Piggyback Intraocular Lens Implantation Research Articles

Secondary Piggyback Intraocular Lens for Correcting Refractive Surprise Post Silicone Oil Removal

Introduction : Pseudophakic refractive error can be caused by IOL malposition and inaccurate biometric examination. Treatment consists of IOL exchange, refractive laser correction, and secondary piggyback IOL. Secondary Piggyback IOL consist of customized IOL implantation on ciliary sulcus.
 Case Illustration : A Male, 62 years old, complains of blurry right eye. He underwent retinal surgery with silicone oil tamponade surgery 5 years ago and underwent silicone oil evacuation, phacoemulsification, and intraocular lens implantation one year later. The visual acuity of the right eye was 1/60 with BCVA of 0.2. He was diagnosed with Pseudophakia of both eyes and Hypermetropia Surprise of the right eye. He was planned to undergo piggyback intraocular lens implantation in the right eye (Figure 1). The visual acuity one week after operation of the patient's right eye was 0.32 (Figure 2).
 Discussion : Biometric examination in eye with silicon oil tamponade have longer axial length, causing pseudophakic refractive errors. Treatments consist of IOL replacement, refractive laser correction, and piggyback IOL implantation. IOL replacement has a high risk and requires quite high operator skills. Refractive laser correction is performed in small refractive errors. Piggyback IOL implantationis easier, safer, have more accurate IOL power, and reversible.
 Conclusion : Power of the intraocular lens is influenced by axial length, keratometry reading, lens thickness, and other parameters. Axial length measurement in patients with silicone oil tamponade requires greater accuracy to prevent pseudophakic refractive errors. IOL Piggyback implantation procedure is an alternative in person that can’t undergo laser correction or IOL exchange.

Application of Femtosecond Laser + Piggyback Multifocal Intraocular Lens Implantation in Patients with Super-High Myopia Complicated with Cataract

ABSTRACT Objective To observe the clinical effect of piggyback multifocal intraocular lens (IOL) implantation in treating patients with high myopia complicated with cataract. Methods This was a prospective controlled study. We compared 32 eyes of 32 patients who underwent femtosecond laser-assisted cataract surgery with piggyback IOL implantation (two IOLs were implanted into the capsule) with 32 eyes of 32 patients who also underwent the same surgery (one IOL implanted into the capsule) due to high myopia complicated with cataract at the Wuhan Aier Eye Expert Hospital between January 2019 and October 2020. All patients were followed up for three months after surgery. Uncorrected distance visual acuity (UCDVA), uncorrected intermediate visual acuity (UCIVA), uncorrected near visual acuity (UCNVA), best-corrected distance visual acuity, distance-corrected intermediate visual acuity (DCIVA), distance-corrected near visual acuity (DCNVA), postoperative spectacle independence, postoperative visual interference, equivalent spherical lens, defocus curve, and IOL tilt and eccentricity were evaluated. Results Three months after surgery, the patients’ UCIVA, UCNVA, DCIVA, and DCNVA were 0.49 ± 0.07, 0.38 ± 0.15, 0.47 ± 0.09, and 0.36 ± 0.12, respectively, in the research group and 0.56 ± 0.18, 0.72 ± 0.22, 0.55 ± 0.13, and 0.69 ± 0.15, respectively, in the control group; the differences between the two groups were statistically significant (P < .05). The spectacle independence rate was higher in the research group (93%) than in the control group (13%). The overall satisfaction regarding postoperative visual quality was also higher in the research group than in the control group. The absolute mean value of the spherical equivalents was 0.48 ± 0.28 D in the research group and 0.62 ± 0.33 D in the control group; the difference between the two groups was statistically significant (P < .05). Conclusion Piggyback multifocal IOL implantation can expand the multifocal IOL application range, and satisfy the desire of patients with high myopia complicated with cataract to see both near and far.

Secondary piggyback intraocular lens for posterior microphthalmos

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.

