A Novel Concept Of Correcting Pseudophakic Residual Presbyopia Using Off Label Presbyopic Phakic Diffractive Intraocular Lens

We report a case of a pseudophakic patient with  residual  presbyopia who received off -label placement of a presbyopic phakic intraocular lens (pIOL)

resulting in improved near visual acuity

Retrospective non comparative   clinical study was conducted in a  tertiary care ophthalmology hospital setup in India .

A 48 year old female patient  beautician by profession came with history of cataract surgey with Alcon Vivity EDOF(Non Diffractive ) PCIOL implantation done in both eyes one year back came with complaint of difficulty in near vision in Right eye.She also gave history of another surgery done for the Left eye with piggyback PCIOL implantation.After examination she was emmetropic for distance vision 6/6 (20:20)  and  unaided J5(20:40 ETDRS) for near vision.She required +2.D for J1(20:20 ETDRS) near vision in Right eye.In the left eye she was unaided 6/18 (20:60 ) for distance, improved with -.2 .0 D to 6/6 (20:20) and unaided J2(20:25 ETDRS) for near vision.She was unhappy because she became myopic from emmetropia in the left eye.She wanted solution for right eye so that she could do her near work without glasses.After examining visual acuity on different distances, refractive status,corneal topography,endothelial cell density,anterior chamber depth,white-to white,mesopic pupil size,and intraocular pressure ,we decided to implant this novel phakic IOL with diffractive optic in the Right eye. We examined all above parameters immediately and  four weeks after surgery.

  At the follow up 4 weeks after surgery operated eye was emmetropic 6/6 (20:20) for distance and  J1 (20:20) for near.Near vision was excellent without the need to wear reading glasses.There was neither a significant change in IOP nor a significant sugical impact on endothelial cells.Patient satisfaction was high.

Our case demonstrates successful use of The presbyopic phakic IOL by a piggyback technique in a pseudophakic patient with residual presbyopia,resulting in improved near visual acuity.