Refractive Surgery In A Pseudophakic Patient With An Epiretinal Membrane Using A Secondary Sulcoflex® Trifocal Rayner Lens Implant.

Resolution of the case by phacoemulsification and implantation of the monofocal intraocular lens in capsular bag, visual tolerance test with multifocal contact lenses and secondary implant in sulcus.

The epiretinal membrane (ERM) is a retinal pathology that involves the growth of a tissue on the surface of the macular area, which can evolve causing decreased vision and distortion of images.

The secondary sulcus implant of a Sulcoflex® Trifocal intraocular lens (IOL) provides a reversible form of multifocality.

Optical management using contact lenses, which simulate multifocal vision, is decisive for the indication of refractive surgery using a secondary implant.

A single patient with cataract and epiretinal membrane was studied and intervened. Biometric measurements were taken using optical interferometry (I.O.L. Master500). Analysis of the anterior and posterior segment is performed using Optical Coherence Tomography (OCT), Zeiss Cirrus.

72-year-old woman, multifocal contact lens wearer who wants independence from optical correction. Follow-up in the ophthalmology service of Hospital San Rafael because of progressive decrease in VA due to progressive cataract and ERM.

Phacorefractive surgery is planned in 3 steps:

• First step: phacoemulsification of the cataract and implantation of a monofocal IOL in the capsular bag.
• Second step: visual quality test using multifocal contact lenses.
• Third step: diffractive trifocal lens sulcus implantation.

Optical calculation of the lens in sulcus using the Gills method.

Two months after the second surgery, the patient is in good ocular condition and with an uncorrected visual acuity (UNCVA) of 0.0 (LogMAR) in far and near vision, and intermediate vision of 0.1 (logMAR).

The Sulcoflex® Rayner lens position features a 0.604mm Vault.

The intraocular pressure is 16 mm Hg.

The Piggy-Back technique with intraocular lenses is a reproducible surgical procedure with contact lenses, which is not only useful for the correction of large optic ametropia or refractive surprises in cataract surgery but can also be applied more frequently in those pseudophakic patients who want correction of presbyopia and have complex retinas or doubt about their visual quality with a multifocal intraocular lens in a first and only implant.