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Piggyback lens corrects residual refractive error in pseudophakic eyes
J Refract Surg. 2010;26(10):766-769.
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A piggyback toric lens corrected residual refractive error in a group of pseudophakic eyes, a study found.
The study included eight eyes of five pseudophakic patients implanted with a STAAR toric Implantable Collamer Lens to correct residual refractive error. Investigators assessed uncorrected and corrected distance visual acuity, manifest refractive sphere and astigmatism before surgery and 6 months after surgery.
"In our small series of eyes, implantation of a toric ICL appears to be effective and predictable, but potential complications such as pupillary block mandate routine use of iridectomies," the study authors said. "Further evaluation of differences in the efficacy and safety between ICL and conventional IOL piggyback insertion with a larger series of patients is warranted."
Study data showed that mean logMAR uncorrected distance visual acuity improved from 0.759 preoperatively to 0.201 at 6 months postoperatively. Correction was attained within 0.5 D of targeted spherical equivalent refraction. No eyes lost more than one line of corrected distance visual acuity. One eye had pupillary block 1 day after surgery.
Manifest refractive astigmatism was within 0.5 D of the intended value in five eyes (62.5%) and 1 D in seven eyes (87.5%). Implants were well-centered in all eyes, the authors said.
The correction of residual refractive error in pseudophakic eyes with the use of a secondary piggyback toric ICL appears to be effective and predictable. This novel approach would seem to have limited utility because most pseudophakic patients with residual astigmatic refractive errors will be a candidate for keratorefractive surgery. I was surprised that most patients had a high ICL vault. I would think that the sizing of the ICL in pseudophakic eyes may be less challenging than in phakic eyes. Because there is no risk of inducing a cataract with a low vault in a pseudophakic eye, I would err on choosing a shorter length ICL to prevent high vaults that would still be problematic in pseudophakic eyes.
– Jason E. Stahl, MD
Durrie Vision,
Overland Park, Kan.
Assistant Clinical Professor of Ophthalmology, Kansas
University Medical Center, Prairie Village, KS
Disclosure:Dr. Stahl is a
consultant for Alcon, AMO, Bausch + Lomb and TrueVision.