Interesting case. I would be worried about interlenticular opacification (ILO) as we noted in past when placing both acrylic piggyback lenses in the bag for high hyperopes. I just saw an exhyperope with a dense ILO with 2 MA30 in the bag. In general I think piggybacking is most safe long term when one IOL is in the bag and the other is in the 3:44 sulcus. Typically with one made of silicone and the other of acrylic. This alternative configuration presumably makes it harder for the epithelial cells to find their way between the lenses as they can when both IOLs are in the bag. Hopefully in this case this will not be a problem. Thank you for sharing these interesting cases.
Wow, I haven’t listened to the podcast yet, but I was always taught with piggyback IOL’s or when using 2 lenses, avoid using the same material for the second lens to avoid uncorrectable haze/pseudomembrane glistening between the IOL’s that is only fixed with explanting one lens and replacing it with a silicone lens on top of the acrylic lens. This is even with the updated acrylic lenses by Alcon too, I would still think about using a silicone lens as the second lens not only to prevent the haze/glistening but also to reduce incidence of positive dysphotopsias. Interesting! Thank you for sharing!
