{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T19:36:27Z","timestamp":1786649787566,"version":"build-2736575974"},"reference-count":12,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","license":[{"start":{"date-parts":[[2023,5,1]],"date-time":"2023-05-01T00:00:00Z","timestamp":1682899200000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-sa\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2023,5]]},"abstract":"<jats:p>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.<\/jats:p>","DOI":"10.4103\/ijo.ijo_2198_22","type":"journal-article","created":{"date-parts":[[2023,5,17]],"date-time":"2023-05-17T03:24:01Z","timestamp":1684293841000},"page":"2247-2250","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Novel custom designed toric piggyback intraocular lens for the correction of residual postoperative astigmatism"],"prefix":"10.4103","volume":"71","author":[{"given":"Debapriya","family":"Chatterjee","sequence":"first","affiliation":[{"name":"Cornea and Refractive Surgery Services, LJ Eye Institute, Ambala, Haryana, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vikas","family":"Mittal","sequence":"additional","affiliation":[{"name":"Cornea and Refractive Surgery Services, LJ Eye Institute, Ambala, Haryana, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2023,5,17]]},"reference":[{"key":"R1-20251006","doi-asserted-by":"crossref","first-page":"676","DOI":"10.3928\/1081597X-20130826-01","article-title":"Resolving refractive error after cataract surgery:IOL exchange, piggyback lens, or LASIK","volume":"29","author":"Fern\u00e1ndez-Buenaga","year":"2013","journal-title":"J Refract Surg"},{"key":"R2-20251006","doi-asserted-by":"crossref","first-page":"187","DOI":"10.3928\/1081597X-20130212-01","article-title":"Implantation of three-piece silicone toric additive IOLs in challenging clinical cases with high astigmatism","volume":"29","author":"Thomas","year":"2013","journal-title":"J Refract Surg"},{"key":"R3-20251006","doi-asserted-by":"crossref","first-page":"1052","DOI":"10.1097\/ICO.0000000000000506","article-title":"Supplementary, sulcus-fixated intraocular lens in the treatment of spherical and astigmatic refractive errors in pseudophakic eyes after keratoplasty","volume":"34","author":"Meyer","year":"2015","journal-title":"Cornea"},{"key":"R4-20251006","doi-asserted-by":"crossref","first-page":"402","DOI":"10.1016\/S0886-3350(02)01536-5","article-title":"Sutured piggyback toric intraocular lenses to correct high astigmatism","volume":"29","author":"Gills","year":"2003","journal-title":"J Cataract Refract Surg"},{"key":"R5-20251006","doi-asserted-by":"crossref","first-page":"1612","DOI":"10.1016\/S0886-3350(00)00485-5","article-title":"Opacification of piggyback IOLs associated with an amorphous material attached to interlenticular surfaces","volume":"26","author":"Werner","year":"2000","journal-title":"J Cataract Refract Surg"},{"key":"R6-20251006","doi-asserted-by":"crossref","first-page":"1821","DOI":"10.1016\/j.jcrs.2005.06.034","article-title":"Elevated intraocular pressure in secondary piggyback intraocular lens implantation","volume":"31","author":"Iwase","year":"2005","journal-title":"J Cataract Refract Surg"},{"key":"R7-20251006","doi-asserted-by":"crossref","first-page":"1090","DOI":"10.1016\/j.jcrs.2009.12.045","article-title":"New supplementary intraocular lens for refractive enhancement in pseudophakic patients","volume":"36","author":"Kahraman","year":"2010","journal-title":"J Cataract Refract Surg"},{"key":"R8-20251006","doi-asserted-by":"crossref","first-page":"693","DOI":"10.3928\/1081597X-20110512-01","article-title":"Performance of the Sulcoflex piggyback intraocular lens in pseudophakic patients","volume":"27","author":"Khan","year":"2011","journal-title":"J Refract Surg"},{"key":"R9-20251006","doi-asserted-by":"crossref","first-page":"1965","DOI":"10.1007\/s10792-018-1027-7","article-title":"Outcomes of toric supplementary intraocular lenses for residual astigmatic refractive error in pseudophakic eyes","volume":"39","author":"McLintock","year":"2019","journal-title":"Int Ophthalmol"},{"key":"R10-20251006","first-page":"329","article-title":"Measurement of ciliary sulcus diameters using high frequency ultrasound biometry. 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