• Refractive Mgmt/Intervention

    This prospective noncomparative case series study evaluated the results of piggyback collagen collamer lens (ICL) implantation for correction of pseudophakic refractive error after cataract surgery.

    Study design

    All 18 patients were not candidates for laser vision correction (LVC) enhancements. Patients received either the V4C or V4B models of Visian ICL (STAAR Surgical) for myopia and hyperopia, respectively, and were followed for 18 months.


    Mean manifest refraction spherical equivalent improved from -3.08 D to -0.44 D after ICL placement. Mean UDVA improved from 1.03 logMAR at baseline to 0.05 logMAR at month 18, and CDVA improved from 0.47 to -0.006 logMAR. No interlenticular opacification, also known as red rock syndrome, was observed. Mean endothelial cell count diminished significantly during the first year (P<0.001), then remained relatively stable for the next 6 months.


    The biggest limitation to this study is the low number of enrolled subjects. However, this is expected given that only patients who were not LVC candidates qualified. In addition, only the myopic V4C model is available in the United States.

    Clinical significance

    Currently, treatment of post-cataract ametropia is limited to IOL exchange, LVC enhancement and piggyback IOLs. As not all patients are candidates for LVC and IOL exchange carries significant risk, having another option that is effective and highly reversible is quite advantageous.

    In addition, the vaulted design of this ICL maintains a large space between itself and the main IOL, reducing the risk of complications such as interlenticular opacification, as was seen in this small study.