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

Abstract

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 $\pm$ 7.92, which reached 0.42 $\pm$ 1.26 postoperatively (P $<$ 0.001). The postoperative spherical equivalent was within $\pm$ 1 diopter of target refraction in all patients. The average preoperative uncorrected distance visual acuity was 1.13 $\pm$ 0.35 LogMAR, which significantly improved to 0.41 $\pm$ 0.24 LogMAR postoperatively (P = 0.008). There were no intra- or postoperative complications during the 22.4 $\pm$ 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: Intraocular Lens Implantation; Piggyback IOL Implantation; Residual Ametropia.

Figure 1

Target refraction plotted against achieved refraction. Triangles depict myopic patients and bullets represent hyperopic patients. All patients were within $\pm$ 1 diopters of target refraction.