Clinical Outcomes of Piggybacking a One-Piece IOL With a Three-Piece IOL in Eyes With Nanophthalmos

To compare the nanophthalmic eyes in which a three-piece intraocular lens (IOL) along with a one-piece IOL and two one-piece IOLs were used for piggyback IOL implantation into the capsular bag. This retrospective comparative case series included 61 eyes of 31 patients. Group 1 consisted of 31 eyes of 16 patients who underwent piggyback implantation of a one-piece IOL along with a three-piece IOL into the capsular bag. Group 2 consisted of 30 eyes of 15 patients who underwent piggyback implantation of two one-piece IOLs into the capsular bag. IOL spherical power was determined by calculating the arithmetic mean of the Holladay 1 formula and Hoffer Q formula, targeting emmetropia. Main outcomes were postoperative visual acuity and refraction, IOL centration and tilt, and complications. The mean postoperative follow-up time was 15.6 ± 5.2 months in Group 1 and 14.8 ± 4.3 months in Group 2 (P = .51). There was no significant difference between the two groups in terms of preoperative and postoperative spherical equivalent (P = .52 and .42, respectively). Twenty-six eyes (83.8%) in Group 1 and 26 eyes (86.60%) in Group 2 were within ±1.50 D of emmetropia. Mean IOL decentration was significantly lower in Group 1 (0.03 ± 0.08 mm) than Group 2 (0.14 ± 0.18 mm) (P = .003). The mean IOL tilt was 1.45 ± 2.94 degrees in Group 1 and 4.00 ± 4.23 degrees in Group 2 (P = .008). Piggyback implantation of a three-piece IOL combined with a one-piece IOL provides less IOL decentration and tilt in patients with nanophthalmos. The use of the arithmetic mean of the Holladay 1 and Hoffer Q formulas for IOL power calculation provides more accurate results. [J Refract Surg. 2022;38(12):812-818.].

Phacoemulsification with double-in-bag intraocular lens implantation in nanophthalmic eyes with angle-closure glaucoma.

To report the outcomes of phacoemulsification with piggyback intraocular lens (IOL) implantation, with double-in-bag IOLs in the management of angle-closure glaucoma (ACG) in nanophthalmic eyes. This is a retrospective case series on nanophthalmic eyes with variable presentations of ACG. Phacoemulsification with double-in-bag IOL implantation was done for the included eyes. Baseline and follow-up corrected distance visual acuity (CDVA), spherical equivalent (SE), intraocular pressure (IOP), and the number of glaucoma medications were evaluated. Surgical details were extracted, and complications were recorded. Six eyes of three patients were included. The mean axial length was 17.24 ± 1.02mm. The mean preoperative IOP was 20 ± 2.7mmHg with medical treatment. The mean preoperative CDVA (logMar) was 0.83 ± 0.37 with mean SE 12.7 ± 1.77 diopters. The mean postoperative IOP at 3-month and 1-year follow-ups was 14 ± 5.3mmHg and 15.5 ± 4.1mmHg, respectively. Postoperative CDVA was 0.78 ± 0.41, with mean SE -0.04 ± 2 diopters. No significant intraoperative or postoperative complications were reported. One eye developed posterior capsule opacification (PCO), and another eye developed visually insignificant inter-lenticular opacification (ILO). In the evaluated nanophthalmic eyes with ACG, lens extraction with double-in-bag IOL implantation showed promising results regarding the IOP control as well as the visual and refractive outcomes.

Secondary Piggyback Intraocular Lens for Management of Residual Ametropia after Cataract Surgery

PurposeTo investigate the indications, clinical outcomes, and complications of secondary piggyback intraocular lens (IOL) implantation for correcting residual refractive error after cataract surgery.MethodsIn this prospective interventional case series, patients who had residual refractive error after cataract surgery and were candidates for secondary piggyback IOL implantation between June 2015 and September 2018 were included. All eyes underwent secondary IOL implantation with the piggyback technique in the ciliary sulcus. The types of IOLs included Sulcoflex and three-piece foldable acrylic lenses. Patients were followed-up for at least one year.ResultsEleven patients were included. Seven patients had hyperopic ametropia, and four patients had residual myopia after cataract surgery. The preoperative mean of absolute residual refractive error was 7.20 7.92, which reached 0.42 1.26 postoperatively (P 0.001). The postoperative spherical equivalent was within 1 diopter of target refraction in all patients. The average preoperative uncorrected distance visual acuity was 1.13 0.35 LogMAR, which significantly improved to 0.41 0.24 LogMAR postoperatively (P = 0.008). There were no intra- or postoperative complications during the 22.4 9.5 months of follow-up.ConclusionSecondary piggyback IOL implantation is an effective and safe technique for the correction of residual ametropia following cataract surgery. Three-piece IOLs can be safely placed as secondary piggyback IOLs in situations where specifically designed IOLs are not available.

