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
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
RESULTS: Distance UCVA 

RESULTS: Distance BCVA
RESULTS: Near UCVA
RESULTS: Near BCVA
RESULTS : Near BCVA 
with distance correction
RESULTS: Near VA Pseudoaccomodation ?
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