Novel custom designed toric piggyback intraocular lens for the correction of residual postoperative astigmatism

We report the outcomes of a custom-designed toric piggyback intraocular lens in a patient with high postoperative residual astigmatism. A 60-year-old male patient underwent customized toric piggyback IOL for postoperative residual astigmatism of 13 D, with follow-up examinations for IOL stability and refractive outcomes. The refractive error stabilized at two months and remained stable at one year, with a correction of nearly 9 D of astigmatism. The IOP remained within normal limits, and there were no postoperative complications. The IOL remained stable in the horizontal position. To our knowledge, this is the first case report of correction of unusually high astigmatism by a novel smart toric design of piggyback IOL.

Clinical application progress of Piggyback intraocular lens implantation / 国际眼科杂志(Guoji Yanke Zazhi)

@#With the continuous progress and development of modern surgical equipment, the types of intraocular lens and the continuous improvement of people's requirements for visual quality, cataract surgery has been transformed from traditional vision restoration surgery into a high-quality and high-demand refractive surgery. Piggyback intraocular lens implantation was originally a new surgical method for clinicians to implant two or more posterior chamber intraocular lenses in patients' eyes to correct hyperopia or secondary correction refractive errors after cataract surgery. With the birth and promotion of functional lenses in recent years, this surgical method has been applied to the field of refractive cataract surgery, which expanded the application of functional intraocular lens and achieved good postoperative effect. This review discusses the development and current clinical application of Piggyback intraocular lens implantation, and further expounds its development trend in the future.

Clinical application of piggyback liver transplantation and modified surgery / 中华消化外科杂志

Orthotopic liver transplantation (OLT) was first implemented by Starzl in 1963.With the development of liver transplantation,Tzaris was the first to report piggyback liver transplantation (PBLT) in 1989.The fundamental difference between OLT and PBLT:end to end vascular anastomosis between the donor and recipient is performed after diseased liver resection with the posthepatic inferior vena cava in OLT,while PBLT is to preserve the recipient's hepatic vein and end to end vascular anastomosis between interior vena cava of donor and shaped hepatic vein is performed.However in the clinical practice,the above two techniques cannot meet the needs of clinical liver transplantation technology.Since 1993 the author has implemented a series of improvements in liver transplantation technology based on PBLT and performed ameliorated piggyback liver transplantation (APBLT).This article focuses on the technical characteristics and clinical application of APBLT.

Late Hepatic Venous Outflow Obstruction Following Inferior Vena Cava Stenting in Patient with Deceased Donor Liver Transplantation Using Modified Piggyback Technique / 대한이식학회지

Following liver transplantation, a few reports have documented hepatic venous outflow obstruction (HVOO) after inferior vena cava (IVC) stenting for the treatment of IVC stenosis. However, HVOO occurred early after IVC stenting and was mostly associated with living donor liver transplantation. Here, we report a case of HVOO that occurred 31 months after IVC stenting in a man who received deceased donor liver transplantation (DDLT) using a modified piggyback (PB) technique. The cause of HVOO was unclear, but one possible explanation is that the balloon-expandable IVC stent might have compressed the IVC chamber on the donor liver side, which would have changed the outflow hemodynamics, resulting in intimal hyperplasia. Therefore, simultaneous hepatic venous stenting with IVC stent placement could help prevent HVOO in patients receiving DDLT with the modified PB technique.

Relationship between hepatic venous outflow obstruction and patterns of hepatic vein drainage into inferior vena cava in piggyback liver transplantation / 中华器官移植杂志

Objective To investigate the relationship between hepatic venous outflow obstruction (HVOO) and patterns of the hepatic vein (HV) drainage into inferior vena cava (IVC) in piggyback liver transplantation (PBLT).Methods A retrospective analysis on 202 cases of PBLT (from May 2000 to Aug.2015) was conducted.The recipients' patterns of HV drainage into WC and the angle ∠COB between the reconstructed outflow and IVC in the cross section were recorded by preoperative 3D reconstruction.And the lengths and diameters of recipients' HVs were measured during operations.The relationship between the incidence of HVOO and patterns of HV drainage into IVC was analyzed.Results There were 3 patterns of HV drainage into IVC:type Ⅰ (n =136),trunk of left and middle HVs;type Ⅱ (n=52),trunk of right and middle HVs;type Ⅲ (n=14):trunk of three HVs.There was no statistically significant difference within the HVs of each type,when the lengths and diameters were compared respectively.However,the angle ∠COB of type Ⅰ [(164 ±10.14)°] was significantly bigger than type Ⅱ [(44 ± 12.2)°] and type Ⅲ [(96 ± 13.1) °] (P＜0.05).Accordingly,the highest incidence of HVOO (23.5％) was foundin type Ⅰ,followed by type Ⅱ (9.6％),and type Ⅲ had the lowest incidence (7.1 ％) (P＜0.05).The correlation coefficient Cramer's V =0.765.Conclusion This study demonstrated that there was preferable relativity between the HVOO incidence and the patterns of HV drainage into IVC.Type I is more likely to have HVOO.Type Ⅲ is the most ideal one for PBLT.

