Piggyback Intraocular Lens 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.

Reposition of dislocated piggyback intraocular lens in a patient with induced keratectasia after radial keratotomy

Aim – to substantiate low-traumatic sutureless surgery for piggyback intraocular lens (IOL) reposition as a method of choice in a patient after previous keratorefractive surgery and cataract phacoemulsification.
 The article provides the examination and surgical treatment data of one patient with piggyback intraocular lens dislocation after previous radial keratotomy and keratectasia.
 The presented clinical case shows that proper consideration of eye anatomical features allows for effective low-traumatic sutureless piggyback IOL reposition in patients who have previously undergone radial keratotomy, and may lead to sustainable high visual and functional results.

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.

Outcomes of a Toric Monofocal Piggyback Intraocular Lens for Residual Astigmatic Refractive Error in Pseudophakic Eyes

ABSTRACTPurpose/AimTo evaluate the visual outcomes, refractive outcomes and rotational stability of a toric piggyback intraocular lens (1stQ AddOn, GmbH, Mannheim, Germany) for astigmatic refractive error in pseudophakic eyes.Materials and MethodsVisual and refractive outcomes were assessed based on the standard graphs for reporting refractive surgery outcomes. Rotational stability was assessed according to the Intraocular Lens (IOL) standards of the International Organisation for Standards.ResultsTwenty-two eyes of 17 patients (age: 65.1 ± 9.3 years) underwent toric piggyback IOL insertion. After a minimum follow-up of 3 months, 18 eyes (82%) achieved an uncorrected distance visual acuity (UDVA) of 0.00 logMAR (20/20) or better and all eyes achieved 0.1 logMAR (20/25). Mean UDVA improved from 0.27 ± 0.03 to 0.12 ± 0.03 and 0.04 ± 0.04 at one and 3 months (all p < .05). Nineteen eyes (86%) achieved an UDVA at least equal to the pre-operative corrected distance visual acuity (CDVA). No eyes lost more than one line of CDVA. All eyes achieved within 0.5D of target spherical equivalent (SE). In 18 eyes (82%), the residual astigmatism magnitude was 0.5D or less. The mean absolute difference between the target axis and the achieved axis 1 and 3 months postoperatively was 2.5° ± 2.7° and 3.2° ± 3.3°, respectively. The final IOL orientation was within 10 degrees of target axis in 19 of 22 (86.4%) eyes, within 20 degrees in 21 of 22 (95.2%) eyes and within 30 degrees in 22 of 22 (100%) eyes. IOL rotational repositioning was required in two eyes (9.1%).ConclusionsIn this cohort of patients, the 1stQ AddOn toric monofocal piggyback IOL resulted in very good visual and refractive outcomes and showed reasonable rotational stability. This IOL appears to be an effective treatment option for residual astigmatic refractive error in pseudophakic eyes.

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.

Refractive enhancements for residual refractive error after cataract surgery.

Advances in cataract surgery have allowed surgeons to achieve superior refractive outcomes but have also led to higher patient expectations. Despite ever-evolving technology, residual refractive errors still occur. Postcataract refractive enhancements may be required to deliver satisfactory visual outcomes. This review aims to discuss the potential causes of residual refractive errors and the various enhancement modalities to correct them. A thorough preoperative workup to detect and address underlying pathologic causes of impaired vision should be performed prior to enhancement or corrective procedures. Corneal-based procedures are the safest and most accurate methods of correcting mild cases of residual refractive error. Hyperopic, high myopic, and high astigmatic errors are best managed with lens-based enhancements. Piggyback intraocular lenses (IOLs) are safer and more effective compared with IOL exchange. Toric IOL rotation and IOL exchange are ideally performed in the early postoperative period. A multitude of options exist for effective correction of residual refractive errors. The choice on how to best manage these patients depends on many factors such as the cause of refractive error, type of IOL used, ocular comorbidities, and patient preference.

Pseudophakic Dysphotopsia: Review of Incidence, Cause, and Treatment of Positive and Negative Dysphotopsia

