Piggyback Intraocular Lens Implantation For The Treatment Of Cataract In Children: A Case Report

Published 2025 - 43rd Congress of the ESCRS

Reference: PO072 | Type: Case Report | DOI: 10.82333/mx9s-nc94

Authors: Yuchen Wang* ¹ , Xuemin Li ¹

¹ophthalmology,Peking University Third hospital,beijing,China

Purpose

A 4-year-old child with congenital cataract who underwent piggyback intraocular lens (IOL) implantation was reported. Combined with the age and target diopter of this child, +1.0D hyperopia was reserved. Due to the large IOL diopter required for correction as the target diopter, which exceeds the maximum diopter of common single-focus IOL, piggyback IOL implantation is applied for children. Piggyback IOL, also known as double IOL, has not been used to treat cataract in children with short ocular axis in China. In addition, piggyback IOL implantation is risky, with the possibility of secondary glaucoma and other complications. Therefore, the implantation of piggyback IOL, especially for children with cataract, is worth further discussion.

Setting

The patient is a 4-year-old male. In April 2020, the patient's family complained that the child had unclear binocular vision. In July, he had an eye exam in the hospital, and the test results were too inaccurate to measure.He went to the hospital for treatment. The patient was born naturally at full term with a normal birth weight. He had no history of oxygen inhalation or eye disease. His mother had no infection during pregnancy, no history of medication, and a history of congenital cataract.

Report of case

The OD was 0.1 and 0.3 when corrected. the OS was 0.05, and 0.3 when corrected.The pressure in both eyes was normal. There was no deviation or nystagmus in both eyes. The articular opacity of both eyes was located on the optic axis and blocked the pupil hole. No obvious abnormalities were observed in other parts of the front of the eye.An ultrasound results showed that the ocular AL of the right eye was 19.67 mm and the corneal curvature was 43.85D when the horizontal axis was 176°. The corneal curvature at 86° was 47.39D.The Pentacam test showed a depth of 2.74 mm in the right eye and 2.70 mm in the left eye.

After calculation, the implanted Iols were 30.0D ZCB00 and 4.0D HOYA IOL in the right eye and 30.0D ZCB00 and 5.0D HOYA IOL in the left eye. The ZCB00 IOL was implanted into the capsular bag and the posterior capsular clamp was performed. The HOYA IOL was implanted into the ciliary groove and placed in parallel, with an Angle of 90° between the lens loops. The patient recovered well after surgery. One month after the operation of amblyopia training, the patient was 2.0DS with -3.0DC in OD, the corrected visual acuity was 0.8, the distance between the posterior surface of the human crystalline body of the ciliary sulcus and the anterior surface of the intraocular lens in the capsule was 0.715mm. OS is 1.75DS with -1.50DC, corrected visual acuity 0.9, posterior surface of ciliary sulcus intraocular lens 0.676mm from anterior surface of intraocular lens in pouch.

Conclusion/Take home message

In summary, there were problems with using piggyback IOL in children. These problems included immature lens diopter calculation and postoperative complications. We also need to compare early and long-term postoperative complications between piggyback IOL and single IOL. However, we have gradually developed a formula for predicting myopia drift after cataract surgery in children, and we have also agreed on a theoretical calculation formula for the change in diopter of the intraocular lens implanted in the ciliary groove. As a result, there is now a theoretical basis for calculating piggyback intraocular lens diopters, which makes it possible to achieve the expected reserve diopter of children with cataracts after surgery.