Current status of veno-venous bypass in liver transplantation / 中华肝胆外科杂志

Since Shaw et al,first reported the first case successfully treated by veno-venous bypass (VVB),there has been great controversy on the routine application of VVB during conventional liver transplantation and piggyback liver transplantation in recent decades.With the improvements on the surgical skills,surgical techniques and anesthesiology,only a small portion of patients have the indications for VVB in liver transplantation routinely.This article reviews the current publications in this topic,which may provide new insight into the liver transplantation in clinical practice.

Ameliorated piggyback liver transplantation / 中华肝胆外科杂志

Classical piggyback liver transplantation (CPBLT) is an advanced technique based on standard orthotopic liver transplantation (SOLT),which has more advantages compared to the SOLT.However,there are still some problems with CPBLT to be solved,such as complicated surgical procedures,postoperative hepatic venous outflow obstruction and thrombosis.Recently,in order to solve these problems,modifications have been made,being named ameliorated piggyback liver transplantation (APBLT).The APBLT solved above-mentioned problems,and expanded the application of PBLT.Therefore,this article describes the technique of these ameliorations,and discusses their individual characteristics.

A Case of Corrected Residual Refractive Error after Cataract Surgery with the Sulcoflex Piggyback IOL

PURPOSE: To report a case of corrected residual refractive error after cataract surgery with sulcoflex piggyback intraouclar lens (IOL). CASE SUMMARY: A 77-year-old man was diagnosed as having hypermature cataract in the right eye and his corrected visual acuity in the same eye was hand-motion before surgery. Refractive error was +9.0 diopter (D) 6 months after conventional cataract surgery in the right eye. The authors performed additional cataract surgery using a piggyback method inserting a +10.0 D IOL in the ciliary sulcus. Four weeks after surgery, his refractive error was -1.25 D, visual acuity increased to 120/200 and 60/200 (with and without correction, respectively). No complication was observed during follow-up time and the patient was satisfied with his results. CONCLUSIONS: Correction of residual refractive error after cataract surgery with sulcoflex piggyback IOL is safe and effective.

Piggyback implantation using Toric intraocular lens in high myopia / 国际眼科杂志(Guoji Yanke Zazhi)

To assess the postoperative outcomes of piggyback implantation using Acrysof Toric intraocular lens ( lOL ) in high myopia combined with corneal astigmatism. ●METHODS: Sixty patients who had phacoemulsification with lOL implantation due to high myopia, cataract and corneal astigmatism from January 2010 to June 2013 were randomly divided into observation group (piggyback Toric lOL implantation, both an Acrysoft lQ Toric lOL and a minus foldable acrylic three piece lOL were implanted in the capsular bag, n= 30) and control group (foldable lOL implantation, n = 30). Postoperative follow - up went on 6mo. lnformation collected included uncorrected visual acuity ( UCVA), lOL position, residual astigmatism and complications. ● RESULTS: The UCVA increased from 3. 52 ± 0. 03 preoperatively to 4. 78±0. 01 at 6mo postoperatively in the observation group, from 3. 51±0. 03 preoperatively to 4. 30± 0. 13 at 6mo postoperatively in the control group. The observation group's postoperative UCVA was better than that of the control group. There was statistically significant difference ( t = 3. 612, P ●CONCLUSlON: Piggyback implantation using Toric lOL can help to solve the problem of no matching Toric lOL power for the high myopia combined with corneal astigmatism at the current stage. lt improves the UCVA and reduces the astigmatism after the cataract surgery.

