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Piggyback IOL implantation ‘viable’ option when needed
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SAN DIEGO — Piggyback IOL implantation is an aggressive technique in children but is an option in certain cases, according to a speaker.
“I’m asked frequently about piggyback intraocular lenses and whether or not these days this is something that should be recommended,” M. Edward Wilson, MD, of Storm Eye Institute, Medical University of South Carolina, said at the American Association for Pediatric Ophthalmology and Strabismus annual meeting.
In children, Wilson places the primary IOL in the bag and the secondary IOL in the ciliary sulcus where it can be removed later. He calls the procedure “temporary polypseudophakia” to indicate the intention to remove the secondary lens after eye growth. He does not use the technique often, “only when I’m seeing the patient late, I really think the family is going to be noncompliant, and I’m just trying to do everything I can to get the eye to emmetropia first.”
Wilson and colleagues conducted a study of 51 eyes of 40 children who underwent this type of piggyback IOL implantation. In 42 eyes, the implantation was done at the time of cataract surgery; in nine eyes, the implantation was done secondarily because of small pupils.
Safety is acceptable, according to Wilson. Four of 51 eyes (8%) underwent unplanned piggyback removal: one for IOL tilt, one for pupillary capture, one for suspected pupillary block and one for a pupillary membrane.
“We looked more closely at the 44 eyes that have greater than 5 years of follow-up. Explant was done at a median of 3.24 years after implantation, but the timing was variable,” Wilson said. Explantation ranged from 5 or 6 months after implantation to a median of 11 years of follow-up, with nine of the eyes not yet explanted due to lack of eye growth. Median age at cataract extraction was 0.51 years and at piggyback implantation was 0.73 years.
Outcomes after piggyback IOL implantation in Wilson’s series were no better than alternatives, however, possibly due to negative selection bias, he said.
“Planned sulcus IOL removal was uncomplicated in our series, “ Wilson said. “I use [the technique] seldom because I’m more comfortable doing an IOL exchange, even when it’s in the bag, but I still think this is a viable option.” – by Patricia Nale, ELS
Reference:
Wilson ME. Are piggyback IOLs recommendable for children? Presented at: American Association for Pediatric Ophthalmology and Strabismus annual meeting; March 28 to 31, 2019; San Diego.
Disclosure: Wilson reports no relevant financial disclosures.