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Piggyback iol
Piggyback IOL refers to the implantation of a second intraocular lens onto an existing one to correct postoperative refractive errors, requiring specific preconditions such as a stable primary IOL and a healthy anterior chamber. The procedure has particular indications, including hyperopic postoperative refractive errors, but is contraindicated in cases of loose zonules or significant corneal endothelial cell loss. While it has advantages like improved image quality and better depth of focus, potential complications include intralenticular opacification and postoperative pigment dispersion.
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Discussion on Piggyback IOL and its significance in intraocular lens procedures.
First described in 1993 by Gayton & Sanders, originally for cataract & microphthalmos. Later used for correcting postoperative refractive errors.
Piggyback IOLs are additional lenses placed alongside existing ones. The first in the bag, the second in the bag or sulcus.
Important conditions for piggyback IOL include a stable PCIOL, normal anterior chamber, healthy corneal endothelium, and absence of pigment dispersion.
Key factors: IOL power and materials to follow in choosing piggyback IOLs include edge design and position to avoid complications.
Recommended for patients with hyperopic postoperative errors or those with a history of RK, prone to hyperopic surprises.
Not advisable for patients with loose zonules, posterior synechiae, or reduced corneal endothelial counts.
Benefits over explanting IOL include easier placement, enhanced image quality, and an increased depth of focus.
Potential risks include intralenticular opacification, pigment dispersion, iris chafing, chronic iridocyclitis, glaucoma, hyphema, and corneal decompensation.
Different types of IOLs suitable for capsular bag and sulcus placement, including multifocal and toric models designed for secondary implantation.
Two types: Primary polypseudophakia for high hyperopia/myopia and secondary polypseudophakia for postoperative adjustments.
Power can be calculated using the Holladay IOL Consultant formula along with specific nomograms for different eye sizes.
Calculating lens power required for overpowered pseudophakes based on eye size with specific equations.
Final remarks and conclusion of the discussion on Piggyback IOL.
Piggyback iol
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- 2. 1st describedin 1993 by Gayton & Sanders in a case of cataract & microphthalmos, in which the calculated IOL power was +46 Diopters. Later on, it is used to correct post operative refractive errors.
- 3. WHAT IS PIGGYBACKIOL? An IOL that ”piggybacks” onto an existing IOL or two IOLs implanted simultaneously. 1st IOL is placed in the capsular bag 2nd IOL (piggyback) is placed in the bag or sulcus.
- 4. PRE REQUISITES astable PCIOL within an intact capsular bag, a normal or deep anterior chamber, a normal corneal endothelium, and no evidence of pigment dispersion syndrome.
- 5. CONSIDERATION The relevant considerationsfor piggyback IOL procedures are: the IOL power, material, edge design, and position. IOLs with low negative or low positive dioptric power are required. The material should be different from that of the existing IOL in the eye (i.e., acrylic vs. silicone) to minimize the risk of an intra lenticular membrane formation.
- 6. The piggybacklens is placed in the ciliary sulcus and should have a rounded (not square) edge, a posterior angulation, and a 3-piece design with sufficient overall length (to prevent pigment dispersion and iris damage from chafing the posterior iris surface.)
- 7. INDICATION patients witha hyperopic postoperative refractive error. Patients with a history of RK, because they are prone to hyperopic surprises after cataract surgery.
- 8. CONTRAINDICATION loose zonulesfrom trauma or pseudoexfoliation Posterior synechiae to the capsular bag significantly reduced corneal endothelial cell count
- 9. ADVANTAGE Easier toplace 2nd IOL than to explant IOL & replace it Better image quality Increased depth of focus
- 10. COMPLICATIONS Intralenticular opacification(interpseudophakos Elshnig’s pearls) -- RED ROCK SYNDROME Postoperative pigment dispersion, which occurs when the piggyback lens rubs against the posterior surface of the iris. Iris chafing, Chronic iridocyclitis, Glaucoma (secondary angle closure glaucoma) Hyphema, and Corneal decompensation.
- 11. OPTIONS FOR PIGGYBACKIOL For placement in the capsular bag, an IOL with a negative shape factor such as the three-piece hydrophobic acrylic IOL is an excellent choice. single-piece hydrophobic acrylic IOLs should not be placed into the sulcus because they may induce uveitis- glaucoma- hyphema syndrome. For the ciliary sulcus lens, a large diameter, low profile, round edge, biconvex newer generation silicone IOL is recommended.
- 12. Secondary piggybackIOLs are available as monofocal, multifocal, toric & multifocal toric models. There are three IOLs specially designed for secondary implantation in the ciliary sulcus to correct pseudophakic ametropias or pseudophakic presbyopia: the Sulcoflex, the Add- on & the 1st Add- on.
- 13. TYPES OF PIGGYBACKIOL IMPLANTATION Primary Polypseudophakia: High hyperopia or myopia (mostly both in the bag) Secondary Polypseudophakia: To manage postoperative refractive surprise (mostly lower power IOL in sulcus), done after 6 weeks of the first surgery.
- 14. PIGGYBACK IOL POWER CALCULATION Easilycalculated utilizing the Holladay IOL Consultant (R Formula)
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- 16. Piggyback IOL (Gills Nomogram) Underpowered pseudophakes (hyperopes): 1. Small eye (<21 mm): power = (1.5 X SE) + 1 2. Average eye (22 – 26 mm): power = (1.4 X SE) + 1 3. Long eye (>27 mm): power = (1.3 X SE) + 1
- 17. Overpowered pseudophakes(myopes): 1. Small eye (<21 mm): power = (1.5 X SE) - 1 2. Average eye (22 – 26 mm): power = (1.4 X SE) - 1 3. Long eye (>27 mm): power = (1.3 X SE) - 1
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