Piggyback intraocular lens implantation to correct myopic pseudophakic refractive error after penetrating keratoplasty

PURPOSE: To determine the safety and efficacy of implanting a second intraocular lens (IOL) to correct myopic pseudophakic refractive error after penetrating keratoplasty (PKP). SETTING: Department of Ophthalmology, Toronto Western Hospital, Toronto, Ontario, Canada. METHODS: In this retrospective case series, 6 eyes of 6 post-PKP pseudophakic patients had a second piggyback IOL implantation to correct a residual myopic refractive error. The uncorrected visual acuity (UCVA) and the best corrected visual acuity (BCVA) were measured at regular intervals during a 7-month follow-up. Efficacy was determined by the achieved refractive correction and Snellen UCVA measurements. Safety was measured by loss of BCVA and complications (intraoperative and postoperative). RESULTS: The UCVA improved in all cases. Five patients achieved a BCVA of 20/40 or better postoperatively. Before surgery, the mean spherical equivalent (SE) was -8.08 diopters (D) (range -6.13 to -12.00 D). After surgery, the mean SE was -0.94 D (range -2.38 to +0.25 D). Four patients were within +/-1.50 D of emmetropia. There were no intraoperative or postoperative complications. CONCLUSION: Implanting a piggyback IOL was a safe and effective means of correcting myopic pseudophakic refractive error post PKP.     

Piggybacking intraocular implants to correct pseudophakic refractive error

ObjectiveTo determine the safety and efficacy of implanting a second intraocular lens (IOL) to correct pseudophakic refractive error.DesignNoncomparative, prospective, consecutive case series.ParticipantsEight eyes of eight normal pseudophakes and seven eyes of seven postpenetrating keratoplasty (PK) pseudophakes were included in the study.InterventionA second intraocular lens (IOL) was implanted anterior to the first in each eye in the study.Main outcome measuresEfficacy was determined based on the achieved refractive correction and Snellen uncorrected visual acuity measurements. Safety was determined based on loss of best-corrected visual acuity and operative and postoperative complications.ResultsBefore surgery, spherical equivalents ranged from −5.12 diopters (D) to 7.5 D, with a mean absolute deviation from emmetropia of 3.38 D (1.62). After surgery, spherical equivalents ranged from −2.75 D to 0.5 D, with a mean absolute deviation from emmetropia of 1.21 D (0.90). Before surgery, only 7% of patients had 20/40 or better uncorrected vision, whereas after surgery, 50% had that level of vision.ConclusionsImplanting a second IOL is a viable option for correcting pseudophakic refractive error.     

Long-term results of clear lens extraction combined with piggyback intraocular lens implantation to correct high hyperopia

AIM: To evaluate the efficacy and safety of one-stitch anastomosis through the skin with bicanalicular silicone tube intubation in repairing of bicanalicular laceration.METHODS:The clinical data of 15 consecutive patients with both superior and inferior canalicular laceration in one eye who underwent surgical repair using one-stitch anastomosis through the skin and bicanalicular stent were retrospective studied. All the operations were performed under surgical microscope, 5-0 silk sutures were used and were with bicanalicular silicone tube (diameter was 8mm) intubation, for one lacerated canaliculi one-stitch anastomosis through the skin. The stents were left in place for 3 months postoperatively and then removed. The follow-up period was 3 - 36 months (average 14 months).RESULTS:In 15 patients, 13 patients were cured entirely, 1 patient was meliorated, 1 patient with no effects. All patients had got good recovery of eyelid laceration with no traumatic deformity in eyelid and canthus. Complication was seen in one case, for not followed the doctor’s guidance to come back to hospital to had the suture removed on the 7^th day after operation, when he came at the 15^th day, the inferior canalicular wall and eyelid skin were corroded by the suture caused 2mm wound, and the inside silicone tube was exposed, a promptly repair with 10-0 nylon suture was done, the wound healed in a week. There were no early tube protrusions and punctal slits in the patients.CONCLUSION:One-stitch anastomosis through the skin with bicanalicular silicone tube intubation is a good method in repair of bicanalicular laceration in one eye, the cut ends can be anastomosed directly, and with excellent cosmetic results, it is acceptable for the patients. For there is no suture remained in the wound permanently, so there is no suture-related granuloma which may cause obstruction or stenosis of canaliculi. It is simple, economical, effective and safe.     