Safety of piggyback intraocular lenses (polypseudophakia) in children: long-term outcomes of a 15-year, single-surgeon study

To report the outcomes of piggyback (PB) intraocular lens (IOL) implantation, or temporary polypseudophakia, in children who have undergone cataract surgery and to assess their safety in pediatric patients. The medical records of consecutive patients who underwent PB IOL implantation at a single institution over a period of 15years were reviewed retrospectively. Outcome measures were reoperation rate, complications, and outcome of planned explantation. A total of 48 eyes of 38 children received PB IOL implantation: 40 eyes at the time of cataract surgery and 8 eyes as a later secondary procedure. Of these, 38 eyes of 31 patients with primary PB IOL implantation had follow-up of >3years and were included in the present analysis. Median age at cataract surgery with PB IOL implantation was 6.5months (0.5months to 2.4years). Median follow-up was 12.5years (range, 3.0-20.7). Four eyes required reoperation for adverse events related to PB IOL implantation (1 each for IOL tilt, pupillary capture, pupillary block glaucoma, and pupillary membrane). All 4 of these eyes were operated for cataract before 3months of age. The sulcus-fixated PB IOL underwent a planned explantation in 33/38 eyes. Eight eyes needed intraocular pressure-lowering topical medications. Planned PB IOL explantation was uncomplicated in our series. Early complications occurred in 4 eyes, but late complications were not noted, and glaucoma developed at predictable rates for this population. Piggyback IOL placement in our cohort of young children appears to have an acceptable safety profile.

Three-piece add-on posterior chamber intraocular lens implantation for the correction of symptomatic pseudophakic ametropia: a retrospective study

Purpose To evaluate the implantation of secondary low-power sulcus piggyback posterior chamber intraocular lenses (PCIOLs) for the correction of unaccepted postoperative refractive surprises or anisometropia.Patients and methods We retrospectively reviewed 17 cases with uncomplicated cataract extraction using phacoemulsification with in-the-bag PCIOL implantation and undesired residual postoperative refractive error. Patients underwent secondary piggyback intraocular lens implantation with add-on monofocal SECURA-sPB through a 3.2-mm clear corneal incision. The primary outcome measure was uncorrected distance visual acuity. Moreover, we evaluated intraoperative or postoperative complications.Results The mean age of patients was 65.2±10.1 years. The mean time to piggyback lens insertion was 6.5±3.1 months, and the mean follow-up period was 14.4±4.6 months. The mean preoperative uncorrected distance visual acuity was 20/80, and it increased significantly to be 20/30 postoperatively (P<0.001). The mean preoperative cylinder was 1.30±0.70 D, and it decreased significantly to be 0.54±0.45 postoperatively (P<0.001). The mean preoperative spherical deviation from emmetropia was 3.4±0.73 D, and the postoperative arithmetic prediction error mean was −0.32±0.55 D. No major intraoperative or postoperative complications were recorded.Conclusion Low-power add-on sulcus PCIOLs provided safe and effective refractive results in pseudophakic patients with refractive surprises.

Refractive lens exchange and piggyback intraocular lens implantation in nanophthalmos: Visual and structural outcomes

