Management of traumatic aniridia and aphakia with an iris reconstruction implant

Abstract

We describe the clinical features and management of a 36-year-old man with aniridia and aphakia following blunt ocular trauma. Examination showed partial aniridia and aphakia. We discuss the various options available in the management of this patient and describe the surgical technique involved in the implantation of an iris reconstruction implant.

Combined transscleral fixation of an artificial iris prosthesis with an intraocular lens

“…Aside from esthetic aspects, partial or total loss of iris tissue may also be related to various degrees of glare, photophobia, and visual impairment. In patients with major iris defects, an artificial iris prosthesis provides satisfactory anterior segment reconstruction with a remarkable functional outcome (3)(4)(5)(6)(7)(8)(9)(10) . Various implants have been developed for the treatment of aphakia with aniridia.…”

“…Because the management of aphakia is not possible with such artificial iris implants, the transscleral fixation of IOL has to be scheduled in aphakic eyes with a lack of a sufficient capsular support. Hence, many authors have published an excellent visual prognosis with transsclerally fixated IOLs in aphakic cases without any capsular support (2)(3)(4)(5) . In order to reduce the risk of both corneal decompensation and macular edema, transscleral fixation of a standard IOL in combination with a custom-tailored artificial iris prosthesis in the same surgical session has been published very recently in cases with concomitant aniridia and aphakia (4,5) .…”

“…Pupillary defects may cause glare and photophobia to various degrees; however, traumatic aniridia may lead to severe visual deterioration. Because corneal endothelial cell density is reduced in eyes with a traumatic cataract, every surgical trauma entails a potential risk of aggravating corneal decompensation (1)(2)(3) . After custom-tailored iris prosthesis became available for ocular implantation, some authors have described a combined surgical approach for treating aphakia and aniridia with haptic fixation of an intraocular lens (IOL) on artificial iris implants prior to intraocular placement (4,5) .…”

Safety of an artificial iris in a phakic eye

“…Sectorial or total iris defects may be caused by congenital aniridia, 13 trauma, 5,9,14 iris atrophy, 15 iridectomy, 16 or recurrent anterior uveitis resulting in severe iris damage. 15 Iris defects may cause significant complaints of photophobia, glare, decreased quality of image, impaired vision, and even diplopia.…”

“…2 As traumatic iris lesions are often combined with lesions of the crystalline lens, 3 most reported cases of iris reconstruction concern aphakic eyes 4-6 or pseudophakic eyes. [7][8][9] However, not all traumatic iris lesions are accompanied by lens defects. In the following case report, a sectorial foldable artificial iris made of hydrophobic silicone elastomer with pigments (Artificial Iris-Fibre Free [Dr. Schmidt Intraocularlinsen GmbH]) was implanted in a phakic eye to repair a posttraumatic iris defect.…”