One-year visual outcome of secondary piggyback pinhole device implantation in pseudophakic eyes with irregular corneal astigmatism and iris trauma

PurposeRetrospective case series evaluating the efficacy and safety of implanting XtraFocus^™ pinhole device in pseudophakic patients with irregular corneal astigmatism with concurrent or standalone iris defect.MethodsElectronic case records were searched for: uncorrected distance visual acuities (UDVA) and corrected distance visual acuities (CDVA), automatic or manifest refraction and spherical equivalent (SE). All main outcomes were evaluated preoperatively and postoperatively at 1, 3, 6, 9 and 12 months, along with patients’ satisfactory outcome and complications.ResultsEleven pseudophakic eyes of 11 patients with a mean age of 54 (range 27–81) years were included. Median UDVA improved significantly from logMAR 0.7 (range 0.1–1.22) pre-operatively to 0.4 (range 0–1.3) at 1-month (p = 0.002); median CDVA remained unchanged at logMAR 0.4 (range 0–0.1) pre-operatively and 0.4 (range 0–0.8) at 1-month (p = 0.36). There were no significant statistical differences in both UDVA and CDVA between the post-operative periods. Ten patients (90.9%) had initial UDVA improvement at 1-month post op. Eight (72.7%) patients expressed satisfaction with improved vision or reduction of glare/halos. Three (27.3%) patients had unsatisfactory visual outcome resulting in 2 requested for implant explantation due to worsening of glare and distressing floaters.ConclusionsXtraFocus^™ is effective in improving vision or reducing glare in pseudophakic patients with irregular corneal astigmatism or intragenic iris trauma, with over 70% expressed satisfactory outcome. Disturbing floaters and glare preclude its use in some resulting in implant explantation.Subject terms: Eye manifestations, Corneal diseases     

Secondary piggyback implantation versus IOL exchange for symptomatic pseudophakic residual ametropia

Background

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.

Method

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?±?4.2 months and 20?±?3.6 months in groups I and II respectively. The visual and refractive outcomes were evaluated, and any intraoperative or postoperative complications was recorded.

Results

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.

Conclusion

Secondary piggyback implantation in the ciliary sulcus is an effective, safe, and easy treatment for a pseudophakic ametropia.     

Laser in situ keratomileusis to correct refractive errors after keratoplasty

PURPOSE: To assess the safety and effectiveness of excimer laser in situ keratomileusis (LASIK) to correct refractive myopia, astigmatism, or both after keratoplasty. SETTING: Eye Clinic Day Hospital, S?o Paulo, Brazil. METHODS: Twenty-two eyes that had previously had corneal transplantation were studied. Laser in situ keratomileusis was performed using the Chiron automated microkeratome and the VISX Twenty-Twenty B excimer laser. RESULTS: Mean follow-up after LASIK was 10.09 months +/- 3.87 (SD). The spherical equivalent refraction dropped from -4.55 +/- 3.66 D before LASIK to -0.67 +/- 1.24 D after surgery. At the last examination, 72.7% of patients had a refractive error within +/- 1.00 D of emmetropia and 54.5% had uncorrected visual acuity of 20/40 or better. Vector analysis of astigmatic correction showed an index of success of 54.0%. Best spectacle-corrected visual acuity was unchanged in 8 cases, improved in 9, and decreased in 5. Significant endothelial cell loss, keratoplasty wound dehiscence, and other serious complications did not develop in any eye. CONCLUSION: The correction of refractive error with LASIK in postkeratoplasty patients proved to be safe, effective, and predictable. Further studies with longer follow-up are needed to determine the method's clinical value.     

Minus-power intraocular lenses to correct refractive errors in myopic pseudophakia.

PURPOSE: To evaluate the effectiveness of a secondary, piggyback, minus-power intraocular lens (IOL) to correct the refractive error in patients with myopic pseudophakia. METHODS: In this prospective noncomparative cohort study, 51 myopic pseudophakic patients received implantation of a minus-power IOL as a secondary procedure to correct residual pseudophakic myopia. RESULTS: The mean residual myopia of -3.05 diopters (D) was reduced to -0.38 D. All eyes were within +/- 1.00 D of the desired refraction. Uncorrected visual acuity was 20/40 or better in 72% of eyes, and best corrected visual acuity was 20/40 or better in 96%. Uncorrected visual acuity improved by 2 or more lines in 85% of eyes and by 5 or more lines in 65%. CONCLUSION: Clinical outcomes can now be improved in patients with myopic pseudophakia whose previous options (i.e., lens exchange or refractive surgery) were more traumatic or less predictable.     