To evaluate the best piggyback intraocular lens (IOL) implantation method and the outcomes in nanophthalmos eyes and to define the postoperative structural changes. Farabi Eye Hospital, Tehran, Iran. Prospective case series. Candidates for refractive surgery who were nanophthalmic were recruited. Patients had refractive lens exchange followed by implantation of both IOLs in the bag or 1 IOL in the bag and 1 IOL in the sulcus. The baseline and follow-up visual acuity, refractive status, and structural Scheimpflug imaging were evaluated. Ultrasound biomicroscopy (UBM) was performed 6months postoperatively. The study comprised 9 nanophthalmic patients (18 eyes) with a mean preoperative uncorrected distance visual acuity (UDVA) of 1.53 logarithm of the minimum angle of resolution (logMAR)±0.3 (SD), mean corrected distance visual acuity (CDVA) of 0.34±0.2 logMAR, and mean spherical equivalent (SE) of +13.55±4.0 diopters (D). The mean postoperative UDVA improved from baseline. There was no significant difference in the mean UDVA and CDVA between the 2 IOL groups. Postoperatively, both groups had a significant improvement in SE, a significant rise in anterior chamber depth and angle, and similar UBM measurements. Piggyback IOL implantation was an effective refractive procedure in nanophthalmic eyes. Both implantation methods resulted in similar outcomes; however, the small number of patients in each group made it less likely that possible differences would be found. The increase in angle values might help prevent the development of closed-angle glaucoma.

Visual Outcomes and Complications of Piggyback Intraocular Lens Implantation Compared to Aphakia for Infantile Cataract.

Purpose:To evaluate the long-term visual outcomes and complications of the piggyback intraocular lens (IOL) implantation compared to aphakia for infantile cataract.Patients and Methods:In a comparative study from 1998 to 2007, piggyback IOL implantation (piggyback IOL group) was performed for 14 infants (23 eyes) with infantile cataract and 20 infants (32 eyes) who were aphakic (aphakia group) after infantile cataract surgery. Data were collected on logMAR visual acuity, and postoperative complications over a mean follow-up time of 6.2 ± 1.7 years and 5.8 ± 1.7 years.Results:The mean age at surgery was 7.5 ± 0.6 months and 6.0 ± 3.3 months for the piggyback and the aphakic group respectively (P > 0.05). At the last follow-up visit, visual acuity was 0.85 ± 0.73 (median = 0.70, interquartile range = 0.3–1.32) in the piggyback IOL group and 0.89 ± 0.56 (median = 0.86, interquartile range = 0.50–1.24) in the aphakic group (P > 0.05). There was a positive relationship between age and visual outcomes in the aphakic group (r = 0.4, P = 0.04) but not in the piggyback IOL group (P = 0.48). There was no significant difference between the mean myopic shift in the piggyback IOL group (∑5.28 ± 1.06 D) and the aphakic group (∑5.10 ± 1.02 D) (P > 0.05). The incidence of reoperation due to complications in piggyback IOL group was higher than aphakic group (%48 vs. %16, respectively, P ≤ 0.01). However, in patients older than 6 months, this risk was not significantly different compared to the aphakic group.Conclusions:Although piggyback IOL implantation for infantile cataract is optically acceptable as a treatment option, there is no significant difference in visual outcomes compared to aphakia. The incidence in reoperation due to complications in patients aged 6 months or younger is higher than those treated with aphakia.

Piggyback Intraocular Lens Implantation to Correct Pseudophakic Refractive Error After Segmental Multifocal Intraocular Lens Implantation

To evaluate refractive and visual outcomes of secondary piggyback intraocular lens implantation in patients diagnosed as having residual ametropia following segmental multifocal lens implantation. Data of 80 pseudophakic eyes with ametropia that underwent Sulcoflex aspheric 653L intraocular lens implantation (Rayner Intraocular Lenses Ltd., East Sussex, United Kingdom) to correct residual refractive error were analyzed. All eyes previously had in-the-bag zonal refractive multifocal intraocular lens implantation (Lentis Mplus MF30, models LS-312 and LS-313; Oculentis GmbH, Berlin, Germany) and required residual refractive error correction. Outcome measurements included uncorrected distance visual acuity, corrected distance visual acuity, uncorrected near visual acuity, distance-corrected near visual acuity, manifest refraction, and complications. One-year data are presented in this study. The mean spherical equivalent ranged from -1.75 to +3.25 diopters (D) preoperatively (mean: +0.58 ± 1.15 D) and reduced to -1.25 to +0.50 D (mean: -0.14 ± 0.28 D; P < .01). Postoperatively, 93.8% of eyes were within ±0.50 D and 98.8% were within ±1.00 D of emmetropia. The mean uncorrected distance visual acuity improved significantly from 0.28 ± 0.16 to 0.01 ± 0.10 logMAR and 78.8% of eyes achieved 6/6 (Snellen 20/20) or better postoperatively. The mean uncorrected near visual acuity changed from 0.43 ± 0.28 to 0.19 ± 0.15 logMAR. There was no significant change in corrected distance visual acuity or distance-corrected near visual acuity. No serious intraoperative or postoperative complications requiring secondary intraocular lens removal occurred. Sulcoflex lenses proved to be a predictable and safe option for correcting residual refractive error in patients diagnosed as having pseudophakia.

