitting was stable in all cases.

Transient cataract and hypermetropization in diabetes mellitus: case report.

A 13-year-old male patient with a recent history of hyperglycemia developed an acute bilateral posterior subcapsular cataract, consisting of fine feathery streak-like opacities. On examination, his uncorrected visual acuity was 20/50 and J4 at near in both eyes. Under cycloplegia, a moderate hypermetropic refraction was noted in both eyes. He was diagnosed with acute posterior subcapsular cataract secondary to diabetes mellitus. Two weeks after resolution of the hyperglycemic state, the bilateral feathery streak-like posterior subcapsular opacities regressed completely, hypermetropic refraction decreased and uncorrected visual acuity improved to 20/20 and J1 in both eyes.

[Surgical correction of astigmatism during cataract surgery]. / Correção do astigmatismo na cirurgia da catarata.

PURPOSE: To evaluate the effect of peripheral limbar relaxing incisions (PLRI) in the reduction of the astigmatism during cataract surgery. METHODS: We studied prospectively 103 eyes of 103 patients submitted to PLRI, using the Nichamim nomogram during cataract surgery by phacoemulsification. After the first and sixth month we analized the changes in astigmatism topography, induction of astigmatism and success rate. The patients were divided into two groups according to the astigmatism (with-the-rule and against-the-rule), and studied separately. RESULTS: There was a statistically significant change in the mean astigmatism topography in the preoperative and postoperative periods in both groups. There was an induction of 1.10 +/- 0.9 D and 37% of success rate in the with-the-rule group and 1.70 +/- 0.80 D and 51% of success rate in the against-the-rule group after six months of follow-up. CONCLUSIONS: The peripherical relaxing limbal incisions (PLRI) are effective in reducing the preoperative astigmatism during cataract surgery. The procedure is safe and easy. The Nichamin nomogram caused hypocorrection in both types of preoperative astigmatism.

New pinhole sulcus implant for the correction of irregular corneal astigmatism.

PURPOSE: To evaluate the effect on visual acuity of the implantation of a new intraocular pinhole device (Xtrafocus) in cases of irregular corneal astigmatism with significant visual impairment. SETTING: University of São Paulo, São Paulo, Brazil. DESIGN: Prospective case series. METHODS: Pseudophakic eyes of patients with irregular corneal astigmatism were treated with the pinhole device. The causes of irregular corneal astigmatism were keratoconus, post radial keratotomy (RK), post-penetrating keratoplasty (PKP), and traumatic corneal laceration. The device was implanted in the ciliary sulcus in a piggyback configuration to minimize the effect of corneal aberrations. Preoperative and postoperative visual parameters were compared. The main outcome variables were manifest refraction, uncorrected and corrected distance and near visual acuities, subjective patient satisfaction, and intraoperative and postoperative adverse events and complications. RESULTS: Twenty-one patients (ages 35 to 85 years) were included. There was statistically significant improvement in uncorrected and corrected (CDVA) distance visual acuities. The median CDVA improved from 20/200 (range 20/800 to 20/60) preoperatively to 20/50 (range 20/200 to 20/20) in the first month postoperatively and remained stable over the following months. Manifest refraction remained unchanged, while a subjective visual performance questionnaire revealed perception of improvement in all the tested working distances. No major complication was observed. One case presented with decentration of the device, which required an additional surgical intervention. CONCLUSIONS: The intraocular pinhole device performed well in patients with irregular astigmatism caused by keratoconus, RK, PKP, and traumatic corneal laceration. There was marked improvement in visual function, with high patient satisfaction.

Keratorefractive approaches to achieving pseudoaccommodation.

Although presbyopia is ostensibly an age-related disease of the lens, ciliary body, and zonular apparatus, surgeons have nonetheless persevered in their attempts to create a solution to the problem of diminished near vision by performing keratorefractive procedures. This article discusses two approaches of varying technological sophistication, beginning with surgically induced astigmatism and continuing through enhanced monovision. Sometimes simple solutions are the best, and the technological innovation in cataract and refractive surgery has met with unrivalled success in the last three decades.

[Pellucid marginal degeneration: diagnosis and treatment]. / Degeneração marginal pelúcida da córnea: diagnóstico e tratamento.

Pellucid marginal degeneration is characterized by a progressive stromal thinning of the inferior corneal segment, between 4 and 8 o'clock, with a crescentic shape. The area of corneal thinning has a width of about 1 to 2 mm, and it is separated from the corneoscleral limbus by an area of normal corneal tissue. The initial treatment consists of optical correction. However, when the disease progresses to advanced stages, surgical procedures are necessary such as wedge resection, lamellar crescentic resection, penetrating keratoplasty, lamellar keratoplasty, epikeratoplasty and, recently, intracorneal segments.

[Tarsorrhaphy: applications in a Cornea Service]. / Tarsorrafia: aplicações em um Serviço de Córnea.

