PIGGYBACK IMPLANTATION OF FOR HIGH HYPEROPIA 24 MONTHS

PIGGYBACK IMPLANTATION OF FOR HIGH HYPEROPIA 24 MONTHS FOLLOW UP JL. FEBBRARO I. VIELPEAU, F. KRIFA, S. BERBACHE, S. GANEM Department of Ophthalmology S. GANEM M. D. Rothschild Foundation - Institut de la myopie Paris - France

INTRODUCTION GAYTON 1993: First piggyback implantation in cataract surgery to obtain emmetropia in extremely short eyes.

PATIENTS and methods • • • Retrospective study 30 eyes, 20 patients Mean age : 70 years (range : 8 – 90 Y) Sexe : 16 women, 4 men Mean follow-up : 18 M (range : 6 to 30 M)

Patients and METHODS • CCI: 3. 5 mm / Limbal: 6 mm • Phacoemulsification • 2 PCI in the bag : - Silicone : 13 (SI 40) - Acrylic hydrophilic : 9 (Stabibag, hydrophobic : 6 (AR 40) - PMMA : 2 (CP 60) Quattro)

Patients and METHODS • Axial length : - Mean : 20. 97 mm - Min : 19. 75 mm - Max : 22. 16 mm

Patients and METHODS IOL calculation formula: Combined Holladay / SRK/T

Patients and METHODS Diopters 35 30 25 20 15 10 5 0 1 4 7 10 13 16 19 22 25 28 31 Eyes Total IOL emmetropic power : + 26 D to + 32 D

Patients and METHODS IOLs power distribution: Equally distributed between anterior and posterior IOLs

RESULTS: SE Postop SE postop 1, 5 1 0, 5 0 -0, 5 -1 -1, 5 -2 -2, 5 1 4 7 10 13 16 19 22 25 28 Eyes Mean SE : -0, 50 D ; Range : -2. 25 to +1. 50 D

RESULTS: Distance UCVA VA VA 20 25 30 50 100 400 1 4 7 10 13 16 19 22 25 28 Eyes Mean VA: 20/50; Range: 20/200 to 20/25+

RESULTS: Distance BCVA VA 20 25 30 50 100 400 1 4 7 10 13 16 19 22 25 28 Eyes Mean VA: 20/30+ Range: 20/100 to 20/20

RESULTS: Near UCVA Parinaud (P) 8 7 6 5 4 3 2 1 0 1 3 5 7 9 11 13 15 17 19 21 23 25 27 Mean VA: P 4. 3; Range: P 8 to P 2 29 Eyes

RESULTS: Near BCVA Parinaud (P) 5 4 3 2 1 0 1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 Eyes Mean VA: P 2. 5; Range: P 5 to P 2

RESULTS : Near BCVA with distance correction VA mean : P 3. 7 ; min : P 8 ; max : P 2

RESULTS: Near VA Pseudoaccomodation ? Near UCVA 8 7 6 5 4 3 2 1 0 Near BCVA With distance correction Near BCVA With near correction

RESULTS: Complications • Decentration : 1 case at 3 months PO

RESULTS: Complications • Decentrement : 1 case at 3 months post op • Hyperopic shift : 3 cases

RESULTS: Complications • Decentrement : 1 case at 3 months • Hyperopic shift : 3 cases • PCO : - at 3 months : 3 cases without LBCVA - at 1 year : 4 cases (2 YAG) - at 2 years : 6 cases (4 YAG)

RESULTS : Complications • Decentrement : 1 case à 3 months • Hyperopic shift : 3 cases • PCO : - at 3 months : 3 cases without LBCVA - at 1 year : 4 cases (2 YAG) - at 2 years : 6 cases (4 YAG) • Pigment deposit between IOLs : 1 case at 8 months with 3 lines of loss BCVA (20/40)

RESULTS : Complications • Decentration : 1 case at 3 months PO • Hyperopic shift : 3 cases • PCO : - at 3 months : 3 cases without LBCVA - at 1 year : 4 cases (2 YAG) - at 2 years : 6 cases (4 YAG) • Pigment between IOLs : 1 case at 8 months with 3 lines of LBCVA (20/40) • Interface opacification : 0 case

DISCUSSION • Advantages of Piggyback : - Less spherical aberrations - Pseudoaccomodation - Wound size Ref : Gayton JL: J Cataract Refract Surg 1993 ; 19 : 776 -777

DISCUSSION • Inconvenients of Piggyback : - Interface opacification - Hyperopic shift - Surgical technique - Cost Ref : Shugar JK. J Cataract Refract Surg 1999 ; 25 : 863 -867

DISCUSSION • Which is the most appropriate IOL calculation formula? HOLLADAY, HOFFER Q, SRKT >>> SRKI & SRKII Ref : Shugar J, Lewis C, Lee A: J. cataract refract surg 1996 ; 22 : 1368 -1372 Holladay JT, Gills JP, Leidlein J: Ophtalmology 1996 ; 103 : 1118 -1123

DISCUSSION • Which is the best type of IOL ? Silicone, acrylic hydrophilic or hydrophobic, PMMA ? Key points : - Biocompatibility (interface opacification) - Resistance to secondary deformation

DISCUSSION • Prevention of interface opacification: - Large CCC - Meticulous I/A - Implantation bag/sulcus - IOL (acrylic hydrophilic/phobic) - Haptics perpendicular Ref : Masket S JCRS April 1998

CONCLUSION • Seducing technique in extremely short eyes: IOL power > 29 D • Secondary indications: Pseudophakic eyes with refractive errors

CONCLUSION • Satisfactory results in our study in terms of reliability and refractive results • Necessity of longer follow up to assess the best type of IOL and the most appropriate site of implantation