Long-term results of clear lens extraction combined with piggyback intraocular lens implantation to correct high hyperopia.

To assess the refractive outcome of clear lensectomy combined with piggyback intraocular lens implantation in highly hyperopic patients. This case review included 19 eyes of 10 patients with high hyperopia and axial length less than 21mm. Intraocular lens power was calculated for emmetropia using the Holladay II formula in 17 eyes, and SRK/T formula in 2 eyes following clear lens extraction and piggyback intraocular lens implantation. Patients were examined periodically over 24 months for visual acuity and spherical equivalent (SE). The mean postoperative SE at 24 months was 0.20±1.39D (range, -3.00 to 2.50D), better than preoperative 9.81±2.62D (range, +6.00 to +14.50D) (P<0.001). Five eyes had SE within ±0.5D of emmetropia and 11 eyes within ±1.00D at postoperative 24 months. The mean postoperative uncorrected visual acuity (UCVA) at 24 months was 0.60±0.36, significantly improved compared to preoperative 1.39±0.33 (P<0.001). The mean best-corrected visual acuity (BCVA) at 24 months was 0.49±0.35, not statistically different compared to preoperative 0.38±0.30 (P=0.34). Twelve eyes maintained and 1 gained 1 or more Snellen line of BCVA, 4 eyes lost 1 line, and 2 eyes lost 2 lines at 24 postoperative months. Twelve eyes best-corrected near visual acuity (BCNVA) achieved J1 at postoperative 24 months compared to preoperative 7 eyes and the other 7 eyes better than J3. Clear lens extraction combined piggyback intraocular lens implantation appears to be an effective procedure to correct high hyperopia but mild overcorrection and intralenticular opacification may require secondary procedure.

Intraocular Lens Power Calculations in a Patient with Posterior Keratoconus

We describe a patient with posterior keratoconus accompanied by hyperopia and a cataract, which were successfully treated by cataract surgery and secondary piggyback intraocular lens (IOL) implantation. Case report. A 47-year-old woman presented to our clinic with low vision in her right eye. Uncorrected distant visual acuity was 20/400 in the right eye with a manifest refraction of +11.5 diopters. On the slit-lamp examination, localized posterior keratoconus and lens opacity were noted in the right eye. First, we performed phacoemulsification and posterior chamber IOL implantation. Postoperatively, hyperopic shift was noted because localized posterior elevation of the cornea is not considered in the conventional IOL power calculation. After secondary piggyback IOL implantation in the sulcus, her refractive error was finally properly corrected and uncorrected distant visual acuity improved to 20/50. In patients with posterior keratoconus, IOL power calculation from conventional keratometry may be inaccurate, and secondary piggyback IOL procedure may be needed after cataract surgery.

Refractive Changes after Removal of Anterior IOLs in Temporary Piggyback IOL Implantation for Congenital Cataracts

PurposeTo assess the refractive change and prediction error after temporary intraocular lens (IOL) removal in temporary polypseudophakic eyes using IOL power calculation formulas and Gills' formula.MethodsFour consecutive patients (7 eyes) who underwent temporary IOL explantation were enrolled. Postoperative refractions calculated using IOL power calculation formulas (SRK-II, SRK-T, Hoffer-Q, Holladay, and the modified Gills' formula for residual myopia and residual hyperopia) were compared to the manifest spherical equivalents checked at 1 month postoperatively.ResultsThe mean ages of temporary piggyback IOL implantation and IOL removal were 6.71 ± 3.68 months (range, 3 to 12 months) and 51.14 ± 18.38 months (range, 29 to 74 months), respectively. The average refractive error was -13.11 ± 3.10 diopters (D) just before IOL removal, and improved to -1.99 ± 1.04 D after surgery. SRK-T showed the best prediction error of 1.17 ± 1.00 D. The modified Gills' formula for myopia yielded a relatively good result of 1.47 ± 1.27 D, with only the variable being axial length.ConclusionsFormulas to predict refractive change after temporary IOL removal in pediatric polypseudophakia were not as accurate as those used for single IOL implantation in adult eyes. Nonetheless, this study will be helpful in predicting postoperative refraction after temporary IOL removal.