Refractive Changes after Removal of Anterior IOLs in Temporary Piggyback IOL Implantation for Congenital Cataracts

PURPOSE: To assess the refractive change and prediction error after temporary intraocular lens (IOL) removal in temporary polypseudophakic eyes using IOL power calculation formulas and Gills' formula. METHODS: Four consecutive patients (7 eyes) who underwent temporary IOL explantation were enrolled. Postoperative refractions calculated using IOL power calculation formulas (SRK-II, SRK-T, Hoffer-Q, Holladay, and the modified Gills' formula for residual myopia and residual hyperopia) were compared to the manifest spherical equivalents checked at 1 month postoperatively. RESULTS: The mean ages of temporary piggyback IOL implantation and IOL removal were 6.71 +/- 3.68 months (range, 3 to 12 months) and 51.14 +/- 18.38 months (range, 29 to 74 months), respectively. The average refractive error was -13.11 +/- 3.10 diopters (D) just before IOL removal, and improved to -1.99 +/- 1.04 D after surgery. SRK-T showed the best prediction error of 1.17 +/- 1.00 D. The modified Gills' formula for myopia yielded a relatively good result of 1.47 +/- 1.27 D, with only the variable being axial length. CONCLUSIONS: Formulas to predict refractive change after temporary IOL removal in pediatric polypseudophakia were not as accurate as those used for single IOL implantation in adult eyes. Nonetheless, this study will be helpful in predicting postoperative refraction after temporary IOL removal.

Refractive Changes after Removal of Anterior IOLs in Temporary Piggyback IOL Implantation for Congenital Cataracts

PURPOSE: To assess the refractive change and prediction error after temporary intraocular lens (IOL) removal in temporary polypseudophakic eyes using IOL power calculation formulas and Gills' formula. METHODS: Four consecutive patients (7 eyes) who underwent temporary IOL explantation were enrolled. Postoperative refractions calculated using IOL power calculation formulas (SRK-II, SRK-T, Hoffer-Q, Holladay, and the modified Gills' formula for residual myopia and residual hyperopia) were compared to the manifest spherical equivalents checked at 1 month postoperatively. RESULTS: The mean ages of temporary piggyback IOL implantation and IOL removal were 6.71 +/- 3.68 months (range, 3 to 12 months) and 51.14 +/- 18.38 months (range, 29 to 74 months), respectively. The average refractive error was -13.11 +/- 3.10 diopters (D) just before IOL removal, and improved to -1.99 +/- 1.04 D after surgery. SRK-T showed the best prediction error of 1.17 +/- 1.00 D. The modified Gills' formula for myopia yielded a relatively good result of 1.47 +/- 1.27 D, with only the variable being axial length. CONCLUSIONS: Formulas to predict refractive change after temporary IOL removal in pediatric polypseudophakia were not as accurate as those used for single IOL implantation in adult eyes. Nonetheless, this study will be helpful in predicting postoperative refraction after temporary IOL removal.

Cataract Surgery Using Piggyback Method in Patient With Nanophthalmos

PURPOSE: To report a case of cataract surgery using a piggyback method in a patient with pure nanophthalmos with an axial length under 16.00 mm in both eyes. CASE SUMMARY: The authors performed cataract surgery using a piggyback method inserting two intraocular lenses (IOLs) in a 44-year-old male with nanophthalmos with axial lengths of OD 15.36 mm, and OS 15.59 mm. Primary implantation of two IOLs of +53.0D as calculated by the SRK/T and Holladay formula was performed in the right eye using a piggyback method. In the left eye, two IOLs of +60.0D calculated by the Hoffer Q formula were implanted. Postoperative hyperopic refractive errors occurred in both eyes. The differences between the preoperative target spherical equivalent (SE) and the postoperative one year four month SE were 9.68D in the right eye and 1.63D in the left eye. CONCLUSIONS: Due to high diopter IOL requirements in nanophthalmic patients (less than 16.00 mm) during cataract surgery, the refractive errors were well corrected, without complications, by using a piggyback method. In the present case study, the Hoffer Q formula produced better results than did the SRK/T or Holladay formula in reducing the difference in preoperative and postoperative SEs, but more surgical cases and research are required to establish the most appropriate formula for cataract surgery in nanophthalmos.

Virtual piggyback liver transplantation using three-dimensional imaging technique / 中华消化外科杂志

Objective To study the value of three-dimensional (3D) visualization and virtual surgery system in piggyback liver transplantation. Methods Two patients who suffered from choledocholithiasis were scanned by 64-slice spiral CT and the data were collected. The segmentation of the hepatic CT images was carried out. The 3D model of the liver and the intrahepatic vessels was reconstructed, and was imported to the FreeForm Modeling System in STL format for smoothing and modifying. Piggyback liver transplantation was simulated with the force-feedback equipment (PHANToM). Results The reconstructed 3D model of the liver was vivid, and the process of the virtual piggyback liver transplantation was verisimilar. Conclusions The 3D model of the liver enables the simulation of piggyback liver transplantation. It can reduce the risk and complications of the surgery, and enhance the communication between doctor and patient through designing surgical plan and demonstrating visualized operation before surgery. Virtual liver transplantation is also helpful during the training of medical workers.

