Secondary piggyback implantation versus IOL exchange for symptomatic pseudophakic residual ametropia

  • Hatem E. El Awady
  • Asaad A. Ghanem
Refractive Surgery



To evaluate the safety and efficacy of implanting a secondary IOL in comparison with IOL exchange to correct residual spherical refractive error after cataract surgery.


This prospective case series included 23 pseudophakic eyes of 23 patients. They were divided into two groups: group I included 12 eyes for whom secondary piggyback IOL implantation in the ciliary sulcus was done, and group II included 11 eyes for whom IOL exchange was done. The mean follow up was 18 ± 4.2 months and 20 ± 3.6 months in groups I and II respectively. The visual and refractive outcomes were evaluated, and any intraoperative or postoperative complications was recorded.


The mean spherical equivalent in group I (secondary piggyback implantation), was reduced from −6.2 ± 2.2 diopters preoperatively to −0.28 ± 0.59D postoperatively in myopic eyes and from 4.79 ± 1.02D to 0.03 ± 0.74D in hyperopic eyes. Ninety-two percent of eyes were within ±0.5D of intended correction. In group II (IOL exchange), the mean SE was reduced from −5.88 ± 3.1D preoperatively to 0.16 ± 1.09 D postoperatively in myopic eyes and from 5.05 ± 0.93D preoperatively to 0.11 ± 0.69D postoperatively in hyperopic eyes. Eighty-two percent of eyes had postoperative SE within ± 0.5D of the intended correction. UCVA improved significantly in both groups. Rupture of the posterior capsule occurred in one eye in group II. Only one eye in group II lost one line of BCVA.


Secondary piggyback implantation in the ciliary sulcus is an effective, safe, and easy treatment for a pseudophakic ametropia.


Secondary piggyback IOL exchange Pseudophakic ametropia 



The authors thank Taha Baker for his care and diligence during the writing of the paper.

Declaration of interest

None of the authors has a financial or proprietary in any material or method mentioned. The authors alone are responsible for the content of the paper.

Financial support



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Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  1. 1.Mansoura Ophthalmic Center, Faculty of MedicineMansoura UniversityMansouraEgypt

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