Pseudophakic negative dysphotopsia: Surgical management and new theory of etiology

To evaluate the benefit of various surgical methods to address pseudophakic negative dysphotopsia. Private practice, Los Angeles, California, USA. Interventional case series. The following 4 surgical methods were used to treat negative dysphotopsia: secondary piggyback intraocular lens (IOL) implantation, reverse optic capture, in-the-bag IOL exchange, and iris suture fixation. Ultrasound biomicroscopy (UBM) was used to analyze posterior chamber anatomy. The primary outcome was partial or complete resolution of the negative dysphotopsia symptoms 3 months postoperatively. Twelve eyes of 11 patients with negative dysphotopsia had surgical treatment. All 10 patients who had piggyback IOL implantation or reverse optic capture had partial or complete resolution of symptoms by 3 months. No patient who had in-the-bag IOL exchange (n = 3) or iris suture fixation of the capsular bag-IOL complex (n = 1) improved despite alteration of IOL material or edge design in the case of IOL exchange or UBM confirmation of posterior chamber collapse in the case of iris suture fixation of the capsular bag-IOL complex. Consistent with a new hypothesis, resolution of negative dysphotopsia symptoms depended on IOL coverage of the anterior capsule edge rather than on collapse of the posterior chamber alone. Furthermore, negative dysphotopsia was not attributed to a particular IOL material or edge design. .

Astigmatism management at the time of cataract surgery

Patients expect their vision to improve after cataract surgery and, increasingly, they expect to be free of the encumbrance of glasses and contact lenses. These expectations are driven by technological advancements throughout the ophthalmic industry and the experiences of family and friends. To meet or exceed patient expectations, cataract surgeons must pay increasing attention to the management of pre-existing corneal astigmatism at the time of cataract surgery. Pre-existing corneal astigmatism is a significant component of preoperative ametropia. To achieve satisfactory postoperative refractive results, it is important to correct pre-existing spherical errors by accurate biometry and intraocular lens (IOL) power calculation, and to manage preoperative corneal cylinder errors by a suitable method. Guided by preoperative corneal topography, patients with varying degrees of corneal astigmatism can be placed into a variety of dioptric categories. These categories dictate a systematic ‘stepladder’ approach to guide the optimum approach to surgical correction. For patients with less than 1 D of corneal astigmatism, the preferred approach is to place the phacoemulsification incision on the steep corneal meridian. For 1–3 D of corneal astigmatism, single or paired peripheral corneal-relaxing incisions may be used. Alternately, for astigmatic errors of 1–4 D, toric IOLs can be implanted. Astigmatism of 4.5–7 D may be addressed using a combined approach of toric IOL implantation and peripheral corneal relaxing incision placement in the steep meridian of corneal cylinder. Moreover, high-powered toric IOLs, currently available in select European and Asian markets and not currently approved by the US FDA, may be implanted in the USA if an ophthalmologist obtains a compassionate use exemption from the FDA and local Institutional Review Board approval. If visually significant refractive errors are present after cataract surgery, surgical management options include piggyback IOL implantation, IOL exchange, toric IOL rotation, photorefractive keratectomy and laser-assisted in situ keratomileusis. Of these options, photorefractive keratectomy and laser-assisted in situ keratomileusis usually provide the most simple solution to manage suboptimal refractive outcomes. This simple stepladder approach to astigmatism management, which is based on preoperative corneal topography, enables cataract surgeons to achieve excellent unaided visual acuity in the absence of vision-limiting ocular comorbidities.

