Pigmentary dispersion syndrome with a secondary piggyback 3-piece hydrophobic acrylic lens

We describe a case of pigmentary dispersion syndrome resulting from secondary piggyback implantation of a 3-piece hydrophobic acrylic squared-edged intraocular lens (IOL) in the ciliary sulcus. The intraocular pressure remained elevated despite pharmacological treatment, with a heavily pigmented trabecular meshwork. The piggyback IOL was subsequently explanted and replaced by a silicone IOL with smooth round edges. Examination of the explanted IOL under light and scanning electron microscopy showed clusters of pigment epithelial cells located around the periphery of the anterior optic surface.