Official ESCRS | European Society of Cataract & Refractive Surgeons
Copenhagen 2016 Registration Programme Exhibitor Information Virtual Exhibition Satellite Meetings Glaucoma Day 2016 Hotel Star Alliance

10 - 14 Sept. 2016, Bella Center, Copenhagen, Denmark

This Meeting has been awarded 27 CME credits


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Low diopter piggy-back ICL for correcting residual refractive error after multifocal IOL implantation: a prospective study

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Session Details

Session Title: Keratoconus and Phakic IOLs

Session Date/Time: Monday 12/09/2016 | 16:30-18:30

Paper Time: 18:09

Venue: Hall C4

First Author: : G.Duncker GERMANY

Co Author(s): :    C. Buchholz   T. Duncker                 

Abstract Details


To assess the effectiveness of the STAAR Surgical Visian Toric Implantable Collamer Lens (VTICL) for the correction of residual myopia/hyperopia with astigmatism after MIOL in-the-bag implantation. In order to assess efficacy, the following data have been gathered over half a year: Improvement of Uncorrected Visual Acuity (UCVA), decrease in refractive myopia/hyperopia and cylinder, predictability (i.e., intended correction vs. achieved correction for spherical and cylindrical components including distribution of axis shifts), stability of the refractive outcome (i.e., change in manifest sphere and cylindrical outcomes over time), rotation of the Visian Toric ICL and vault.


This prospective, open, monocenter study was conducted at the Institute of Ophthalmolgy, Halle, Germany.


The planned number of eyes to be operated on were 30 of 30 patients. All patients were operated on by one surgeon (GD) using an eyetracker device (SMI, Verion).The inclusion criteria were as follows: All patients with in-the-bag multifocal posterior chamber IOL´s having a residual refractive error: Myopic compound astigmatism: SEQ ≥ 0.75 D or any mixed astigmatism (sphere ≥0.5 D, cyl ≥ 0.5 D), compound hyperopic astigmatism: SEQ ≥ 0.75 D, age 30 to 80 years, expected increase of UCVA minimum two lines. MIOL in-the-bag implantation should have been performed at least 3 months prior to piggy-back implantation.


UCVA increased from 0.49 to 1.08 on the average. Refractive myopia decreased from – 0.92 to + 0.12 D. Refractive hyperopia decreased from + 1.1 to +0.04 D. Refractive cylinder decreased from - 1.05 to – 0.47 D. Astonishingly, the subjective refraction became stable already 7 to 14 days postoperatively. Regarding the position of the toric ICL, the axis deviation was 4.3° on the average. However, this had little impact on the subjective refraction. The rotation of the ICL remained stable throughout the study period. The vertical vault, measured by Scheimpflug imaging, was 1497µ and the horizontal measurements revealed 1467µ on the average.


Minor refractive errors can result in significant reduction of UCVA after MIOL insertion. This study shows that low diopter piggy-back ICL is a suitable and reversible measure to increase UCVA in multifocal patients.

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