Endocapsular artificial iris implantation for iris defects: Reducing symptoms, restoring visual function and improving cosmesis

Abstract

Background: To investigate repair of iris defects by endocapsular implantation of an artificial iris, in relation to visual outcomes, safety profile and patient satisfaction.Methods: Retrospective, consecutive case series from Greenlane tertiary teaching hospital and Eye Institute, Auckland, New Zealand. Medical records of patients implanted with an endocapsular artificial iris were reviewed and followed for minimum 3 months. Patient characteristics, surgical management, clinical outcomes and subjective responses were recorded.Results: Nineteen artificial irises were implanted in 18 patients. Etiologies were iris melanotic lesion excision (73.7%), trauma (10.5%), congenital aniridia (10.5%) and Urrets-Zavalia syndrome (5.3%). During postoperative follow-up [14.1 ± 12.4 months (range: 3 to 59 months)], best corrected visual acuity (BCVA) and intraocular pressure (IOP) did not change significantly [BCVA, 0.23 logarithm of the minimum angle of resolution (logMAR) (20/32 Snellen) preoperatively vs. 0.18 logMAR postoperatively (20/25 Snellen) (Z = À0.222, p = 0.824); IOP, 15 mmHg preoperatively vs. 17 mmHg postoperatively (Z = 1.377, p = 0.1447)]. Mild or self-limiting complications included: elevated IOP (42.1%), cystoid macular oedema (15.8%); persisting postoperative uveitis (15.8%) and minor vaulting of the prosthesis (15.7%). Moderate or severe complications included significant vaulting of prosthesis requiring surgical revision (5.3%) and a single eye (5.3%) with trabeculectomy and corneal graft failure. 94.4% of patients were very satisfied with the cosmesis and would be highly likely to have the procedure again. Conclusions: This study confirms that endocapsular insertion of an artificial iris is typically associated with good functional and cosmetic results and a relatively low risk of significant complications.

Cysts and tumours of the iris: Diagnostic tools and key management considerations—A review

“…11 Any compromise or defect to the iris can result in a significant change to the eye's cosmetic appearance and also lead to photophobia, glare, difficulty reading and altered contrast sensitivity. 12…”

Microscopic analysis of preinsertion cutting modalities on custom, flexible iris prostheses

“…3–5 These color-changing implants placed solely for esthetic purposes in otherwise healthy eyes should not be confused with therapeutic iris prostheses, which, while less common, are still worthy of study and are the primary subject of this paper. 6–9 Inflammatory sequelae after therapeutic iris implants have been reported in some series, such as in the study by Mayer et al, while other series with the same device have not demonstrated this issue with the same frequency as Mayer's. 9,10 Early studies of UGH syndrome disclosed an association with rough, sharp, or serrated edges of intraocular implants.…”