Secondary piggyback intraocular lens for posterior microphthalmos

Abstract

We describe a rare case of posterior microphthalmos (PM) submitted to cataract surgery and highlight the problem of high residual hyperopia in these eyes due to the limited commercial availability of a high-powered intraocular lens (IOL). A 50-year-old highly hyperopic man who pretended refractive surgery presented in our hospital. Pre-operative Snellen best-corrected visual acuity (BCVA) was 20/125 in the right eye with a spherical correction of +17.00 D and 20/40 in the left eye with a spherical correction of +18.75. The anterior segment and fundus exam were typical for PM. Optical axial length was 15.50 mm in the right eye and 15.53 mm in the left eye and anterior segment dimensions were within normal limits. IOL power calculation for emmetropia ranged between +51.5 and +62.5 D using modern IOL formulas. Cataract surgery was performed in a bilateral and sequential manner with the implantation of monofocal foldable acrylic +45.0 D IOL with the improvement of spherical correction to +11.00 D bilaterally. Secondary implantation of supplementary sulcus IOL with the maximum +10.0 D power was then performed bilaterally and sequentially with a final BCVA of 20/125 in the right eye with spherical correction of +5.75 D and 20/40 in the left eye with spherical correction of +5.25 D. Piggyback IOL implantation is beneficial and, in most times, necessary in PM since one IOL will not be sufficient to achieve emmetropia. Different piggyback strategies in regard to timing (primary vs. secondary) and chosen IOLs (in-the-bag, sulcus, and iris-claw) can be used.