Surgical management of iris defects with prosthetic iris devices

Mavrikakis, Ioannis; Mavrikakis, Emmanouil; Syam, P P; Bell, Julia A.; Casey, Julian Hickman; Casswell, A G; Brittain, G. P. H.; Liu, C

doi:10.1038/sj.eye.6701448

Cited by 45 publications

(45 citation statements)

References 9 publications

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“…Most cases of aniridia occur after severe ocular trauma, less common causes are congenital, ICE-syndrome, or an iatrogenic iris defect. While small defects can be repaired with specific suture techniques [1], more complex cases require an iris prosthesis [2,3]. Due to limited flexibility of the iris tissue, better iris implants have evolved over the last decade with soft and foldable material for easy and minimal invasive implantation and with enough structural stability for suturing [4].…”

Section: Introductionmentioning

confidence: 99%

Long-term results after artificial iris implantation in patients with aniridia

Rickmann

Szurman

Januschowski

et al. 2016

Graefes Arch Clin Exp Ophthalmol

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The artificial iris prosthesis revealed a good clinical outcome in terms of long-term stability, cosmetic appearance, visual function, and represents a good functional iris diaphragm for compartmentalisation. Complications such as glaucoma, darkening of iris tissue, and need for consecutive anterior segment surgery are clearly associated with implants with integrated fiber mesh, but not to those without. Hence, the use of full iris prostheses without embedded fiber mesh, even in cases with remnant iris, and the use of slightly smaller implants than officially recommended may be beneficial.

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Section: Introductionmentioning

confidence: 99%

Long-term results after artificial iris implantation in patients with aniridia

Rickmann

Szurman

Januschowski

et al. 2016

Graefes Arch Clin Exp Ophthalmol

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“…[1][2][3][4] However, these procedures carry the risk for serious intraoperative and postoperative complications such as anterior capsule tear, postoperative anterior uveitis, secondary glaucoma, and implant migration. 7 Topical thymoxamine has been found to be beneficial in treating the traumatic dilated pupil but was ineffective in some cases, with side effects including ocular irritation and hyperemia. 5 In our patient, intracorneal inlay implantation was the safest and least invasive option to reduce glare without the need for long-term topical treatment.…”

Section: Discussionmentioning

confidence: 99%

Corneal inlay implantation to treat extensive glare and photophobia in a young patient with traumatic mydriasis

Warrak¹,

Sammouh²,

Baban³

2015

Journal of Cataract and Refractive Surgery Online Case Reports

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“…Accordingly, intracapsular devices are vulnerable to late capsular bag dislocation from repeat trauma, capsule contracture, or progressive zonulysis. 1,4 We report what we believe is the first use of a capsular tension segment to manage late subluxation of a capsular bag complex containing a posterior chamber intraocular lens (PC IOL) and 2 iris devices. …”

mentioning

confidence: 98%

Capsular tension segments in repositioning capsular bag complex containing an intraocular lens and iris prosthesis

Snyder¹,

Osterholzer²

2012

Journal of Cataract and Refractive Surgery

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Placement of an iris prosthesis has been shown to reduce glare and improve visual acuity. 1-3 Coexisting zonular weakness is common in congenital aniridic patients with progressive zonulopathy and trauma with iris defects. Accordingly, intracapsular devices are vulnerable to late capsular bag dislocation from repeat trauma, capsule contracture, or progressive zonulysis. 1,4 We report what we believe is the first use of a capsular tension segment to manage late subluxation of a capsular bag complex containing a posterior chamber intraocular lens (PC IOL) and 2 iris devices. CASE REPORTA 74-year-old man was referred for a subluxated unstable capsular bag complex containing a PC IOL and 2 iris prosthetic elements. Cataract surgery had been performed previously, and 1 year after the surgery, 2 interdigitating 50c elements had been implanted in the capsular bag to control glare from traumatic aniridia.Examination showed a mobile capsular bag complex "floating" over an intact hyaloid face. A dispersive ophthalmic viscosurgical device (OVD) was injected to open the capsulorhexis margin. Two type 6D capsular tension segments (Morcher GmbH), pre-threaded with 8-0 polytetrafluoroethylene sutures (Gore-Tex, W.L. Gore & Associates, Inc.), were serially placed into opposite fornices of the capsular bag ( Figure 1). Two sets of scleral openings were created superiorly and inferiorly at the level of the ciliary sulcus. The blunt suture ends were respectively retrieved from the anterior chamber with a 23-gauge microforceps via the scleral openings and externalized. Suture tension was adjusted, recentering and stabilizing the capsular bag complex containing the IOL and iris prostheses (Figure 2). The knots and tags were rotated internally and covered by both conjunctiva and Tenon fascia.The postoperative course was unremarkable, with visual recovery to baseline and sustained significant subjective decrease in glare. DISCUSSIONA variety of techniques have been described to manage subluxated IOLs. Repositioning a capsular bag with a rigid iris prosthesis in situ can be very challenging since sutures cannot pass through rigid poly(methyl methacrylate) (PMMA) material. In addition, passing sutures through the bag between the elements could result in splitting the bag because the prosthesis prevents fusion of the anterior and posterior capsule leaflets, unlike when the bag is occupied by an IOL alone. We are aware of only 1 unreported case in which an in-the-bag PMMA iris prosthesis-IOL complex was repositioned without exchange by placing sutures directly through the acrylic optic of the IOL and then securing it to the sclera, which required considerable surgical dexterity. A In the case we describe, we were able to successfully suture refixate the bag complex using capsular tension Figure 1. Capsular tension segment is placed into the inferior capsule fornix. The white arrow shows the device sliding under the capsulorhexis margin.Figure 2. At the end of the case, the PC IOL-capsular bag-iris prosthesis complex is centered and stabl...

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Surgical management of iris defects with prosthetic iris devices

Cited by 45 publications

References 9 publications

Long-term results after artificial iris implantation in patients with aniridia

Long-term results after artificial iris implantation in patients with aniridia

Corneal inlay implantation to treat extensive glare and photophobia in a young patient with traumatic mydriasis

Capsular tension segments in repositioning capsular bag complex containing an intraocular lens and iris prosthesis

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