Bilateral simultaneous artificial iris implantation for post-traumatic aniridia: a case report

Cosmetic iris implants - double edge sword

Iris implants were originally described as an option to treat photophobia and glare associated with aniridia, coloboma, corectopia or any other causes of acquired or congenital iris defects. They are not designed to be used in healthy phakic eyes and not approved by regulatory bodies anywhere in the world for cosmesis. However, widespread publicity and the compulsive need for beautification has popularised the use of these implants illicitly. Implantation into phakic eyes causes mechanical irritation of angle structures leading to chronic inflammation, pigment dispersion, prolonged endothelial cell loss and compression of the trabecular meshwork. The consequences are dire, leading to presentation of such patients with serious complications involving the cornea, angle, and lens. Here we give an extensive review of available literature on cosmetic iris implants and also describe a case with bilateral cosmetic iris implants (New-ColorIris). The patient presented with corneal decompensation, glaucoma, and cataract in both eyes, seven years after the implantation and was successfully managed with explantation of the device followed by a DMEK Triple procedure.

Bilateral Artificial Iris implantation in patients with bilateral iris defects

Purpose

Binocular traumatic or atraumatic iris defects can lead to an increased sensitivity to glare and cosmetic disfigurement. Surgical iris reconstruction is one approach to alleviate these problems. We report the clinical outcomes after medically indicated bilateral implantation of an Artificial Iris prosthesis in three patients with binocular iris defects with different etiologies.

Observations

All three patients underwent binocular CUSTOMFLEX ArtificialIris (AI) (HumanOptics AG, Erlangen, Germany) implantation with simultaneous cataract surgery. Corrected distance visual acuity (CDVA), manifest refraction, Contrast sensitivity, endothelial cell density and subjective visual impairment as well as subjective cosmetic disfigurement were measured pre- and postoperatively. CDVA remained stable or improved in all three patients. We observed an increase in contrast sensitivity and reduction of glare sensitivity in two patients. All patients reported satisfaction with the cosmetical result after the implantation.

Conclusions and importance

The bilateral Artificial Iris implantation is an effective therapeutic option to reduce glare sensitivity and to achieve an aesthetically pleasing result also in selected patients with binocular traumatic or atraumatic iris defects.