Piggyback Intracapsular Multifocal and Toric IOLs
Narrative Responses:
Purpose
Currently there is no United States-approved combination multifocal toric IOL to treat concurrently both presbyopia and astigmatism. This study demonstrates the use of piggyback IOLs as a novel approach in treating patients with these two conditions.
Methods
Unrandomized, uncontrolled prospective study of cataract extraction (CE) by phacoemulsification with piggyback intracapsular IOLs. Patients were chosen based on astigmatic error and desire for multifocality. Patients with pre-existing conditions were excluded from analysis. All patients received a one piece acrylic MFIOL implanted into the capsular bag followed by a silicone plate toric IOL. The use of dissimilar material theoretically increases adherence and reduces interlenticular membranes and IOL rotation. In order to routinely calculate IOL power with this novel approach, IOL constants were optimized using Holladay II calculations, yielding an optical A-constant 119.26, ACD 5.7, SF of 1.94.
Results
32 patients, mean age of 65, and 52 eyes underwent CE with follow up of 30.7 ±23 days. 3 eyes were excluded (2 with macular scars and 1 with AMD). Mean preoperative (preop) corneal curvatures and astigmatism were 42.9 ±1.8D, 43.9 ±5.9D, and 1.9 ±1.0D respectively. Preop best corrected visual acuity (BCVA) in logmar was 0.23, postoperative (postop) uncorrected visual acuity (UCVA) was 0.21 and postop BCVA was 0.08 (p<0.001). Preop near BCVA was 0.18 with postop near UCVA 0.14. Preop manifest astigmatism was 1.42 ±0.6D with postop of 0.135 ±0.19D (p<0.01).
Conclusion
Uncomplicated phacoemulsification with piggyback intracapsular MFIOL and toric IOL yielded a significant improvement in BCVA and reduction of manifest astigmatism. An improvement in near UCVA was observed. Postoperatively, anterior segment crowding was absent, no IOL rotated, and patient satisfaction was very high.