Elevated intraocular pressure in secondary piggyback intraocular lens implantation

We report 2 cases of postoperative intraocular pressure (IOP) elevation in secondary piggyback intraocular lens (IOL) implantation without history of glaucoma or ocular hypertension. A 74-year-old woman with myopic pseudophakia and a 68-year-old man with hyperopic pseudophakia received secondary piggyback AcrySof IOL implantation in their left eyes. In both patients, the left IOP gradually increased and sustained around 30 mm Hg for about 1 year. In the first, IOP continued elevating despite topical and systemic medications. There was an episode of pupillary block in the second. Gonioscopically, heavier trabecular meshwork pigmentation in their left eyes was observed. Because of this, the 2 IOLs implanted were removed and replaced by an adequate IOL and trabeculotomy was performed in the former. The AcrySof IOL has a truncated optic edge, which increases the risk for chafing the iris, resulting in pigment dispersion syndrome; thus, it would be a poor choice for a sulcus-placed piggyback implantation.     

Refractive changes produced by capsule contraction after piggyback acrylic intraocular lens implantation

I describe a case of anterior capsule contraction after implantation of piggyback acrylic intraocular lenses (IOLs). Treatment by neodymium:YAG capsulotomy resulted in anterior chamber deepening despite a myopic shift. With acrylic IOLs, refractive changes may be due to optical deformation rather than axial shifts.     

Refractive errors induced by displacement of intraocular lenses within the pseudophakic eye

Simple methods were developed to estimate refractive errors when intraocular lenses are not fitted optimally within pseudophakic eyes. The accuracy of these methods was determined by comparing results obtained with them to results obtained by raytracing through a model eye. Accuracy was good for longitudinal displacement and tilting, and reasonable for transverse displacement. Refractive errors are related linearly to the magnitude of the longitudinal displacement, and are related to the square of the magnitude of tilt or transverse displacement. The refractive error upon transverse displacement is quadratically dependent upon lens shape.     

Pupillary capture of the optic in secondary piggyback implantation

Two patients who received a minus-power intraocular lens implanted as a secondary piggyback to correct pseudophakic myopia experienced pupillary optic capture following dilation in the early postoperative period. Both cases were successfully managed by pressing the optic back into the ciliary sulcus and constricting the pupil with pilocarpine.     

Two-stage laser in situ keratomileusis to correct refractive errors after penetrating keratoplasty

PURPOSE: To evaluate the effect of a two-stage laser in situ keratomileusis (LASIK) procedure on eyes with high astigmatism and/or anisometropia after penetrating keratoplasty. METHODS: Eleven postoperative penetrating keratoplasty eyes were included in a prospective, non-controlled study. All patients had at least 4.00 D of astigmatism and/or at least 3.00 D of anisometropia and were spectacle and contact lens intolerant. Two-stage LASIK was performed; in the first stage a hinged corneal flap 160 microm in thickness and 9 mm in diameter was created. After stabilization of corneal shape (1 to 3 months after keratotomy), the corneal flap was lifted and laser refractive treatment (second stage) was performed. RESULTS: After the first stage, a statistically significant reduction in refractive astigmatism (P<.01) was recorded. In all eyes but one, best spectacle-corrected visual acuity was maintained or improved after the procedure. Three months after the second stage, refractive astigmatism in 8 of 11 eyes (73%) was within +/- 1.00 D, and spherical equivalent refraction in 9 of 11 eyes (82%) was within +/- 1.00 D of intended correction. Preoperative irregular astigmatism persisted in three patients (3 eyes) who could not be corrected within +/- 1.00 D of refractive astigmatism and/or +/- 1.00 D of intended spherical equivalent refraction. In one eye, an interface infiltrate developed shortly after creation of the flap, and resulted in limited melting. CONCLUSIONS: A two-stage LASIK procedure improved visual acuity and refraction in postoperative penetrating keratoplasty eyes with high astigmatism and/or anisometropia. Complications were uncommon but can lead to loss of vision.     

Bilateral ciliary sulcus implantation of secondary piggyback multifocal intraocular lenses

Ciliary sulcus implantation of secondary multifocal intraocular lenses (IOLs) is an uncommon procedure. We describe a young pseudophakic patient with monofocal IOLs who achieved a high level of satisfaction following bilateral implantation of multifocal IOLs. They were used successfully to correct a residual refractive error for distance vision and to provide spectacle-independence for near vision. Postoperative symptoms such as glare were not problematic.