We describe 6 surgical techniques used to implant a silicone iris prosthesis: sector-shaped iris segments that require suturing, injector-assisted sulcus fixation, injector-assisted capsular bag fixation with an intraocular lens (IOL) and capsular tension ring, folded iris tissue implanted with a forceps and sutured to the sclera with a scleral-fixated IOL, "sandwich" or "backpack" implantation with an IOL, and open-sky implantation with a perforating keratoplasty. The results of the techniques performed in 51 patients are discussed. Sector-shaped iris segments required longer surgery because of the complexity of intracameral sutures and carried risks for knots to loosen and sutures to cut through residual iris tissue. The combined implantation of an iris and IOL proved complex and lengthy but solved lens and iris abnormalities in 1 procedure and provided long-lasting stable conditions. The procedures that implanted a complete iris in pseudophakic eyes were shorter and required smaller incisions, a sutureless approach, and injector-assisted implantation.

BackgroundLaboratory analysis and optical quality assessment of explanted hydrophilic intraocular lenses (IOLs) with clinically significant opacification after posterior lamellar keratoplasty (DMEK and DSAEK).MethodsThirteen opacified IOLs after posterior lamellar keratoplasty, 8 after descemet stripping automated endothelial keratoplasty (DSAEK), 3 after descemet membrane endothelial keratoplasty (DMEK) and 2 after both DSAEK and DMEK were analysed in our laboratory. Analyses included optical bench assessment for optical quality, light microscopy, scanning electron microscopy (SEM) and energy dispersive X-Ray spectroscopy (EDS).ResultsIn all IOLs the opacification was caused by a thin layer of calciumphosphate that had accumulated underneath the anterior optical surface of the IOLs in the area spared by the pupil/anterior capsulorhexis. The calcifications lead to a significant deterioration of the modulation transfer function across all spatial frequencies of the affected IOLs.ConclusionsThe instillation of exogenous material such as air or gas into the anterior chamber increases the risk for opacification of hydrophilic IOLs irrespective of the manufacturer or the exact composition of the hydrophilic lens material. It is recommended to avoid the use of hydrophilic acrylic IOLs in patients with endothelial dystrophy that will likely require procedures involving the intracameral instillation of air or gas, such as DMEK or DS(A)EK.