We reviewed the literature concerning positive dysphotopsia (PD) and negative dysphotopsia (ND) regarding cause, incidence, and clinical and surgical management. In addition, we summarized our surgical experience in managing dysphotopsia. A PubMed review, limited to English language articles, yielded 149 citations; multifocal (diffractive optic) and phakic intraocular lens (IOL) dysphotopsia were excluded. Overall, 39 articles were determined to be relevant for the objectives of this investigation. Regarding PD, 7 articles corroborated that the cause of PD is related primarily to internal reflection of oblique light rays that strike the square (truncated) edge of the IOL and are reflected onto the retinal surface. No round-edged foldable IOLs are available in the United States at this time, although IOLs modified with a round anterior edge and square posterior edge show a trend toward decreased incidence of PD. High index of refraction (I/R), surface reflectivity, and IOL optic design are additional causative factors for PD. Regarding the authors' surgical experience, changing the optic material to have a lower I/R improved PD symptoms in the large majority of patients. The cause of ND seems to be multifactorial and less well understood, with some disparity between clinical and laboratory findings. Four articles that explore using ray-tracing optical modeling suggest an "illumination gap," in which some temporally incident light rays to the nasal retina pass anterior to the IOL and some are refracted posteriorly by the IOL, resulting in a gap and resultant temporal shadow. However clinically, ND is associated invariably with well-centered in-the-bag IOLs. Other implicating factors include nasal anterior capsule override, haptic orientation, large-angle κ value, and high hyperopia. Persistent ND has been treated successfully or reduced with reverse (anterior) optic capture, sulcus IOL placement, piggyback IOLs, and neodymium:yttrium-aluminum-garnet nasal capsulectomy. Two articles reference a new optic edge designed to capture the anterior capsulotomy, mimicking reverse optic capture. Persistent dysphotopsia after cataract surgery is a significant cause for patient dissatisfaction. The cause and management of both ND and PD are of significance, and new IOL designs and alternative surgical strategies may help to mitigate these unintended side effects of IOL implantation.

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.

Comparison between Refractive Outcome of Primary Piggyback Intraocular Lens versus Secondary Lens Iris Claw Lens in Posterior Microphthalmos.

Purpose To compare the refractive outcome of 2 different methods of intraocular lens implantation in cases of posterior microphthalmos, primary piggyback IOLs versus secondary iris claw lenses. Methods This study was a retrospective interventional comparative study that included 60 eyes of 30 patients. The included patients had bilateral microphthalmos with high axial hyperopia and had undergone a lens-based surgical procedure for hyperopia correction. The included patients were equally divided into two groups. The first group had undergone refractive lens exchange (RLE) with primary piggyback IOL implantation. The second group undergone RLE with maximum available IOL power implanted followed by a secondary implantation of Artisan iris-fixated IOL (Ophtec B.V., Groningen, the Netherlands). Results The 2 groups were highly comparable to each other regarding the mean age, axial length (AL), manifest refraction (MR), and K readings. Postoperatively, there was a statistically significant difference between the 2 groups regarding the manifest refraction spherical equivalent (MRSE), mean absolute error (MAE), and uncorrected distance visual acuity (UDVA). There was no significant difference between the 2 groups regarding the CDVA. At 36 months, 20% and 73% of the eyes were within ±0.5 D of intended refraction at 36 months in 1ry piggyback and 2ry Artisan groups, respectively. Fifty-three percent and 93% of the eyes were within ±1.0 D of intended refraction at 36 months in 1ry piggyback and 2ry Artisan groups, respectively (p=0.001). Conclusion Secondary procedure with implantation of iris-fixated intraocular lens yielded very good results for treatment of axial hyperopia in cases of posterior microphthalmos. The primary piggyback IOL showed less satisfactory results with cases of under correction and the possible complication of interlenticular opacification. Both groups showed good safety parameters.

Effect of a sulcus-fixated piggyback intraocular lens on negative dysphotopsia: Ray-tracing analysis

To use optical modeling to demonstrate how a sulcus-fixated piggyback intraocular lens (IOL) affects negative dysphotopsia. Mayo Clinic, Rochester, Minnesota, USA. Retrospective case series. Optical modeling was performed on 3 patients with negative dysphotopsia who were treated with a sulcus-fixated piggyback IOL. Ray-tracing software was used to simulate peripheral retina illumination preoperatively and postoperatively. Biometric data and ultrasound biomicroscopy images were used to construct eye models. Ray intensities were adjusted for surface reflections and normalized by cosine function to compensate for pupil obliquity at high incident angles. Preoperatively, retinal illumination profiles showed a region of dim or nonilluminated peripheral nasal retina at visual angles of approximately 83 to 95 degrees. A piggyback IOL shifted the iris anteriorly (mean 0.41mm; range 0.37 to 0.47mm) and the primary IOL posteriorly (mean 0.10mm; range 0.05 to 0.19mm) and increased the mean distance between the iris and primary IOL from 0.46mm preoperatively to 0.75mm postoperatively. This increased distance allowed input rays to begin missing the primary IOL at lower incident angles (≥76 degrees) compared with preoperatively (≥84 degrees), resulting in increased illumination of the peripheral retina. Illumination of the peripheral retina, including the preoperative dark area, was increased in 2 patients. The negative dysphotopsia shadow resolved in 2 eyes and was unchanged in 1 eye. In negative dysphotopsia patients, a secondary piggyback IOL allowed additional light to miss the primary IOL and illuminate larger areas of peripheral retina. Increased illumination of the peripheral retina that included the preoperative dark region was associated with improved negative dysphotopsia postoperatively.

