Primary sulcus implantation of a diffractive multifocal pseudophakic piggyback intraocular lens

Purpose To evaluate the efficacy and safety of the combined implantation of a monofocal intraocular lens (IOL) in the capsular bag with a diffractive multifocal IOL designed for sulcusplacement (Reverso). Setting Purpan Hospital, Toulouse, and HeliosClinic, Saint-Jean-de-Luz, France. Design Prospective case series. Methods The multifocal IOL piggyback IOL was implanted in the sulcusduring cataract surgery. Visual acuity, defocus curve, contrast sensitivity, IOL positioning, and patient satisfaction were assessed with 1-year follow-ups. Results Fifty-four eyes of 27 patients were included. At 1-month, monocularuncorrected distance (UDVA) and near (UNVA) visual acuitieswere 0.13 logarithm of the minimum angle of resolution (logMAR) ± 0.18 (SD) and 0.20 ± 0.16 logMAR, respectively. Binocular UDVA and UNVA were 0.03 ± 0.06 and 0.12 ± 0.08 logMAR, respectively. At 1 year, the mean monocularlogMAR UDVA, corrected distance visual acuity, UNVA, and corrected near visual acuitywere 0.10 ± 0.11, 0.02 ± 0.06, 0.18 ± 0.12, and 0.13 ± 0.08, respectively. The defocus curve and contrast sensitivity values were comparable to those obtained with other multifocal IOLs. On Scheimpflug imaging, the mean distance between the sulcusmultifocal IOL and the monofocal IOL was 517 ± 141 μm. At 1 year, ultrasound biomicroscopyshowed an annular fibrosis of the anterior capsule in 94.4% of the eyes. Complications included 1 posttraumatic IOL decentration and 1 slight corectopia. Eighty-nine percent of patients reported satisfaction. Conclusions The piggyback implantation of this multifocal IOL seemed to be safe and effective. It might provide similar results as a primary in-the-bag multifocal IOL, with the advantage of reversibility that might extend primary or secondary implantation.