Evaluation of anterior segment parameter changes using the Pentacam after uneventful phacoemulsification

This study set out to evaluate the influences of uneventful phacoemulsification on the anterior segment parameters obtained with the Pentacam rotating Scheimpflug camera and intraocular pressure (IOP). A total of 42 eyes of 34 patients (26 men, eight women) were evaluated preoperatively, and at 1, 3 and 6 months postoperatively with the Pentacam. Intraocular pressure was measured with the Goldmann applanation tonometer. The non-parametric paired t-test was used to compare preoperative and 1-, 3- and 6-month postoperative measurements of anterior chamber depth (ACD), anterior chamber volume (ACV), anterior chamber angle (ACA) width, central corneal thickness (CCT), the central 3-, 5- and 7-mm corneal volume (CV), pupil size, and IOP. Pearson's correlation test was used to evaluate the relationships between IOP and ACD, ACV and ACA width. The differences between ACD, ACV, ACA and IOP values taken preoperatively and those taken postoperatively at 1, 3 and 6 months were statistically significant (p<0.05). The differences between CCT, central 3-, 5- and 7-mm CV, and pupil size measurements taken preoperatively and those taken postoperatively at 1, 3 and 6 months were not statistically significant (p>0.05). The decrease in IOP was not correlated with the changes in ACD, ACV and ACA (p>0.05). Uneventful phacoemulsification significantly reduced IOP, increased ACD and ACV, and widened the ACA. However, alterations in CV, CCT and pupil size values were not statistically significant. Alterations in ACD, ACV, ACA and IOP remain stable after the first month of surgery.

Piggyback intraocular lens implant to correct severe refractive error after penetrating keratoplasty in pseudophakes

This letter describes two cases in which severe refractive error after penetrating keratoplasty (PK) in pseudophakes was corrected with piggyback intraocular lens (IOL) implantation. A 65-year-old woman had bilateral phacoemulsification...

Angle-Closure Glaucoma after Piggyback Intraocular Lens Implantation

To report a case of angle closure glaucoma after piggyback intraocular lens implantation and its treatment. The authors present the case of a 75-year-old woman who was seen in the emergency department with angle closure glaucoma. Two years before she had undergone piggyback intraocular lens (IOL) implantation in order to correct a refractive error after cataract surgery. Ultrasound biomicroscopy revealed a closed angle with synechiae in 360 degrees as well as the presence of two IOLs: one in the capsular bag and the other in the ciliary sulcus. Extraction of the anterior IOL was precluded due to the poor endothelial count. Peripheral iridotomy and trabeculectomy were ineffective to lower the intraocular pressure (IOP); the authors decided to implant with an Ahmed valve and to place the valve's tube between the two IOLs to protect the endothelium. After Ahmed valve implantation, IOP maintains stable around 10-12 mmHg without medical treatment. Ahmed valve implantation is a good option in angle closure glaucoma due to piggyback. The placement of the valve's tube between the two IOLs is a good option to protect corneal endothelium.

Refractive enhancement following presbyopia-correcting intraocular lens implantation

Presbyopia-correcting intraocular lenses are widely available. Residual ametropia is one of the most common issues that can result in patient dissatisfaction. Options for correcting refractive surprises include piggyback intraocular lens implantation, corneal incisional surgery and laser correction. Excimer laser surgery is a safe and predictable method to correct residual amounts of ametropia in pseudophakic patients with monofocal intraocular lenses; however, there is scant published literature regarding this technique. Presbyopia-correcting intraocular lenses require emmetropia for the best visual outcome, as small amounts of astigmatism or residual refractive errors can limit their visual performance. Laser-assisted in-situ keratomileusis and photorefractive keratectomy are safe and effective results in pseudophakic patients. Surgeons can refine the refractive outcome after intraocular lens implantation with the excimer laser to achieve better results and higher patient satisfaction. Excimer laser corneal surgery for fine-tuning residual ametropia after presbyopia-correcting intraocular lenses is a safe adjunct treatment to increase patient satisfaction. Which technique (photorefractive keratectomy or laser-assisted in-situ keratomileusis) to use depends on surgeon preference and patient characteristics, as both demonstrate similar results in published literature. Knowledge of all available refractive methods and technologies are crucial for improving outcomes in these patients.