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

Abstract

Purpose: To determine the induced edge effects of different clinically utilized device post-manufacture modification styles and modalities on custom iris implants. Settings: 1) Academically affiliated multispecialty private practice group, 2) Academic medical Center Design: Laboratory study Methods: Sample custom iris prostheses were cut using patterns, blades, and surgical instruments described in the literature. The cut edges were evaluated with slit lamp microscopy, light microscopy, and scanning electron microscopy. Results: Disposable blades yielded smoother cuts than scissors. Trephine blade brand significantly impacted the cut surface smoothness of the silicone matrix. Meshwork-embedded prostheses had some irregular sharp edges where the mesh fibers were cut with all modalities, though these were worse with scissors and one tested trephine brand compared to the other. Pseudo-iridectomies and scissor cuts created sharp points and corners in the device periphery. Conclusions: Post-manufacture modifications of iris implants should be minimized. The cut margins of the fiber-free implants have fewer sharp edges and may be preferable for sulcus placement. In-the-bag device placement may mitigate clinical impact of sharp edges and corners. These practices may help to minimize inflammatory sequelae post-implantation.