Morphological appearance and size of contact zones of piggyback intraocular lenses

J Cataract Refract Surg. 2001 Feb;27(2):219-23. doi: 10.1016/s0886-3350(00)00608-8.


Purpose: To characterize the morphology, size, and change in size of the contact zone of piggyback intraocular lenses (IOLs) of different materials and optic designs.

Setting: Department of Ophthalmology, Vienna General Hospital, Vienna, Austria.

Methods: In a prospective study, 9 eyes of 7 patients received piggyback IOLs of the following materials: poly(methyl methacrylate) (PMMA), acrylic, hydrogel, and silicone. The contact zone between the anterior and posterior IOLs was photodocumented from 1 day to 1 year after surgery using specular microscopy. The contact zone area was measured.

Results: A contact zone was present with all IOL materials studied. The area of contact, however, differed significantly. With PMMA IOLs, the contact zone was small and surrounded by Newton rings, indicating the tiny gap between the IOLs. With IOLs of soft material, such as silicone and hydrogel, it was larger than with PMMA IOLs and had a slightly irregular shape. With foldable acrylic IOLs, it was regular, round, and slightly larger than with the soft materials. The contact area enlarged primarily during the first 3 months after surgery. After 1 year, 2 eyes with acrylic piggyback IOLs had a membrane formation around the contact zone and 2 eyes developed Elschnig pearls between the IOLs.

Conclusion: In piggyback IOL eyes, the shape and size of the contact zone were strongly dependent on the IOL material and optic design. Contact area enlargement seemed to be induced by capsule shrinkage. Fibrous membrane formation around the contact zone and Elschnig pearl formation between the piggyback IOLs were long-term complications of this technique.

MeSH terms

  • Acrylates
  • Aged
  • Aged, 80 and over
  • Capsulorhexis
  • Humans
  • Hydrogel, Polyethylene Glycol Dimethacrylate
  • Lens Implantation, Intraocular*
  • Lenses, Intraocular*
  • Phacoemulsification
  • Polymethyl Methacrylate
  • Prospective Studies
  • Prosthesis Design*
  • Pseudophakia / pathology*
  • Silicone Elastomers


  • Acrylates
  • Silicone Elastomers
  • Hydrogel, Polyethylene Glycol Dimethacrylate
  • Polymethyl Methacrylate