Clinical Outcomes of Piggybacking a One-Piece IOL With a Three-Piece IOL in Eyes With Nanophthalmos

Abstract

Purpose: To compare the nanophthalmic eyes in which a three-piece intraocular lens (IOL) along with a one-piece IOL and two one-piece IOLs were used for piggyback IOL implantation into the capsular bag. Methods: This retrospective comparative case series included 61 eyes of 31 patients. Group 1 consisted of 31 eyes of 16 patients who underwent piggyback implantation of a one-piece IOL along with a three-piece IOL into the capsular bag. Group 2 consisted of 30 eyes of 15 patients who underwent piggyback implantation of two one-piece IOLs into the capsular bag. IOL spherical power was determined by calculating the arithmetic mean of the Holladay 1 formula and Hoffer Q formula, targeting emmetropia. Main outcomes were postoperative visual acuity and refraction, IOL centration and tilt, and complications. Results: The mean postoperative follow-up time was 15.6 ± 5.2 months in Group 1 and 14.8 ± 4.3 months in Group 2 ( P = .51). There was no significant difference between the two groups in terms of preoperative and postoperative spherical equivalent ( P = .52 and .42, respectively). Twenty-six eyes (83.8%) in Group 1 and 26 eyes (86.60%) in Group 2 were within ±1.50 D of emmetropia. Mean IOL decentration was significantly lower in Group 1 (0.03 ± 0.08 mm) than Group 2 (0.14 ± 0.18 mm) ( P = .003). The mean IOL tilt was 1.45 ± 2.94 degrees in Group 1 and 4.00 ± 4.23 degrees in Group 2 ( P = .008). Conclusions: Piggyback implantation of a three-piece IOL combined with a one-piece IOL provides less IOL decentration and tilt in patients with nanophthalmos. The use of the arithmetic mean of the Holladay 1 and Hoffer Q formulas for IOL power calculation provides more accurate results. [ J Refract Surg . 2022;38(12):812–818.]