Long-Term Refractive Stability After Piggyback Implantable Collamer Lens In A Pseudophakic Eye: A Case Report

To report a case of long-term refractive stability and safety following piggyback ICL implantation for the correction of pseudophakic ametropia, with a follow-up of 10 years.

This case was managed at the Department of Ophthalmology, Unidade Local de Braga, Braga, Potugal, in 2025.

A female patient in her 50s with high myopia presented with symptomatic anisometropia four years after pars plana vitrectomy and subsequent cataract surgery in the left eye. Refractive errors caused visual dissatisfaction (RE: −7.00 −2.00 × 60, LE: −3.50 −0.75 × 80). Slit-lamp and fundus examinations were unremarkable. A staged surgical approach was performed: cataract extraction with monofocal IOL implantation in the right eye followed by piggyback ICL V4c implantation in the left eye, with lens sizing and power calculated based on anterior chamber depth, white-to-white distance and manifest refraction. Six weeks postoperatively, uncorrected distance visual acuity (UDVA) was 8/10 in both eyes and best-corrected visual acuity (BCVA) reached 10/10. Residual refractive errors were minimal (RE: −0.75 × 65, LE: +0.75 × 155). At 10-year follow-up, the piggyback ICL remained stable in the ciliary sulcus anterior to the capsular bag IOL, with a vault of 0.85 mm. No complications occurred, intraocular pressure remained within normal limits and endothelial cell counts were preserved (RE: 1950 cells/mm², LE: 1860 cells/mm²). The patient reported high satisfaction and required correction only for near tasks, with no halos, glare, or dysphotopsia.

Pseudophakic ametropia is residual refractive error after cataract surgery with intraocular lens implantation, affecting visual quality and patient satisfaction. Correction options include IOL exchange, corneal laser refractive surgery and secondary IOL implantation using the piggyback technique.  Recently, implantable collamer lenses have emerged as a supplementary piggyback option. Piggyback ICL implantation is a safe, effective and durable option for correcting pseudophakic ametropia, providing excellent long-term visual and refractive outcomes. This case demonstrates stability, safety, and high patient satisfaction over a 10-year period, supporting the role of ICL piggyback lenses in selected pseudophakic patients.