Cataract Surgery Using Piggyback Method in Patient With Nanophthalmos

Jong Wook Lee; Won Suk Choi; Young Jeung Park; Kyoo Won Lee

doi:10.3341/jkos.2010.51.7.1016

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Lee, Choi, Park, and Lee: Cataract Surgery Using Piggyback Method in Patient With Nanophthalmos

Original Article

J Korean Ophthalmol Soc 2010;51(7):1016-1022.

Published online: 31 August 2010

DOI: https://doi.org/10.3341/jkos.2010.51.7.1016

Cataract Surgery Using Piggyback Method in Patient With Nanophthalmos

Jong Wook Lee, MD, Won Suk Choi, MD, Young Jeung Park, MD, PhD, Kyoo Won Lee, MD, PhD

Cheil Eye Hospital, Daegu, Korea

Address reprint requests to Young Jeung Park, MD, PhD Cheil Eye Hospital #803-2 Sinam-dong, Dong-gu, Daegu 701-011, Korea Tel: 82-53-959-1751, Fax: 82-53-959-1758, E-mail: eyepark9@dreamwiz.com

Received 9 13 2009 Accepted 5 18 2010

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To report a case of cataract surgery using a piggyback method in a patient with pure nanophthalmos with an axial length under 16.00 mm in both eyes.

Case summary

The authors performed cataract surgery using a piggyback method inserting two intraocular lenses (IOLs) in a 44-year-old male with nanophthalmos with axial lengths of OD 15.36 mm, and OS 15.59 mm. Primary implantation of two IOLs of +53.0D as calculated by the SRK/T and Holladay formula was performed in the right eye using a piggyback method. In the left eye, two IOLs of +60.0D calculated by the Hoffer Q formula were implanted. Postoperative hyperopic refractive errors oc-curred in both eyes. The differences between the preoperative target spherical equivalent (SE) and the postoperative one year four month SE were 9.68D in the right eye and 1.63D in the left eye.

Conclusions

Due to high diopter IOL requirements in nanophthalmic patients (less than 16.00 mm) during cataract surgery, the refractive errors were well corrected, without complications, by using a piggyback method. In the present case study, the Hoffer Q formula produced better results than did the SRK/T or Holladay formula in reducing the difference in preoperative and post-operative SEs, but more surgical cases and research are required to establish the most appropriate formula for cataract surgery in nanophthalmos.

Keywords: Nanophthalmos, Piggyback method

References

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Figure 1.

A and B-scan (measured by US-3000^® (NIDEK, Japan)) image showing the axial lengths of the nanophthalmos patient (A and B: OD, C and D: OS)

Figure 2.

Slit lamp photography at post-op 1year 4months (A: Shows 2 well-placed IOLs in the capsular bag. B: Posterior capsular opacity or interlenticular opacity were not observed upon retroillumination.)

Table 1.

IOL power calculation* and the difference between predicted target and actual postoperative refraction

Eye	OD	OS
Axial length (mm)	15.36	15.59
Keratometry reading (D^†)	49.20@177°/51.06@87°	49.63@3°/52.08@93°
Formula	SRK/T	Hoffer Q
Target refraction (D)	+0.07	+0.10
IOL power (D)	53.0	62.0
Actual IOL power (D) (anterior+posterior)	53.0 (30+23)	60.0 (30+30)
Refraction at pre-op (D) (Sphere (D) / Cylinder (D) / Axis(°))	+16.0 / −2.50 / 180	+14.0 / −2.50 / 20
Spherical equivalent at pre-op (D)	+14.75	+12.75
Refraction at post-op 1 month (D) (Sphere (D) / Cylinder (D) / Axis (°))	+10.75 / −2.25 / 5	+4.00 / −3.00 / 30
Spherical equivalent at post-op 1 month (D)	+9.63	+2.50
Difference of predicted target refraction and post-op 1 month refraction (∆D^‡)	9.56	1.00
Refraction at post-op 1 year 4months (D) (Sphere (D) / Cylinder (D) / Axis (°))	+10.50 / −1.50 / 7	+4.75 / −3.25 / 20
Spherical equivalent at post-op 1 year 4 months (D)	+9.75	+3.13
Difference of predicted target refraction and post-op 1 year 4 months refraction (∆D)	9.68	1.63

^* IOL power was measured by IOL master

^® (Carl Zeiss, Germany)

^† D: diopter

^‡ ∆D=actual postoperative refraction-predicted target refraction.

Table 2.

IOL power and target refraction calculated by SRK/T, Holladay, and Hoffer Q formula and modified IOL power according to axial length (keratometry reading: 50.50^* D^†, measurement: IOL master^® (Carl Zeiss, Germany), Lens: AcrySof Natural SN60AT^® (Alcon, TX, USA))

Axial length (mm)	SRK/T		Holladay		Hoffer Q		Holladay^‡ IOL power +10% of IOL power (D)
Axial length (mm)	IOL power (D^†)	Target refraction (D)	IOL power (D)	Target refraction (D)	IOL power (D)	Target refraction (D)	Holladay^‡ IOL power +10% of IOL power (D)
20.50	24.5	0.03	23.5	0.14	24.0	0.20	25.85
20.00	26.5	0.12	25.5	0.04	27.0	−0.10	28.05
19.50	29.0	−0.06	28.0	−0.04	29.5	0.10	30.8
19.00	31.5	−0.17	30.5	−0.04	32.5	0.10	33.55
18.50	33/5	0.15	33.0	0.05	36.0	0.00	36.3
18.00	36.5	−0.14	36.0	−0.12	39.5	0.10	39.6
17.50	39.0	0.03	39.0	−0.17	43.5	0.10	42.9
17.00	42.0	−0.05	42.0	−0.10	48.0	0.00	46.2
16.50	45.0	0.00	45.0	0.12	52.5	0.20	49.5
16.00	48.5	−0.17	48.5	0.13	58.0	−0.10	53.35
15.50	51.5	0.18	52.5	−0.06	63.5	0.00	57.75
15.00	55.5	−0.03	56.5	−0.04	69.5	0.10	62.15

^* Keratometry reading of our patient

^† D: diopter

^‡ IOL power calculating method in journal of Oshika et al.

^1. All three formulas present bigger increments of IOL power as axial length decreases. Moreover, Hoffer Q¹⁶ formula presents far greater increments above other formulas.

^2. When there were axial lengths of 16.50∼20.50 mm, IOL powers were similar between Hoffer Q formula and method journal of Oshika et al.¹⁷

^3. When there is axial length of below 16.00 mm, difference of IOL power between Hoffer Q formula and method in journal of Oshika et al¹⁷ was above 4.65D.

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