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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 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, Quattro) hydrophobic : 6 (AR40) - PMMA : 2 (CP60)
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 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
Patients and METHODS IOLs power distribution: Equally distributed between anterior and posterior IOLs
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
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 29 Eyes Mean VA: P 4.3; Range: P 8 to P 2
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 Near BCVA With distance correction Near BCVA With near correction 8 7 6 5 4 3 2 1 0
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