PURPOSE: To evaluate the main indications for tarsorrhaphy in a Corneal Service, as well as success rate and possible complications. METHODS: All patients who underwent tarsorrhaphy from January 1st, 2002 to December 30th, 2002, in São Geraldo Eye Hospital - Federal University of Minas Gerais were evaluated retrospectively. Reviewed data included patient's sex and age, indication for tarsorrhaphy, duration of signs and symptoms before tarsorrhaphy, time for epithelial healing after tarsorrhaphy, type of tarsorrhaphy, complications, follow-up time. RESULTS: Eighteen patients underwent tarsorrhaphy. The indications for a tarsorrhaphy were exposure keratopathy (27.8%), persistent epithelial defect associated with penetrating keratoplasty (38.8%), neurotrophic ulcer (11.1%), dry eye syndrome (5.6%), Stevens-Johnson syndrome (11.1%), and chemical burn (5.6%). The epithelial defect resolved completely in 15 patients (83.3%). Mean duration of signs and symptoms before tarsorrhaphy was 98.7+/-48.6 days, and time to heal after tarsorrhaphy was 53.2+/-22.8 days. Of the 18 procedures, two (11.1%) were temporary and 16 (88.9%) permanent. Complications after tarsorrhaphy were premature opening of the tarsorrhaphy, trichiasis and pyogenic granuloma. CONCLUSION: Tarsorrhaphy is a simple procedure, being also very safe and effective in the management of nonhealing epithelial defects, with a success rate of 83.3% and with minor complications.

Haptic-induced recurrent vitreous hemorrhage and increased intraocular pressure with a hydrophobic acrylic intraocular lens.

A 72-year-old white woman had phacoemulsification with implantation of a hydrophobic acrylic single-piece intraocular lens (IOL) (AcrySof SA60AT, Alcon) in the right eye. A few weeks after surgery, she reported episodes of blurred vision due to recurrent vitreous hemorrhage, which got worse over time. The increased intraocular pressure (IOP) noted after surgery was controlled with minimal topical treatment. The superior haptic of the hydrophobic acrylic IOL was displaced from the capsular bag over the anterior capsule. The displaced haptic was amputated 16 months after cataract surgery. The episodes of blurred vision vanished completely, and the IOP returned to normal levels without therapy.

Piggyback secundário com LIO de PMMA para correção de surpresa refracional pós-facoemulsificação: resultados a longo prazo de 20 casos / Secondary piggyback with PMMA IOL for the correction of refractive surprise after phacoemulsification. Long-term results of 20 cases

OBJETIVO: Avaliar os resultados a longo prazo da técnica do piggyback secundário utilizada para a correção de ametropia indesejável pós-facoemulsificação. MÉTODOS: Estudo retrospectivo que compreendeu 20 olhos (19 pacientes). A LIO utilizada foi de peça única de PMMA de 12,5 mm de comprimento total, com óptica oval de 5x6mm, com borda fina e arredondada e angulação de 10 graus com as hápticas. A mesma técnica cirúrgica foi utilizada em todos os casos, consistindo na confecção de túnel esclero-corneano com 5mm de largura, através do qual foi implantada a lente secundária no sulco ciliar. RESULTADOS: A ametropia indesejável foi corrigida em todos os casos. Não foi observado qualquer tipo de complicação durante ou após a cirurgia do piggyback secundário. CONCLUSÃO: A utilização de LIO de peça única de PMMA foi segura e eficaz no piggyback secundário para a correção das surpresas refracionais pós-facoemulsificação.

PURPOSE: To evaluate long-term results of the secondary piggyback technique used for the correction of undesired ametropia after phacoemulsification. METHODS: Retrospective study comprising of 20 eyes (19 patients). The IOL used was a single-piece PMMA with an overall length of 12.5mm, a 5x6mm oval thin-edged optic with a 10-degree haptic angulation. The same technique was used in all cases, consisting of a scleral-corneal tunnel with a 5mm opening, through which the secondary intraocular lens was implanted into the ciliary sulcus. RESULTS: The undesired ametropia was corrected in all cases. No complications were observed during or after the secondary piggyback procedure. CONCLUSION: The use of a single-piece PMMA IOL proved to be safe and effective in secondary piggyback for the correction of refractive surprises after phacoemulsification.

Melhora das papilas gigantes na cerato conjuntivite primaveril com o uso de medicamento homeopático: dois casos / Improvement of giant papillary vernal keratoconjunctivitis using homeopathic medicine: two cases

O tratamento convencional da hipertrofia papilar na ceratoconjuntivite primaveril pode associar-se a danos importantes, que podem ser suavizado pela homeopatia. Objetiva-se apresentar os resultados do tratamento homeopático de dois casos desta enfermidade. Avaliaram-se duas crianças masculinas com ceratoconjuntivite primaveril, úlcera em escudo unilateral e hipertrofia papilar gigante. Antes do início do tratamento homeopático foram suspensas todas as medicações convencionais tópicas e sistêmicas. O tratamento foi realizado através de uma única dose por via oral. Os pacientes evoluíram com melhora da úlcera de córnea em escudo e redução importante da hipertrofia papilar. O período de regressão foi de um ano e três meses no primeiro caso e de um ano e oito meses no segundo. Concluiu-se que a homeopatia pode contribuir para o tratamento da ceratoconjuntivite primaveril com úlcera de córnea em escudo e hipertrofia papilar e que novos estudos são necessários para melhor avaliar essa contribuição.

