Journal of Ophthalmic and Vision Research

Published date: Jan 20 2021

Journal Title: Journal of Ophthalmic and Vision Research

Issue title: January–March 2021, Volume 16, Issue 1

Pages: 12 - 20

DOI: 10.18502/jovr.v16i1.8244

Zahra KarjouOphthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran

Mohammad-Reza Jafarinasabdr_jafarinasab@yahoo.comOphthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran

Mohammad-Hassan SeifiOphthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran

Kiana HassanpourOphthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran

Bahareh KheiriOphthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran

Purpose: To investigate the indications, clinical outcomes, and complications of secondary piggyback intraocular lens (IOL) implantation for correcting residual refractive error after cataract surgery.

Methods: In 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.

Results: Eleven 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 intraor postoperative complications during the 22.4 ± 9.5 months of follow-up.

Conclusion: Secondary 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.

Keywords: Residual Ametropia, Intraocular Lens Implantation, Piggyback IOL Implantation

1. Basarir B, Kaya V, Altan C, Karakus S, Pinarci EY, Demirok A. The use of a supplemental sulcus fixated IOL (HumanOptics Add-On IOL) to correct pseudophakic refractive errors. European journal of ophthalmology 2012; 22: 898-903.

2. Alio JL, Abdelghany AA and Fernández-Buenaga R. Management of residual refractive error after cataract surgery. Current opinion in ophthalmology 2014; 25: 291- 297.

3. Jin SX and Lee JK. Refractive surgical corrective options after cataract surgery. Annals of Eye Science 2019; 4.

4. El Awady HE and Ghanem AA. Secondary piggyback implantation versus IOL exchange for symptomatic pseudophakic residual ametropia. Graefe’s Archive for Clinical and Experimental Ophthalmology 2013; 251: 1861-1866.

5. Gayton JL and Sanders VN. Implanting two posterior chamber intraocular lenses in a case of microphthalmos. Journal of Cataract & Refractive Surgery 1993; 19: 776-777.

6. Masket S. Piggyback intraocular lens implantation. Journal of Cataract & Refractive Surgery 1998; 24: 569-570.

7. Fernández-Buenaga R, Alió JL, Ardoy AL, Quesada AL, Pinilla-Cortés L, Barraquer RI. Resolving refractive error after cataract surgery: IOL exchange, piggyback lens, or LASIK. Journal of Refractive Surgery 2013; 29: 676-683.

8. Gayton JL, Apple DJ, Peng Q, Visessook N, Sanders V, Werner L, et al. Interlenticular opacification: clinicopathological correlation of a complication of posterior chamber piggyback intraocular lenses. Journal of Cataract & Refractive Surgery 2000; 26: 330-336.

9. Iwase T and Tanaka N. Elevated intraocular pressure in secondary piggyback intraocular lens implantation. Journal of Cataract & Refractive Surgery 2005; 31: 1821- 1823.

10. Mehta R and Aref AA. Intraocular Lens Implantation In The Ciliary Sulcus: Challenges And Risks. Clinical Ophthalmology 2019; 13: 2317-2323.

11. Kim SK, Lanciano Jr RC and Sulewski ME. Pupillary block glaucoma associated with a secondary piggyback intraocular lens. Journal of Cataract & Refractive Surgery 2007; 33: 1813-1814.

12. Gayton J and Raanan M. Reducing refractive error in high hyperopes with double implants. Maximizing Results: Strategies in Refractive, Corneal, Cataract and Glaucoma Surgery Thorofare, NJ: SLACK 1996: 139-148.

13. Sáles CS and Manche EE. Managing residual refractive error after cataract surgery. Journal of Cataract & Refractive Surgery 2015; 41: 1289-1299.

14. Battat L, Macri A, Dursun D, Pflugfelder SC. Effects of laser in situ keratomileusis on tear production, clearance, and the ocular surface. Ophthalmology 2001; 108: 1230-1235.

15. Trindade FC. Secondary piggyback with PMMA IOL for the correction of refractive surprise after phacoemulsification long-term results of 20 cases. Revista Brasileira de Oftalmologia 2013; 72: 8-11.

16. Gayton JL, Sanders V, Van Der Karr M, Raanan MG. Piggybacking intraocular implants to correct pseudophakic refractive error. Ophthalmology 1999; 106: 56-59.

17. McIntyre JS, Werner L, Fuller SR, Kavoussi SC, Hill M, Mamalis N. Assessment of a single-piece hydrophilic acrylic IOL for piggyback sulcus fixation in pseudophakic cadaver eyes. Journal of Cataract & Refractive Surgery 2012; 38: 155-162.

18. Sanders DR. Matched population comparison of the Visian Implantable Collamer Lens and standard LASIK for myopia of-3.00 to-7.88 diopters. Journal of Refractive Surgery 2007; 23: 537-554.

19. Falzon K and Stewart OG. Correction of undesirable pseudophakic refractive error with the Sulcoflex intraocular lens. Journal of Refractive Surgery 2012; 28: 614-619.

20. Habot-Wilner Z, Sachs D, Cahane M, Alhalel A, Desatnik H, Schwalb E, et al. Refractive results with secondary piggyback implantation to correct pseudophakic refractive errors. Journal of Cataract & Refractive Surgery 2005; 31: 2101-2103.

21. Holladay JT, Gills JP, Leidlein J, Cherchio M. Achieving emmetropia in extremely short eyes with two piggyback posterior chamber intraocular lenses. Ophthalmology 1996; 103: 1118-1123.

22. Chang SH and Lim G. Secondary pigmentary glaucoma associated with piggyback intraocular lens implantation. Journal of Cataract & Refractive Surgery 2004; 30: 2219- 2222.

23. Werner L, Apple DJ, Pandey SK, Solomon KD, Snyder ME, Brint SF, et al. Analysis of elements of interlenticular opacification. American journal of ophthalmology 2002; 133: 320-326.

24. Gills JP and Fenzl RE. Piggyback intraocular lens implantation. Developments in ophthalmology 2002; 34: 209-216.

25. Reiter N, Werner L, Guan J, Li J, Tsaousis KT, Mamalis N, et al. Assessment of a new hydrophilic acrylic supplementary IOL for sulcus fixation in pseudophakic cadaver eyes. Eye 2017; 31: 802.

26. Akaishi L, Tzelikis PF, Gondim J, Vaz R. Primary piggyback implantation using the Tecnis ZM900 multifocal intraocular lens: case series. Journal of Cataract & Refractive Surgery 2007; 33: 2067-2071.

27. Hayashi K and Hayashi H. Comparison of the stability of 1-piece and 3-piece acrylic intraocular lenses in the lens capsule. Journal of Cataract & Refractive Surgery