Refractive Change and Complications Following Single or Temporary Piggyback Intraocular Lens Implantation in Infancy

PURPOSE: The purpose of this study was to assess the incidence of postoperative complications and the change of refractive error in infantile eyes after cataract surgery and single intraocular lens(IOL) or temporary piggyback IOL implantation. METHODS: Eight consecutive patients (13 eyes) who underwent IOL implantation under 12 months of age between 1999 and 2002 were enrolled. Eight eyes of 6 patients had a single IOL implanted and the other 5 eyes of 3 patients underwent temporary piggyback IOL implantations. A retrospective chart review was conducted. RESULTS: The mean age at surgery was 6.1 months. The mean follow-up period was 10 months. The average postoperative refraction at one week was +7.82D after single IOL and +0.32D after piggyback IOL. The average postoperative refraction at last follow-up was +4.25D and -3.5D respectively. Over the follow-up period, the mean refractive change per months was -0.34D in the single IOL group and -0.45D in the piggyback IOL group. Postoperative complications were 12.5 % (1/8 eyes) in single IOL and 20.0% (1/5 eyes) in piggyback IOL. Reoperations were conducted for the complicated eyes in both groups. CONCLUSIONS: The rates of complications and reoperations were slightly higher in piggyback IOL than in single IOL. Nonetheless, additive correction for residual hyperopia was not needed in the piggyback IOL group. There was more deteriorative evidence of amblyopia in piggyback IOL than in single IOL.

Does the Venovenous Bypass influence Coagulation Status in Living-Related Liver Transplantation? / 대한마취과학회지

BACKGORUND: Venovenous bypass (VVB) in liver transplantation has been used to decrease the acute hemodynamic and metabolic changes during anhepatic periods. But, the use of VVB in patients undergoing liver transplantation is still under debate concerning its relative risks and benefits. Therefore, the aim of this study was to examine the influences of VVB on the coagulation status and the amount of transfusion in living-related liver transplantation. METHODS: We conducted this retrospective study on 39 patients who underwent orthotopic living-related liver transplantation using the piggyback technique from March 2001 to April 2002. While 19 patients did not receive venovenous bypass, 20 patients received. We compared the two groups in terms of coagulation-related parameters (prothrombin time, activated partial thromboplastin time, platelet count, fibrinogen and thromboelastograph), the amount of transfusion during intraoperative and post-operative 1day. We also compared the incidences of post-reperfusion syndrome in the two groups. RESULTS: The group that underwent living-related liver transplantation with VVB required more packed red blood cell (p-RBC) transfusion than the other group without VVB from post-reperfusion untill the end of operation (P<0.05). This difference in the amount of p-RBC transfusion may be due to the blood remained in the VVB circuit at the termination of VVB. However, the two groups were similar in terms of coagulation-related parameters, the amount of other blood components, such as fresh frozen plasma, platelet concentrates, cryoprecipitate, total amount of transfusion during the 24 hours post- operatively, and the incidence of post-reperfusion syndrome. CONCLUSiONS: We conclude that the using of venovenous bypass in living-related liver transplantation did not influence coagulation status and the amount of transfusion perioperatively.

Hemodynamic changes during piggyback liver transplantation of different Child class / 第三军医大学学报

Objective To describe the hemodynamic changes during piggyback liver transplantation (PBLT), and to analyze the hemodynamic correlation with various degrees of cirrhosis according to Childpugh classification. Methods Between March 1999 and June 2004, 180 patients underwent PBLT procedure in our institution, and 95 cases were selected and divided according to Child classification. The intraoperative hemodynamics of different time points were retrospectively analyzed, including mean artery pressure (MAP), heart rate (HR), central vein pressure (CVP) and mean pulmonary artery pressure (MPAP). Results Hemodynamic changes were minimal before and during anhepatic phase in all the patients. At reperfusion, a hemodynamic disturbance occurred featured by decrease of MAP and increase of MPAP. Comparison between different Child class showed that in the Child C group, MAP were lower and HR were higher before new liver phase, while CVP and MPAP were higher during new liver phase. Conclusion Hemodynamic changes were minimal before and during anhepatic phase for PBLT, while they were more severe during reperfusion, and they also correlates with the different Child class before transplantation. The more severe of the cirrhosis before transplantation according to Child classification, the greater hemodynamic changes during the operation.