Conventional treatment of papillary hypertrophy in vernal keratoconjunctivitis may be associated with major damage, which might be attenuated by means of homeopatic treatment. We report the results of the treatment of two cases of this disease, two boys with vernal keratoconjunctivitis and unilateral shield ulcer and giant papillary hypertrophy. Before the onset of homeopathic treatment, all conventional topical and systemic medications were suspended. Homeopathic treatment was performed by single dose administered per oral route. Patients evolved with improvement of the corneal shield ulcer and significant decrease of papillary hypertrophy. The period of regression was one year and three months in the first case and one year and eight months in the second. We concluded that homeopathy can contribute to the treatment of vernal keratoconjunctivitis with corneal shield ulcers and papillary hypertrophy and that further studies are needed to better evaluate this contribution.

Transient cataract and hypermetropization in diabetes mellitus: case report

A 13-year-old male patient with a recent history of hyperglycemia developed an acute bilateral posterior subcapsular cataract, consisting of fine feathery streak-like opacities. On examination, his uncorrected visual acuity was 20/50 and J4 at near in both eyes. Under cycloplegia, a moderate hypermetropic refraction was noted in both eyes. He was diagnosed with acute posterior subcapsular cataract secondary to diabetes mellitus. Two weeks after resolution of the hyperglycemic state, the bilateral feathery streak-like posterior subcapsular opacities regressed completely, hypermetropic refraction decreased and uncorrected visual acuity improved to 20/20 and J1 in both eyes.

Paciente de 13 anos, com história recente de hiperglicemia, desenvolveu subitamente, catarata subcapsular posterior em ambos os olhos, consistindo de finas opacidades dispostas em forma de pena. A acuidade visual não corrigida era de 20/50 e de J4 para perto, em ambos os olhos. Sob cicloplegia, verificou-se em ambos os olhos uma moderada refração hipermetrópica. Foi, então, diagnosticado caso agudo de catarata subcapsular posterior secundária ao diabetes mellitus. Observou-se resolução total da opacidade subcapsular posterior em ambos os olhos duas semanas após regressão do quadro hiperglicêmico, assim como redução da refração hipermetrópica com melhoria da acuidade visual.

Correção do astigmatismo na cirurgia da catarata / Surgical correction of astigmatism during cataract surgery

OBJETIVOS: Avaliar a eficácia das incisões periféricas relaxantes limbares (IPRL) na redução do astigmatismo pré-operatório durante a cirurgia de catarata. MÉTODOS: Foram estudados prospectivamente 103 olhos de 103 pacientes submetidos as IPRL, utilizando o nomograna de Nichamin durante a cirurgia de catarata pela facoemulsificação. Após o 1° e 6° mês foram avaliadas as mudanças no astigmatismo topográfico, na indução do astigmatismo e no índice de sucesso. Os pacientes foram separados em dois grupos segundo o tipo de astigmatismo no pré-operatório (a favor da regra e contra a regra) e estudados separadamente. RESULTADOS: Ocorreram diferenças estatisticamente significativas entre os valores dos astigmatismos topográficos no pré e pós-operatório nos dois grupos. Verificou-se indução de 1,10 ± 0,9 dioptrias e 37 por cento de índice de sucesso no grupo de astigmatismo a favor da regra e 1,70 ± 0,80 dioptrias e 51 por cento de índice de sucesso no grupo de astigmatismo contra a regra após o 6° mês de seguimento. CONCLUSÃO: A incisão periférica relaxante limbar é efetiva na redução do astigmatismo pré-existente durante a cirurgia da catarata. O procedimento mostrou ser seguro e de fácil realização. O nomograma de Nichamim na nossa experiência hipocorrige o astigmatismo planejado em ambos os grupos estudados.

PURPOSE: To evaluate the effect of peripheral limbar relaxing incisions (PLRI) in the reduction of the astigmatism during cataract surgery. METHODS: We studied prospectively 103 eyes of 103 patients submitted to PLRI, using the Nichamim nomogram during cataract surgery by phacoemulsification. After the first and sixth month we analized the changes in astigmatism topography, induction of astigmatism and sucess rate. The patients were divided into two groups according to the astigmatism (with-the-rule and against-the-rule), and studied separately. RESULTS: There was a statistically significant change in the mean astigmatism topography in the preoperative and postoperative periods in both groups. There was an induction of 1.10 ± 0.9 D and 37 percent of sucess rate in the with-the-rule group and 1.70 ± 0.80 D and 51 percent of sucess rate in the against-the-rule group after six months of follow-up. CONCLUSIONS: The peripherical relaxing limbal incisions (PLRI) are effective in reducing the preoperative astigmatism during cataract surgery. The procedure is safe and easy. The Nichamin nomogram caused hypocorrection in both types of preoperative astigmatism.