Primary sulcus implantation of a diffractive CrossMark 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 sulcus placement (Reverso). Setting: Purpan Hospital, Toulouse, and Helios Clinic, Saint-Jean-de-Luz, France. Design: Prospective case series. Methods: The multifocal IOL piggyback IOL was implanted in the sulcus during 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, monocular uncorrected distance (UDVA) and near (UNVA) visual acuities were 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 monocular logMAR UDVA, corrected distance visual acuity, UNVA, and corrected near visual acuity were 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 sulcus multifocal IOL and the monofocal IOL was 517 +/- 141 mu m. At 1 year, ultrasound biomicroscopy showed 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. (C) 2018 ASCRS and ESCRS