Joint Effects of Selective Digestive Decontamination and Glutamine on Intestinal Bacterial Translocation of Piggyback Liver Transplantation in Rabbit / 中国普外基础与临床杂志

Objective To investigate the joint effects of selective digestive decontamination (SDD) and glutamine (Gln) on preventing intestinal bacterial translocation of orthotopic piggyback liver transplantation and to observe the incidence of postoperative pneumonia in rabbit. Methods Thirty rabbits received orthotopic piggyback liver transplantation and were randomly divided into three groups (SDD group, SDD+Gln group and control group). Mixed emulsion of tobramycin, polymyxin E and nystatin were given to the rabbits in SDD group. Same dosage of the above components plus Gln were given to the rabbits in SDD+Gln group. Samples of portal vein blood, ileum tissue and lung tissue were obtained in each group at different phases during and after operation, the pathological changes of ileum tissue, the bacterial translocation in blood of portal vein and the incidence of postoperative pneumonia were detected. Results The mixing section area of intestinal blood capillaries in SDD+Gln group was smaller compared with control group (P

Hepatectomia total com preservação da veia cava inferior: "piggy-back" experimental em cães

During the recipient hepatectomy in liver transplantation, preservation of the retrohepatic segment of the inferior vena cava has several advantages: it decreases warm ischemia time by eliminating the infrahepatic caval anastomosis, eliminates the need for venovenous bypass and eases retransplantation. Removal of the liver of the dog without sacrificing the inferior vena cava has been considered impossible because of the intrahepatic course of the vena cava at the sites of entry of the hepatic veins. The following report reviews the history of the piggyback method, and discuss about the feasibility of the total removal of the liver without injury to the vena cava in the dog.

No transplante de fígado, a preservação do segmento retro-hepático da veia cava durante a hepatectomia do receptor apresenta uma série de vantagens: diminuição do tempo de isquemia quente por eliminar a anastomose da veia cava infra-hepática, redução da necessidade da utilização de derivações veno-venosas e simplificação da cirurgia do re-transplante hepático. Em cães, os lobos hepáticos lateral direito e caudado são caprichosamente atravessados pela veia cava inferior, dificultando a completa "esqueletização" do vaso. No presente trabalho, os autores revisam a singular história do método do "piggy-back" experimental e clínico, e discutem a técnica da cirurgia em cães.

Clinical Results of Cataract Operations using Piggy-back Method

PURPOSE: To attain adequate intraocular lens power during cataract surgery in patients with high myopia or hyperopia, the implantation of two intraocular lenses by the piggy-back method are being widely attempted. Therefore, we report the clinical results of implantation of two intraocular lenses by the piggy-back method. MATERIALS AND METHODS: We illustrate a case of a 62-year old high myopic patient with cataract who received lens insertion of -5.0 diopter and -4.0 diopter piggy-back style in the capsular bag. Also, we illustrate a case of a 7-year old female with congenital cataract who received lens insertion in the capsular bag of +18.0 diopter and +17.0 diopter in the right eye and +17.0 diopter and +16.0 diopter in the left eye. RESULTS: Postoperative findings at 2 months showed well positioning of both lenses without noticeable complications.

Piggyback orthotopic liver transplantation in the treatment of Wilson′s disease:a report of 29 cases / 中国普通外科杂志

Objective To summarize the clinical experience of standard piggyback liver transplantation(SPBLT) and modified piggy-back liver transplantation(MPBLT) in the treatment of Wilson′s disease(WD).Methods The clinical records of 29 cases of WD who underwent piggyback liver transplantation over the recent 12 years were analyzed retrospestively.Among them,there were 22 male and 7 female patients,with 6cases aged 8-14y and 23 cases aged 24-37y,who underwent liver transplantation because of chronic advanced liver disease(18cases),fulminant hepatic failure(2 cases),or with normal liver function(9 case),and among them,24 cases showed neurological dysfunction.The modes of operation included SPBLT(13 cases) and MPBLT(16 cases).Results The patients were followed up for 1 month-12 years with the median follow-up time of 47 months.Four patients died in the perioperative period,of which 2 died of hepatic failure due to obstruction of hepatic venous return after SPBLT,and 2 died of hepatic artery thrombosis and bile leakage combined with severe infection.The recipient survival rate at 1 year and 3 years was 86% and 79% respectively.One patient has survived for 12 years.All the levels of serum copper and copper-protein recovered to normal in four weeks post-operatively.Neurological symptoms improved in varying degrees after operation.Conclusions WD patients who undergo PBLT can expect a satisfactory clinical outcome and a good quality of life,and MPBLT can effectively reduce the complications of operation and improve the operation survival rate.