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High hyperopes can benefit from piggyback lens insertion, surgeon says
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ANAHEIM, Calif. — Advances in IOL and power calculation technologies have made the correction of high hyperopia with two “piggybacked” IOLs more reliable, according to a surgeon speaking here.
Johnny L. Gayton, MD, spoke about the advantages, disadvantages and potential complications of piggyback lens insertion in high hyperopes at the American Academy of Ophthalmology meeting.
If piggybacking two IOLs is needed to achieve the correct optical power, Dr. Gayton recommends using Alcon AcrySof IOLs as both the anterior and posterior lenses. “There’s less posterior capsular opacification, less risk of pupillary capture. But the sharp edge can cause pigmentary glaucoma,” he warned.
Another option Dr. Gayton uses is a STAAR silicone as the anterior lens coupled with an AcrySof as the posterior lens. “There’s less PCO, less pigment dispersion, not a lot of light reflecting off the IOL. There is an increased risk of pupillary capture due to the silicone optic being thicker than the acrylic optic,” he said.
Dr. Gayton warned surgeons of their need to educate high hyperopic patients preoperatively about the limited predictability of IOL power when piggybacking. He said the Carl Zeiss Meditec IOLMaster offers surgeons the most accurate biometric measurement for IOL power calculation. “When we’re dealing with nanophthalmic eyes, the Holladay IOL Consultant is the most accurate predictor. It’s also very good for patients with prior refractive surgery,” he said.
Dr. Gayton said he uses a 5-mm capsulorrhexis, a Chang chopper and the Alcon Infiniti phacoemulsifier. “I have to make a little plug here. I have fallen in love with the Chang chopper over the past 2 years,” he said.
“You can prevent interlenticular opacity with bag-sulcus or bag-bag or bag-bag with optics through the anterior capsulorrhexis,” he said. “Try to avoid primary piggyback whenever possible.”
Before using the Holladay II formula, Dr. Gayton said, he encountered four eyes out of 30 that required IOL exchange. The PCO rate was 3%.
He suggests using a single AcrySof lens if the power required is less than +40 D, but a piggyback combination if it is more than +40 D.