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Subsequently, the technique was modified to compensate for post-operative residual refractive errors. In these early cases, an IOL designed for the capsular bag would be implanted in the sulcus.\u00a0\u00a0Although these approaches were less than ideal, alternative means of correcting residual refractive errors were not without their limitations: IOL exchange can be traumatic to the eye and is not easily carried out once fibrosis has occurred, while corneal refractive surgical techniques are not suitable for all patients.\u00a0Piggyback implantation was the term first coined to describe the use of two IOLs, placed together in the capsular bag. The term was later extended to include the procedure where an IOL designed for the capsular bag was placed in the sulcus. Unfortunately, the term piggyback has persisted even though these two approaches have been largely discredited.\u00a0Intraocular lenses are now available which have been specifically designed for placement in the ciliary sulcus. As these newer IOLs avoid the many unacceptable complications brought about by both types of earlier piggyback implantation, it is time to employ a new terminology, such as supplementary IOL or secondary enhancement to distinguish between the placement of an unsuitable capsular bag IOL in the sulcus and the implantation of an IOL specifically designed for ciliary sulcus implantation.\u00a0In addition to minimising possible complications, supplementary IOLs designed for the sulcus have expanded the options available to the ophthalmic surgeon. With these new IOLs it is possible to correct presbyopia and residual astigmatism, and to provide temporary correction of refractive errors in growing, or unstable, eyes. This article aims to review the literature available on supplementary IOL implantation in the ciliary sulcus and to summarise the evidence for the efficacy and safety of this intervention.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Key messages<\/jats:title>\n            <jats:p>\n              <jats:bold>\n                <jats:italic>What is known<\/jats:italic>\n              <\/jats:bold>\n              <jats:list list-type=\"bullet\">\n                <jats:list-item>\n                  <jats:p>Polypseudophakia has been used for over 30 years to correct hyperopia or residual refractive error, but early techniques were associated with significant complications.<\/jats:p>\n                <\/jats:list-item>\n              <\/jats:list>\n            <\/jats:p>\n            <jats:p>\n              <jats:bold>\n                <jats:italic>What is new<\/jats:italic>\n              <\/jats:bold>\n              <jats:list list-type=\"bullet\">\n                <jats:list-item>\n                  <jats:p>The development of specially designed sulcus-fixated supplementary IOLs significantly reduces the risks associated with these procedures, and has also opened up new opportunities in patient care.<\/jats:p>\n                <\/jats:list-item>\n                <jats:list-item>\n                  <jats:p>The reversibility of the procedure allows patients to experience multifocality, and to provide temporary and adjustable correction in unstable or growing eyes.<\/jats:p>\n                <\/jats:list-item>\n                <jats:list-item>\n                  <jats:p>The terms \u201csecondary enhancement\u201d or \u201cDUET\u201d to describe supplementary IOL implantation are preferential to \u201cpiggyback\u201d.<\/jats:p>\n                <\/jats:list-item>\n              <\/jats:list>\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1007\/s00417-024-06618-3","type":"journal-article","created":{"date-parts":[[2024,9,11]],"date-time":"2024-09-11T11:09:18Z","timestamp":1726052958000},"page":"603-624","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Polypseudophakia: from \u201cPiggyback\u201d to supplementary sulcus-fixated IOLs"],"prefix":"10.1007","volume":"263","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6237-7773","authenticated-orcid":false,"given":"Ramin","family":"Khoramnia","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Guenal","family":"Kahraman","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Amon","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Grzegorz","family":"\u0141abuz","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Isabella D.","family":"Baur","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gerd U.","family":"Auffarth","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2024,9,11]]},"reference":[{"key":"6618_CR1","doi-asserted-by":"publisher","first-page":"776","DOI":"10.1016\/S0886-3350(13)80349-5","volume":"19","author":"JL Gayton","year":"1993","unstructured":"Gayton JL, Sanders VN (1993) Implanting two posterior chamber intraocular lenses in a case of microphthalmos. 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No human participants and\/or animals were involved in this review paper.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Research involving human participants and\/or animals."}},{"value":"Ramin Khoramnia reports grants, personal fees, and non-financial support from Alcon, Johnson & Johnson, Hoya, Physiol, Rayner, personal fees, and non-financial support from Kowa, Ophtec, Oculentis\/Teleon, Santen, and Acufocus, outside the submitted work.Michael Amon is a consultant to Rayner Intraocular Lenses Ltd.Gerd U Auffarth reports grants, personal fees, non-financial support and consulting fees from Johnson & Johnson and Alcon, grants, personal fees, and non-financial support from Carl Zeiss Meditec, Hoya, Kowa, Oculentis\/Teleon, Rayner, Santen, Sifi, Ursa-pharm, grants and personal fees from Biotech, Oculus, EyeYon grants from Acufocus, Contamac, Glaukos, Physiol and Rheacell, outside the submitted work.Guenal Kahraman, Grzegorz \u0141abuz and Isabella D Baur certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers\u2019 bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Disclosures of potential conflicts of interest"}}]}}