1. Tamer M. El-Raggal, MD, PhD, FRCSEd Magrabi Eye Hospital, Cairo
2ry piggyback IOL exchange LASIK for correction of ametropia after cataract surgery
Tamer M. El-Raggal, MD, PhD, FRCSEd
Ain Shams University
Magrabi Eye Hospital, Cairo
Egypt
No financial interest

2. Introduction - A-scan errors (in patients with long eyes) & lack of
Causes of refractive surprise after cataract surgery
- Mistakes in corneal measurements after RS.
- A-scan errors (in patients with long eyes) & lack of
precision in patients with short eyes.
- Human error.
- Mislabelling or inversion of implanted IOL.
Solutions to this situation:
(1) Spectacle (2) CL
(3) Surgery
- 2ry piggyback IOL
- Exchange of original IOL
- Laser correction.
El-Raggal, T
ASCRS, 2009

3. Patients& Methods Myopic refractive error: By Holladay.
Prospective comparative study included: 15 pseudophakic eyes of 13 patients:
- 11 myopic residual refractive error hyperopic error.
Group 1: 5 eyes ry piggyback, foldable acrylic IOL in sulcus.
Group 2: 5 eyes IOL explantation with implantation of another.
Group 3: 5 eyes Customized LASIK using Visx Star S4.
Piggyback IOL power
Myopic refractive error: By Holladay.
Power of IOL = 1.0 D of desired SE change.
Hyperopic refractive error: By Gills.
Power of IOL = [1.4 X desired SE change] + 1 D.
El-Raggal, T
ASCRS, 2009

4. Results
Mean age at time of surgery ± 5.19 yrs (range 48 to 67 years).
Refractive procedures performed at mean of ± d (range 3 to 540 d) after cataract extraction.
Complications
Group 1: None
Group 2: 1 Posterior capsule rupture+ vitreous loss anterior vitrectomy+ sulcus implantation
Group 3: 2 epithelail defect ---- heald
El-Raggal, T
ASCRS, 2009

5. Group 2
Group 3
Group 1
El-Raggal, T
ASCRS, 2009

6. Conclusion
IOL exchange safe in high error with early intervention after cataract surgery.
Piggyback implantation is safer in delayed intervention.
LASIK has advantage over other 2 procedures in correction of astigmatism.
Piggyback 2ry IOL, IOL exchange & LASIK safe, effective & predictable options for correction of errors following cataract.
Although LASIK is non-invasive alternative, final UCVA not as high as in virgin eyes.
El-Raggal, T
ASCRS, 2009

7. THANK YOU