Eric C Amesbury MD Kevin M Miller MD The authors have no financial interest PIGGYBACK LENS AFTER MULTIFOCAL IOL IMPLANTATION Introduction Residual refractive error after multifocal IOL implantation can cause visual symptoms and decreased satisfaction Piggyback IOL implantation is a ID: 365988
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PIGGYBACK LENS AFTER MULTIFOCAL IOL IMPLANTATION
Eric C. Amesbury MDKevin M. Miller MD
The authors have no financial interestSlide2
PIGGYBACK LENS AFTER MULTIFOCAL IOL IMPLANTATION
Introduction: Residual refractive error after multifocal IOL implantation can cause visual symptoms and decreased satisfaction. Piggyback IOL implantation is an option for correction of postoperative hyperopia after multifocal IOL implantation.Slide3
PIGGYBACK LENS AFTER MULTIFOCAL IOL IMPLANTATION
Purpose: To report the safety and efficacy of piggyback IOL implantation for residual hyperopia following cataract extraction and diffractive multifocal IOL implantationSlide4
PIGGYBACK LENS AFTER MULTIFOCAL IOL IMPLANTATION
Methods: Case Report
61-year-old maleRight eye phaco with in-the-bag multifocal IOL (AcrySof ReSTOR), 20/50 and J1 uncorrected acuity+1.00 sphere 20/20; patient satisfied with spectacles (20/20 cataract left eye)Slide5
PIGGYBACK LENS AFTER MULTIFOCAL IOL IMPLANTATION
Methods (continued):3 years later: Left eye phaco with multifocal IOL (ReSTOR), 20/15 and J1 uncorrected acuity
Right eye symptomatic with blur and ocular imbalance uncorrected+1.00 diopter 3-piece, rounded-edge silicone piggyback IOL (Staar AQ5010V) implanted in the ciliary sulcus of the right eyeSlide6
PIGGYBACK LENS AFTER MULTIFOCAL IOL IMPLANTATION
Results:
No intraoperative complications20/15 and J1 uncorrected acuityMild pigment dispersion at 2 weeks postop with 30mmHg IOPSlide7
PIGGYBACK LENS AFTER MULTIFOCAL IOL IMPLANTATION
Results (continued):
Aqueous suppressant + prednisolone acetate 1% therapy controlled IOPPigment resolved at 1 month postopOff all meds with normal IOP and no pigment dispersion at 3 monthsSlide8
PIGGYBACK LENS AFTER MULTIFOCAL IOL IMPLANTATION
Discussion:
Piggyback IOL advantages vs. other optionsPiggyback AdvantagesBetter patient satisfaction than corrective contact lens or spectacles
Avoids induced aberration, other risks of H-LASIK/PRK
Less
risk of incorrect IOL power, capsular rupture, vitreous loss, CME vs. IOL
exchange
1,2Slide9
PIGGYBACK LENS AFTER MULTIFOCAL IOL IMPLANTATION
Discussion (continued):
Piggyback IOL Possible Complications:Intraoperative ComplicationPostoperative ComplicationCapsular RuptureZonular DehiscenceVitreous LossInflammation/Pigment
Dispersion3InfectionOcular Hypertension3
Optic
Capture
4
Interlenticular
Opacification
5
*
Hyperopic Shift (Late
)
5
*
*Avoided
with sulcus piggyback and in-the-bag primary IOLSlide10
PIGGYBACK LENS AFTER MULTIFOCAL IOL IMPLANTATION
Discussion (continued):
Alternatives to Piggyback IOL: AlternativeAdvantageDisadvantageContact Lenses Glasses
Non-invasiveUnpopular with “premium” IOL patients
Hyperopic
PRK
Hyperopic LASIK
Less invasive than Piggyback
or IOL Exchange
Decentration, induced aberration may degrade image quality
6,7
IOL
Exchange
Single in-the-bag
IOL
avoids complications from two IOLs
Difficult after
haptic/capsular fibrosis or s/p YAG capsulotomy; risks incorrect IOL power, CME, capsular rupture, vitreous
los
8,9Slide11
PIGGYBACK LENS AFTER MULTIFOCAL IOL IMPLANTATION
Conclusion:
Piggyback lens implantation is a safe and effective option for treating hyperopia following multifocal IOL in the short termPigment dispersion may be a cause for concern in the long termCorrective lens, H-PRK/LASIK, IOL exchange options have separate
advantages/disadvantages to considerSlide12
PIGGYBACK LENS AFTER MULTIFOCAL IOL IMPLANTATION
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Iwase T, Tanaka N. Elevated intraocular pressure in secondary piggyback intraocular lens implantation. J Cataract Refract Surg 2005; 31:1821-
1823.
Gayton JL, Sanders V, Van Der Karr M. Pupillary capture of the optic in secondary piggyback implantation. J Cataract Refract Surg 2001; 27:1514-1515.
Gayton JL, Apple DJ, Peng Q, et al. Interlenticular opacification:
clinicopathologic
correlation
of a complication of posterior chamber piggyback intraocular lenses. J Cataract Refract Surg 2000; 26:330-336.
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Qazi
MA, Roberts CJ,
Mahmoud
AM,
Pepose
JS. Topographic and biomechanical differences between hyperopic and myopic laser in situ
keratomileusis
. J Cataract Refract
Surg
2005; 31:48-60.
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Surg
2003; 29:1924-1931.
Jin JC, Crandall AS, Jones JJ. Changing indications for and improving outcomes of intraocular lens exchange. Am J
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Marques
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