The IOL didn't last: indications and tips for IOL removal, repositioning, and exchange

Pediatric cataract surgeons hope that intraocular lenses (IOLs), once implanted, will meet the refractive needs of the patient and stay well centered and optically clear for many years. However, the IOLs we've counted on lasting a lifetime may opacify, decenter, or become an optical hindrance. Additionally, as the age of primary implantation shrunk, the number of severe myopes from overpowered IOLs in our practices has dramatically expanded. Lastly, piggyback IOL implantation strategies include a planned removal of one of the IOLs after the eye has grown. For all these reasons, the frequency of IOL removal, repositioning, and exchange has meaningfully increased in our practices. A discussion of the indications, challenges, options and tips for such IOL re-operations is warranted.

Primary sulcus implantation of a diffractive multifocal pseudophakic piggyback intraocular lens

To evaluate the efficacy and safety of the combined implantation of a monofocal intraocular lens (IOL) in the capsular bag with a diffractive multifocal IOL designed for sulcus placement (Reverso). Purpan Hospital, Toulouse, and Helios Clinic, Saint-Jean-de-Luz, France. Prospective case series. The multifocal IOL piggyback IOL was implanted in the sulcus during cataract surgery. Visual acuity, defocus curve, contrast sensitivity, IOL positioning, and patient satisfaction were assessed with 1-year follow-ups. Fifty-four eyes of 27 patients were included. At 1-month, monocular uncorrected distance (UDVA) and near (UNVA) visual acuities were 0.13 logarithm of the minimum angle of resolution (logMAR)±0.18 (SD) and 0.20±0.16 logMAR, respectively. Binocular UDVA and UNVA were 0.03±0.06 and 0.12±0.08 logMAR, respectively. At 1year, the mean monocular logMAR UDVA, corrected distance visual acuity, UNVA, and corrected near visual acuity were 0.10±0.11, 0.02±0.06, 0.18±0.12, and 0.13±0.08, respectively. The defocus curve and contrast sensitivity values were comparable to those obtained with other multifocal IOLs. On Scheimpflug imaging, the mean distance between the sulcus multifocal IOL and the monofocal IOL was 517±141μm. At 1year, ultrasound biomicroscopy showed an annular fibrosis of the anterior capsule in 94.4% of the eyes. Complications included 1 posttraumatic IOL decentration and 1 slight corectopia. Eighty-nine percent of patients reported satisfaction. The piggyback implantation of this multifocal IOL seemed to be safe and effective. It might provide similar resultsas a primary in-the-bag multifocal IOL, with the advantage of reversibility that might extend primary or secondary implantation.

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.

Infectious crystalline keratopathy after Descemet’s stripping endothelial keratoplasty

A 68-year-old woman presented with infectious crystalline keratopathy 4 months after she underwent a combined phacoemulsification and Descemet’s stripping endothelial keratoplasty for Fuch’s endothelial dystrophy in her left eye. After...

Prevention and correction of residual refractive errors after cataract surgery

Cataract surgery today has become more of a refractive surgery with high patient expectations and demand for independence from glasses. With advances in biometry, precise intraocular lens (IOL) power calculation is the most important step in achieving desired target refraction. Noncontact optical biometry has become the gold standard worldwide with a few exceptions where contact ultrasound biometry still needs to be performed. Although there is no single formula for IOL power calculation suitable for all eyes, our understanding of which formulae to use in specific situations is much better. Despite advances in biometry and cataract surgery techniques, unsatisfactory visual and refractive outcomes occur occasionally. Enhancement after cataract surgery is required in these cases. The common methods to treat such cases are corneal-based laser refractive surgery or lens-based procedures such as piggyback IOL and lens exchange.

Sulcoflex Piggyback Intraocular Lens Implantation For Correction Of Refractive Errors Following Cataract Surgery

Purpose: To investigate the visual and refractive outcomes following implantation of a Sulcoflex intraocular lens (IOL) to correct pseudophakic refractive error.&#x0D; Methods: This retrospective chart review included 14 pseudophakic eyes of 13 patients who underwent implantation of a Sulcoflex IOL. The Sulcoflex IOL is a piggyback IOL technique where a secondary, supplementary lens is implanted in the ciliary sulcus.&#x0D; Results: Eleven eyes (78.6%) had a postoperative SE within 0.50 D of the targeted SE. Preoperative UDVA was 20/30 in 4 eyes (28.6%), and 20/40 or worse in 10 eyes (71.4%). Postoperative UDVA was 20/30 or better in all eyes, where half (50.0%) of eyes were 20/20 or better. The mean preoperative logMAR (0.50 ± 0.33) significantly improved to 0.06 ± 0.09, p&lt;.01. There were no complications.&#x0D; Conclusions. The significant improvement in UDVA and the precision in reaching the target refraction suggest that the Sulcoflex is a viable and successful treatment option for pseudophakic refractive error.