Piggyback IOL Research Articles

Filling the refractive gap: The piggyback way

Corneal surface irregularities can severely affect preoperative biometry and IOL power calculation, especially in cases where combined keratoplasty and IOL implantation are planned. We report a patient with stage 3 Fuchs endothelial dystrophy who underwent a successful Descemet’s stripping endothelial keratoplasty (DSEK) triple procedure but suffered a hyperopic refractive surprise due to erroneous preoperative biometry and IOL power calculation. Six months later, we corrected the residual refractive error with a secondary piggyback IOL, a Rayner Sulcoflex aspheric IOL. Uncorrected vision improved from 5/60 to 6/9 and vision was maintained with a clear DSEK graft at 5 years follow-up. Preoperative biometric difficulties can be an important cause of postoperative refractive surprise in patients undergoing endothelial keratoplasty-triple procedures. Customized sulcus fixated IOL can be a safe and predictable option for treating such surprises. To our knowledge, ours is the first report of implantation of a piggyback IOL in an eye following DSEK.

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.

Clinical outcomes of the piggyback secondary implantation of a novel multifocal lens in the ciliary sulcus: A case series.

Evaluate the clinical outcomes of the secondary piggyback add-on IOL implantation in the ciliary sulcus for pseudophakic patients previously implanted with a monofocal IOL, who pursue a spectacle-free option after IOL surgery. A prospective case series including seven pseudophakic patients who underwent an in-the-bag monofocal IOL implantation. All eyes underwent a piggyback IOL implantation of the new sulcus designed A4 AddOn IOL in the ciliary sulcus as a secondary procedure for pseudophakic patients pursuing a spectacle-free option for near and intermediate distance after IOL surgery. Seven eyes from six patients were included in this study, from which 4 (71.43%) were female, with a mean age of 58.33 ± 3.5 years (range 54-63; 95% CI 54.66, 62.01). The postoperative spherical equivalent at the 3-month visit was -0.10 m ± 0.82. Also, the UDVA was 0.11 ± 0.08 logMAR, the UIVA 0.01 ± 0.03, and the UNVA 0.01 ± 0.03 3 months after their surgical procedure. The A4 AddOn multifocal IOL's secondary piggyback implant is an efficient alternative for monofocal pseudophakic patients seeking presbyopia solutions. This sulcus-designed IOL provides an optimal visual outcome for near and distance vision.

Эффективность LASIK и имплантации добавочных интраокулярных линз как методов докоррекции остаточных аметропий на псевдофакичных глазах

Эффективность LASIK и имплантации добавочных интраокулярных линз как методов докоррекции остаточных аметропий на псевдофакичных глазах

Are piggyback IOLs recommendable for children?

Are piggyback IOLs recommendable for children?

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.

Dysphotopsia: a multifaceted optic phenomenon.

To summarize the literature on dysphotopsia, focusing on strategies for management and prevention. Clinical studies and ray-tracing diagrams have improved our understanding of the risk factors for positive and negative dysphotopsiae. Well known management and prevention strategies such as piggyback IOL, reverse optic capture, Nd:YAG capsulotomy, and IOL exchange are reviewed, as well as newer strategies such as the infertemporal approach to IOL implantation, 'in-the-bag nasal optic truncation' and new IOL design implantation, and new IOL design. Positive and negative dysphotopsiae are known to occur in a number of patients after cataract surgery. Although studying dysphotopsiae has provided many challenges given its subjective patient experience and its multifactorial cause, these same challenges have generated new theories and ideas regarding dysphotopsiae. A better understanding of the available methods for treatment and prevention can improve management of dysphotopsiae and patient satisfaction.

Piggyback IOL implantation: indication, surgical techniques and complications

Piggyback IOL implantation: indication, surgical techniques and complications

Ocular growth after primary piggyback IOL implantation

Ocular growth after primary piggyback IOL implantation

Pearls for Piggyback IOL Implantation

Today’s cataract patients expect refractive results near emmetropia and relative independence from spectacles. The surgeon therefore needs to be skilled at multiple surgical methods for correcting residual ametropia after the cataract procedure. One useful method is to implant a piggyback IOL in the ciliary sulcus over the existing lens implant. In this issue we discuss the indications, contraindications, surgical technique, and complications involved with piggyback IOL implantation procedure. Piggyback technique of IOL Implantation was first described by Gayton and Sanders in 1993, this technique was initially developed to correct high hyperopic errors and as a secondary procedure to correct postoperative refractive errors. Implanting a second IOL in the posterior chamber is a relatively easy and atraumatic procedure that is not associated with the risk of potential complications seen with IOL exchange. Additionally, the accuracy of IOL power calculation is theoretically higher than in IOL exchange. Piggybacking with PMMA, silicone, or acrylic IOLs has been successful in myopic, hyperopic, and overcorrected pseudophakic patients. With the original IOL placed in the capsular bag, the piggyback IOL is traditionally placed in the sulcus in a brief procedure that takes just few minutes. Calculating the piggyback IOL power can be done quite accurately with the Holladay vergence formula. It is also easily estimated based upon the patient’s refraction. For myopic refractions, multiply the spherical equivalent by 1.2 to determine the piggyback IOL power. For hyperopic refractions, multiply the spherical equivalent by 1.5 to determine the piggyback IOL power. It is important to use an appropriate IOL for piggyback placement; these are three-piece IOLs that are made of hydrophobic acrylic, silicone or collamer material. Note that single-piece hydrophobic acrylic IOLs should not be placed into the sulcus because they may induce uveitis- glaucoma-hyphema syndrome.

