Thursday, October 6, 2011

http://www.youtube.com/user/Drsureshkpandey#p/u/0/iKYTAwGW8FI

In this video, one of the patient discusses his experience of piggyback IOL implantation for correction of high myopia performed at SuVi Eye Institute & Lasik Laser Center, Kota, India (www.suvieye.com). Options for appropriate piggyback IOLs are limited to the correction of residual spherical error. Presently available piggyback styles include aspheric, toric and multifocal lenses. Appropriate power calculation for piggyback IOLs is based simply on residual refractive error and can achieve highly accurate outcomes. Complications of piggybacking can be avoided with proper preoperative planning and IOL selection. Complications include interlenticular opacification, pigment dispersion, iridocyclitis, glaucoma and hyphema.

The most popular piggyback IOL is the AQ5010 (STAAR Surgical, Monrovia, CA) because of its round edge, 6.3 mm optic and 13.5 mm overall diameter, other IOLs include AMO SI 40 IOL, or Clariflex IOL.

The Sulcoflex IOL (Rayner, Ltd., Hove, England) is designed for implantation as a piggyback IOL in the ciliary sulcus of the pseudophakic eye. It is a single-piece hydrophilic acrylic IOL that can be inserted through a 3.0 mm incision. The 6.5 mm optic and haptic edges are round. The haptic is angulated and has an undulated design to preclude rotation. A spherical monofocal version of the Sulcoflex has been implanted in the ciliary sulcus of pseudophakic eyes to correct residual ametropia. Toric, multifocal and aspheric versions of the IOL are also available to correct residual astigmatism, permit presbyopia correction and reduce HOAs in pseudophakic eyes.

Multiple peer-reviewed publications have demonstrated the effectiveness of both primary (at the same time as the initial surgey) and secondary (delayed) placement of piggyback IOLs. Akaishi et al have described placing a silicone piggyback IOL in the sulcus to enhance correction with the Tecnis multifocal (AMO, Santa Ana, CA)3 and the ReSTOR (Alcon Surgical, Ft. Worth, TX);4 recently Jin et al demonstrated correction of residual astigmatism with placement of a toric IOL in the sulcus using an obliquely crossed cylinder technique. Alfonso et al have described placing diffractive multifocal IOLs in the sulcus to provide pseudoaccommodation,and Boisvert et al have developed a Pediatric Piggyback IOL Calculator to facilitate the strategy of temporary polypseudophakia in children to reduce the amount of myopic shift by removing the anterior IOL when the eye become sufficiently myopic.
Despite enthusiasm for piggyback IOLs, surgeons should remain cognizant of potential complications. Interlenticular opacification (ILO) has been reported with the implantation of two acrylic IOLs in the capsular bag; in general, the use of a silicone piggyback IOL placed in the sulcus is recommended to prevent the development of ILO. Pigment dispersion and pigmentary glaucoma have been reported with placement of IOLs with sharp anterior optic edges in the ciliary sulcus, hence the requirement of rounded anterior optic edges for piggyback IOLs. An unusual complication of piggyback IOL insertion is posterior capsule rupture. I
In summary, piggyback IOLs achieve excellent results and probably represent the best choice for correction of residual spherical ametropia in eyes with a history of prior radial keratotomy and eyes with ocular surface disease or suspicious corneal topography which are not good candidates for LASIK or PRK. When an astigmatic component is present and the eye is otherwise healthy, however, corneal refractive procedures offer an unexcelled degree of accuracy and precision in a cost-effective manner.

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