Piggy Game VERIFIED

Your little one will love this parade! A larger-than-life scarecrow keeps a watchful eye on the Piggy Parade as the adorable "piggy" cars travel in a circle of fun. It's the ride of a lifetime for little ones with plenty of room for mom and dad to ride along and enjoy the good times.

Surgical options for the correction of pseudophakic refractive errors include intraocular lens (IOL) exchange, refractive laser correction (Laser in situ keratomileusis (LASIK) or photorefractive keratectomy (PRK)) or the implantation of a secondary IOL by the piggyback technique.[1] [2] The piggyback technique classically consists on the implantation of both the primary and secondary IOL in the capsular bag.[3] The piggyback technique with an Add-On IOL consists on the implantation of the primary IOL in the capsular bag and the secondary IOL in the ciliary sulcus.[1] The main indications for secondary piggyback IOL implantation are: postoperative ametropia and pseudophakic presbyopia.[1] [2][4] [5] [6] [7] [8]

Piggy Game

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The piggyback technique was first described in 1993 by Gayton and Sanders in a case of cataract and microphthalmos, in which the calculated IOL power was +46 diopters (D).[3] Subsequently, it began to be used to correct postoperative refractive errors. The same authors published in 1999 a case series of 8 eyes of 8 normal pseudophakes and 7 eyes of 7 postpenetrating keratoplasty pseudophakes in which a secondary IOL was implanted by the piggyback technique.[9]

Secondary piggyback IOLs are available as monofocal, multifocal, toric and multifocal toric models.[10] There are three IOLs specifically designed for secondary implantation in the ciliary sulcus to correct pseudophakic ametropias or pseudophakic presbyopia: the Sulcoflex (Rayner Intraocular Lenses Ldt, East Sussex, United Kingdom), which was the first to be commercially available, the Add-On (HumanOptics, Erlangen, Germany) and the 1st Add-On (1st Q GmbH, Mannheim, Germany).

There are some complications associated with the piggyback technique namely: interlenticular opacification,[14] [15] [16]postoperative elevation of intraocular pressure,[17] pupillary optic capture after mydriasis, iris chafing, pigment dispersion syndrome and secondary pigmentary glaucoma.[18] The implantation of the secondary IOL in the ciliary sulcus has an important advantage, over the classic implantation of both IOLs in the capsular bag, that is to increase the distance between the two IOLs, thus reducing the possibility of interlenticular opacification.[1][5][19] The three IOLs (Sulcoflex, Add-On and 1st Add-On) were designed to avoid the complications previously described:

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Objectives: To compare the benefits and harms of piggy-back technique versus conventional liver transplantation as well as of the different modifications of piggy-back technique during liver transplantation.

Main results: Two trials randomised in total 106 patients to piggy-back method (n = 53) versus conventional method with veno-venous bypass (n = 53). Both trials were at high risk of bias. There was no significant difference in post-operative mortality, primary graft non-function, vascular complications, renal failure, transfusion requirements, intensive therapy unit (ITU) stay, or hospital stay between the two groups. The warm ischaemic time was significantly shorter in the piggy-back method than the conventional method (MD -11.50 minutes; 95% CI -19.35 to -3.65; P < 0.01). The proportion of patients who developed chest complications were significantly higher in the the piggy-back method than the conventional method (75.8% versus 44.1%; P = 0.01).One trial randomised 80 patients to piggy-back with porto-caval bypass (n = 40) versus piggy-back without porto-caval bypass (n = 40). This trial was at high risk of bias. There was no significant difference in post-operative mortality, re-transplantation due to primary graft non-function, vascular complications, renal failure, or hospital stay between the two groups. Fewer patients required blood transfusion in the piggy-back with porto-caval bypass group (55%) than the piggy-back without porto-caval bypass group (75%) (P = 0.02). There was no significant difference in the mean amount of blood transfused between the groups (MD -1.00 unit; 95% CI -2.19 to 0.19; P = 0.10). The ITU stay was significantly shorter in the piggy-back with porto-caval bypass group (2.9 days) than the piggy-back without porto-caval bypass group (4.9 days; MD -2.00 days; 95% CI -3.82 to -0.18; P = 0.03).There were no trials comparing piggy-back method with conventional method without veno-venous bypass or different techniques of piggy-back method. ff782bc1db