Secondary piggyback implantation versus IOL exchange for symptomatic pseudophakic residual ametropia

To evaluate the safety and efficacy of implanting a secondary IOL in comparison with IOL exchange to correct residual spherical refractive error after cataract surgery. This prospective case series included 23 pseudophakic eyes of 23 patients. They were divided into two groups: group I included 12 eyes for whom secondary piggyback IOL implantation in the ciliary sulcus was done, and group II included 11 eyes for whom IOL exchange was done. The mean follow up was 18 ± 4.2months and 20 ± 3.6months in groups I and II respectively. The visual and refractive outcomes were evaluated, and any intraoperative or postoperative complications was recorded. The mean spherical equivalent in group I (secondary piggyback implantation), was reduced from -6.2 ± 2.2 diopters preoperatively to -0.28 ± 0.59D postoperatively in myopic eyes and from 4.79 ± 1.02D to 0.03 ± 0.74D in hyperopic eyes. Ninety-two percent of eyes were within ±0.5D of intended correction. In group II (IOL exchange), the mean SE was reduced from -5.88 ± 3.1D preoperatively to 0.16 ± 1.09 D postoperatively in myopic eyes and from 5.05 ± 0.93D preoperatively to 0.11 ± 0.69D postoperatively in hyperopic eyes. Eighty-two percent of eyes had postoperative SE within ± 0.5D of the intended correction. UCVA improved significantly in both groups. Rupture of the posterior capsule occurred in one eye in group II. Only one eye in group II lost one line of BCVA. Secondary piggyback implantation in the ciliary sulcus is an effective, safe, and easy treatment for a pseudophakic ametropia.

Analysis and applications of accommodative lenses for vision corrections

Analysis and applications of vision correction via accommodating intraocular lens (AIOL) are presented. By Gaussian optics, analytic formulas for the accommodation rate function (M) for two-optics and three-optics systems are derived and compared with the exact numerical results. In a single-optics AIOL, typical value of M is (0.5-1.5) D∕mm, for an IOL power of (10-20) diopter. For a given IOL power, higher M is achieved in positive-IOL than negative-IOL. In the dual-optics AIOL, maximum accommodation is predicted when the front positive-optics moves toward the corneal plan and the back negative-optics moves backward. Our analytic formulas predict that greater accommodative rate may be achieved by using a positive-powered front optics, a general feature when either front or back optics is mobile. The M function is used to find the piggy-back IOL power for customized design based on the individual ocular parameters. Many of the new features demonstrated in this study can be easily realized by our analytic formulas, but not by raytracing method.

Laser in situ keratomileusis versus lens-based surgery for correcting residual refractive error after cataract surgery

To evaluate and compare the efficacy and safety of laser in situ keratomileusis (LASIK) versus lens-based surgery (intraocular lens [IOL] exchange or piggyback IOL) for correcting residual refractive error after cataract surgery. Private eye center, Salt Lake City, Utah, USA. This retrospective study included 57 eyes of 48 patients who had LASIK (28 eyes) or lens-based correction (29 eyes) for residual refractive error after cataract surgery. The visual and refractive outcomes were evaluated at a mean follow-up of 20 to 24 months. In the LASIK group, the mean spherical equivalent (SE) was reduced from -1.62 +/- 0.80 diopters (D) preoperatively to +0.05 +/- 0.38 D postoperatively in myopic eyes and from +0.51 +/- 1.25 D to +0.19 +/- 0.35 D in hyperopic eyes. Ninety-two percent of eyes were within +/-0.50 D of intended correction. In the lens group, the mean SE was reduced from -3.55 +/- 2.69 D preoperatively to -0.20 +/- 0.50 D postoperatively in myopic eyes and from +2.07 +/- 2.38 D to +0.07 +/- 0.85 D in hyperopic eyes. Eighty-one percent of eyes had postoperative SE within +/-0.50 D of the intended correction. The UCVA improved significantly in both groups. No eye lost more than 1 line of BSCVA. With a similar length of follow-up, no significant difference in postoperative SE was found between the 2 groups (P = .453). The results showed efficacy, safety, predictability, and merits of LASIK and lens-based approaches for correcting different types of residual refractive error after cataract surgery.