Black-on-clear piggyback technique for a black occlusive intraocular device in intractable diplopia

Black-on-clear polypseudophakia lens extraction with dual PMMA implants (1 opaque and 1 clear) placed in the bag. A: Phacoemulsification is performed as per routine practice, preferably through a scleral tunnel. After irrigation/aspiration, a clear PMMA IOL is inserted in the capsular bag. B: An opaque PMMA device is also placed in the capsular bag on top of the clear IOL. Note the size of the opaque device and that a large incision is necessary for placement. C: The haptics are placed parallel to one another with the implants sitting on top of each other. D: The opaque device viewed with an undilated pupil with good cosmetic effect.