Implantation Of Toric Intraocular Lenses (Iols) Overlaying Minus Power Monofocal Piggyback Iols In A Young Patient With High Myopia And Astigmatism

We reported a case of a 33-year-old Asian male patient with high myopia and astigmatism who had been treated with the implantation of an AvanseeTM Preload 1P Toric clear Intraocular Lens (IOL) (Kowa, Japan) with an overlaying PrecizonTM Monofocal 1P minus Piggyback IOL (Ophtec, Netherland). This procedure was selected due to the combination of his thin cornea and high myopia, which would result in suboptimal outcomes if he underwent LASIK surgery.

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

The patient’s preoperative 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 patient preferred not to use a full prescription glasses as he found that using it was both uncomfortable and headache inducing. The necessary IOL power for the patient 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 AvanseeTM Toric single piece IOL with an overlaying PrecizonTM minus piggyback single piece IOL was performed successfully and without complication. At 6 months post surgery, 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. He reported a high level of satisfaction and was able to return to his daily activities as a nurse, which includes doing vision-heavy activities such as reading and driving.

We report a successful primary of Toric IOLs overlaying with minus power monofocal single piece IOL using a piggyback configuration in patient with high myopia and astigmatism. Long term follow-up and further evaluations are necessary in order to establish implantation of Toric IOL and monofocal IOL with piggyback configuration as an accepted lower-cost treatment for high myopia and astigmatism.