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Piggyback IOL may resolve poor postop acuity, halos
A case study suggests that a piggyback IOL can eliminate photic phenomena caused by exposed optic edges.
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Postoperative photic phenomena caused by exposed IOL optic edges can be resolved with the implantation of a piggyback IOL, according to one ophthalmologist.
At this year’s meeting of the American Society of Cataract and Refractive Surgery, Paul H. Ernest, MD, of TLC Eyecare & Laser Center in Jackson, Mich., presented a case study of a 69-year-old man who underwent bilateral cataract surgery in 2003.
After the initial implantation of a 19-D SN60AT AcrySof lens in each eye, the patient achieved uncorrected visual acuity of 20/15. The patient later developed poor vision on cloudy days and in the evening, “washed out” vision and an inability to drive at night due to halos.
After ruling out IOL exchange and Alphagan (brimonidine tartrate, Allergan) and pilocarpine drops as treatment options, Dr. Ernest drew on his experience implanting piggyback IOLs and decided that this would be the best option for the patient.
Successful piggyback
“I proposed this to the patient, telling him quite frankly that this may not work,” Dr. Ernest told Ocular Surgery News in an interview.
Dr. Ernest chose a 0 D STAAR AQ5010V multipiece silicone lens with a 6.3-mm-diameter optic and a thin profile for the piggyback. The lens previously implanted in the capsular bag had a 6-mm optic.
“I realized that 0.3 [mm] isn’t a lot, but at least I’d make sure that I had a lens that was at least as large if not a little larger than the existing optic,” he said.
After implanting the piggyback lens, Dr. Ernest followed the patient closely for 4 days. The patient was “thrilled” when all of his symptoms went away.
Dr. Ernest said the patient had suffered from photic phenomena because of an exposed optic edge and internal reflections in the space between the posterior iris and the anterior lens surface. He believes the piggyback technique was successful because the additional IOL created a new lens edge that eliminated the halos and filled the problematic space between the iris and the first IOL.
Repositioning possible
According to Dr. Ernest, the patient remained symptom-free for 5 months, after which the symptoms returned in the left eye.
He examined the patient and found that the new lens had moved 1 to 2 mm temporally, exposing the nasal part of the implant. Dr. Ernest repositioned the lens, and the symptoms once again resolved.
“What better proof do you have that this thing works, to have it satisfy the patient one eye at a time, and when the lens moves, the symptoms come back, and when we put the lens back in its right place, the symptoms went away,” he said.
Dr. Ernest said that iris contact, pigmentary dispersion syndrome, increased translucency of the iris and iritis are all possible complications of piggyback IOL implantation. This case study serves as a launching point for further study, he said.
“It’s an interesting case study, and hopefully something that stimulates people to consider this, and maybe we’ll have a more mathematical explanation of why it worked. It could be what I said, it could be something different,” he said.
“Hopefully, we don’t have that many people with exposed optical edges,” he said. “But for these people that are so seriously disabled, it is definitely a consideration.”
For Your Information:
- Paul H. Ernest, MD, can be reached at TLC Eye Care of Michigan, 1116 W. Ganson St., Jackson, MI 49202; 517-782-9436; fax: 517-782-3001; e-mail: paul.ernest@tlcvision.com. Dr. Ernest is a paid consultant for Alcon.
- Jared Schultz is an OSN Staff Writer who covers all aspects of ophthalmology. He focuses geographically on Europe and the Asia-Pacific region.