Limbal Relaxing Incisions: A Practical Guide

For both surgeon and patient alike, the success of modern implant surgery is increasingly judged by the refractive and astigmatic outcome. In spite of this, there has not yet been a practical book that addresses the process of performing limbal relaxing incisions (LRIs). Dr. Louis D. “Skip” Nichamin and his contributors aim to fill this void with Limbal Relaxing Incisions: A Practical Guide.

Limbal Relaxing Incisions serves as a guide for novice refractive implant surgeons looking to incorporate incisional astigmatism surgery into their repertoire. It also contains practical pearls that the more experienced practitioner can use to refine astigmatic refractive outcomes following lens-based surgery.

Limbal Relaxing Incisions covers a wide range of information from the history, background, and future of astigmatism management, to important subjects such as measuring cylinder and strategic planning for the surgical correction of astigmatism. Dr. Nichamin and his contributors detail their personal approaches to the use of LRIs, each presenting a slightly different technique and providing simple clinical pearls for both the novice and experienced practitioner. In addition, the book offers a discussion on astigmatic enhancement surgery, potential complications, and insight into the emerging field of Femto-Second Laser technology to further refine and automate astigmatism correction.

Residents in ophthalmology, comprehensive ophthalmologists, refractive cataract surgeons, and keratorefractive surgeons taking up lens-based refractive surgery will appreciate the “this is how I do it” approach in Limbal Relaxing Incisions: A Practical Guide, as well as the emphasis on clinical pearls, written by some of the most experienced refractive cataract surgeons in the field.

Dedication
Acknowledgments
About the Editor
About the Associate Editor
Contributing Authors
Preface
Introduction


Chapter 1 History, Background, and Future of Incisional Astigmatic Surgery
Section 1 The Foundation and Future of Astigmatic Keratotomy
Spencer P. Thornton, MD, FACS
Section 2 Limbal Relaxing Incisions: History, Current State of the Art, and Future
Richard L. Lindstrom, MD; Molly McDonald, OD; and David R. Hardten, MD
Chapter 2 Measuring Astigmatism: Planning Surgery and Tracking Results
Noel A. Alpins, MD, FACS and George Stamatelatos, OD
Chapter 3 Overview for the Use of Limbal Relaxing Incisions
Louis D. “Skip” Nichamin, MD
Chapter 4 This Is How I Do It
Section 1 Limbal Relaxing Incisions to Correct Astigmatism
James P. Gills, MD and Pit Gills, MD
Section 2 How I Perform Limbal Relaxing Incisions
Richard S. Hoffman, MD
Section 3 Astigmatism Correction With Peripheral Corneal Relaxing Incision
Douglas D. Koch, MD and Christian C. Hester, MD
Section 4 My Approach to Limbal Relaxing Incisions
Randall J. Olson, MD
Section 5 My Guide to Peripheral Corneal Relaxing Incisions
Jonathan B. Rubenstein, MD
Section 6 Astigmatism in Three Dimensions
R. Bruce Wallace III, MD
Chapter 5 Enhancement of Patients With Prior Limbal Relaxing Incisions
David R. Hardten, MD and Molly McDonald, OD
Chapter 6 Limbal Relaxing Incision Complications
Parag D. Parekh, MD, MPA
Chapter 7 Femtosecond Laser Limbal Relaxing Incisions
Eric D. Donnenfeld, MD; Allon Barsam, MD, MA, FRCOphth; and An Vo, MD

Financial Disclosures
Index

“This is a high quality book that will help surgeons beginning to perform limbal relaxing incisions learn how to do the technique or experience surgeons how to fine tune their technique.”

- Elizabeth C. Chiang, MD, PhD, Northwestern University Feinberg School of Medicine, Doody’s Review Service

Louis D. “Skip” Nichamin, MD is the Medical Director and Managing Partner of the Laurel Eye
Clinic in Brookville, Pennsylvania, one of the leading private ophthalmic practices in the country.
After graduating from the University of Michigan in Ann Arbor, Michigan and Wayne State
University School of Medicine in Detroit, Michigan with high distinction and recognition, including
membership in the Alpha Omega Alpha Honor Society, he completed his ophthalmic residency
at the Sinai Hospital of Detroit in Michigan where he was awarded the H. Saul Sugar award for his
outstanding performance.

Dr. Nichamin has since been the recipient of numerous awards, lectured extensively around the
world, and authored hundreds of articles and chapters in the fields of cataract and refractive surgery.
His broad surgical experience numbers in the tens of thousands of surgical cases and includes
posterior, as well as anterior, segment procedures.

Dr. Nichamin has been a representative for the American Academy of Ophthalmology Board
of Councilors and served as the Chairman of the Cataract Clinical Committee of the American
Society of Cataract and Refractive Surgery. He holds a board position on the ASCRS Philanthropic
Foundation. Dr. Nichamin is a committee member of the American Academy of Ophthalmology
Preferred Practice Patterns and founding member of the American College of Ophthalmic
Surgery. He has been awarded the Senior Achievement and Secretariat Awards by the American
Academy of Ophthalmology. He is an active consultant in the ophthalmic industry and serves on
numerous medical advisory boards.