Safety of piggyback intraocular lenses (polypseudophakia) in children: long-term outcomes of a 15-year, single-surgeon study

Purpose To report the outcomes of piggyback (PB) intraocular lens (IOL) implantation, or temporary polypseudophakia, in children who have undergone cataract surgery and to assess their safety in pediatric patients. Methods The medical records of consecutive patients who underwent PB IOL implantation at a single institution over a period of 15 years were reviewed retrospectively. Outcome measures were reoperation rate, complications, and outcome of planned explantation. Results A total of 48 eyes of 38 children received PB IOL implantation: 40 eyes at the time of cataract surgery and 8 eyes as a later secondary procedure. Of these, 38 eyes of 31 patients with primary PB IOL implantation had follow-up of >3 years and were included in the present analysis. Median age at cataract surgery with PB IOL implantation was 6.5 months (0.5 months to 2.4 years). Median follow-up was 12.5 years (range, 3.0-20.7). Four eyes required reoperation for adverse events related to PB IOL implantation (1 each for IOL tilt, pupillary capture, pupillary block glaucoma, and pupillary membrane). All 4 of these eyes were operated for cataract before 3 months of age. The sulcus-fixated PB IOL underwent a planned explantation in 33/38 eyes. Eight eyes needed intraocular pressure–lowering topical medications. Planned PB IOL explantation was uncomplicated in our series. Conclusions Early complications occurred in 4 eyes, but late complications were not noted, and glaucoma developed at predictable rates for this population. Piggyback IOL placement in our cohort of young children appears to have an acceptable safety profile. To report the outcomes of piggyback (PB) intraocular lens (IOL) implantation, or temporary polypseudophakia, in children who have undergone cataract surgery and to assess their safety in pediatric patients. The medical records of consecutive patients who underwent PB IOL implantation at a single institution over a period of 15 years were reviewed retrospectively. Outcome measures were reoperation rate, complications, and outcome of planned explantation. A total of 48 eyes of 38 children received PB IOL implantation: 40 eyes at the time of cataract surgery and 8 eyes as a later secondary procedure. Of these, 38 eyes of 31 patients with primary PB IOL implantation had follow-up of >3 years and were included in the present analysis. Median age at cataract surgery with PB IOL implantation was 6.5 months (0.5 months to 2.4 years). Median follow-up was 12.5 years (range, 3.0-20.7). Four eyes required reoperation for adverse events related to PB IOL implantation (1 each for IOL tilt, pupillary capture, pupillary block glaucoma, and pupillary membrane). All 4 of these eyes were operated for cataract before 3 months of age. The sulcus-fixated PB IOL underwent a planned explantation in 33/38 eyes. Eight eyes needed intraocular pressure–lowering topical medications. Planned PB IOL explantation was uncomplicated in our series. Early complications occurred in 4 eyes, but late complications were not noted, and glaucoma developed at predictable rates for this population. Piggyback IOL placement in our cohort of young children appears to have an acceptable safety profile.