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PIGGYBACK IMPLANTATION OF FOR HIGH HYPEROPIA 24 MONTHS FOLLOW UP

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:

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PIGGYBACK IMPLANTATION OF FOR HIGH HYPEROPIA 24 MONTHS FOLLOW UP

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  1. 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

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

  3. 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)

  4. Patients and METHODS • CCI: 3.5 mm / Limbal: 6 mm • Phacoemulsification • 2 PCI in the bag : - Silicone : 13 (SI 40) - Acrylic hydrophilic : 9 (Stabibag, Quattro) hydrophobic : 6 (AR40) - PMMA : 2 (CP60)

  5. Patients and METHODS • Axial length : - Mean : 20.97 mm - Min : 19.75 mm - Max : 22.16 mm

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

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

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

  9. 1,5 1 0,5 0 -0,5 -1 -1,5 -2 -2,5 1 4 7 10 13 16 19 22 25 28 RESULTS: SE Postop SE postop Eyes Mean SE : -0,50 D ; Range : -2.25 to +1.50 D

  10. 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+

  11. 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

  12. 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 29 Eyes Mean VA: P 4.3; Range: P 8 to P 2

  13. 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

  14. RESULTS : Near BCVA with distance correction VA mean :P 3.7 ; min : P 8 ; max : P 2

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

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

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

  18. 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)

  19. 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)

  20. 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

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

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

  23. 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

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

  25. 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

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

  27. 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

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