The Stability Of Piggyback Toric And Monofocal Intraocular Lens After Refractive Lens Exchange

We reported the case of a 33-year-old Asian male patient with high myopia and high astigmatism was planned for a Clear Refractive Lens Exchange (RLE). The patient was not suitable for LASIK surgery. Toric Intraocular Lens (IOL) and monofocal IOL were prepared due to low IOL power calculation.

SILC LASIK CENTER, Dipo Business Center A2 and B1, Jakarta 10260, Indonesia

A 33-year-old Asian male patient, preoperative uncorrected visual acuity both eye was 0.5/60. The manifest refraction was -16.00 c-4.00 x15; 20/30 F2 for the right eye and -15.00 c-4.00x 165; 20/25 for the left eye.  The power of the patient’s last glasses was -9.75 c-4.00x 14; 20/200 for the right eye and -9.75 c-4.00x179; 20/70 for the left eye. The intra ocular presure was 13 mmHg onn the right eye and 14mmHg on the left eye. The value of kerato pahymeter was 484 on the right eye and 489 on the left eye. The necessary IOL power for the patient using Emersion Biometry (Sonomed^TM, Pacscan plus 300AP,USA) was -1D for the right eye and +3D for the left eye. However, the range of commercially available Kowa Avansee toric IOL is from +6 D to +30 D. To achieve emmetropia in this case, it was determined that the addition of Precizon minus piggyback IOL would be necessary.

Implantation of Avansee^TM Toric single piece IOL (Kowa,Japan) with an overlaying Precizon^TM minus piggyback single piece IOL (Ophtec, Netherland) was performed successfully and without complication. At 6 months postoperatively, the patient’s uncorrected visual acuity was 20/30 for the right eye and 20/25 F1 for the left eye. His near vision test was Jaeger 2 without glasses. The IOP was 15mmHg both eye. He reported a high level of satisfaction and was able to return to his daily activities as a nurse, this includes doing vision-heavy activities such as reading and driving.

We report successful primary piggybag implantation of toric overlaying with minus power monofocal single piece IOL in patient with high myopia and astigmatism. The visual acuity was stabil in 6 month follow-up.  Long term follow-up and further evaluation is necessary to establish piggyback IOL implantation of toric IOL and monofocal IOL as an accepted lower-cost treatment for high myopia and astigmatism.