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Ferro Desideri L, Arun K, Doherty G, Bernardi E, Anguita R. Iris Reconstruction: A Surgeon's Guide. J Clin Med 2024; 13:2706. [PMID: 38731235 PMCID: PMC11084487 DOI: 10.3390/jcm13092706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Revised: 04/22/2024] [Accepted: 04/30/2024] [Indexed: 05/13/2024] Open
Abstract
Objectives: The aim of this review paper is to summarise surgical options available for repairing iris defects at the iris-lens plane, focusing on suturing techniques, iridodialysis repair, and prosthetic iris devices. Methods: A thorough literature search was conducted using multiple databases, including Medline, PubMed, Web of Science Core Collection, and the Cochrane Library, from inception to February 2024. Relevant studies were screened based on predefined criteria, and primary references cited in selected articles were also reviewed. Results: Various surgical techniques were identified for iris defect repair. Suturing methods such as interrupted full-thickness sutures and the McCannel technique offer solutions for smaller defects, while iridodialysis repair techniques address detachment of the iris from the ciliary body. Prosthetic iris devices, including iris-lens diaphragm devices, endocapsular capsular tension ring-based devices, and customizable artificial iris implants, provide options for larger defects, each with its own advantages and limitations. Conclusions: Successful iris reconstruction requires a personalised approach considering factors like defect size, ocular comorbidities, and patient preference. Surgeons must possess a thorough understanding of available techniques and prosthetic devices to achieve optimal outcomes in terms of both visual function and, nonetheless, cosmetic appearance.
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Affiliation(s)
- Lorenzo Ferro Desideri
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 15, CH-3010 Bern, Switzerland; (L.F.D.); (E.B.)
- Department for BioMedical Research, University of Bern, Murtenstrasse 24, CH-3008 Bern, Switzerland
- Bern Photographic Reading Center, Inselspital, Bern University Hospital, University of Bern, CH-3010 Bern, Switzerland
| | - Kirupakaran Arun
- Moorfields Eye Hospital, NHS Foundation Trust, London EC1V 2PD, UK;
| | - Grace Doherty
- Faculty of Medicine, Queen’s University Belfast School of Medicine, Belfast BT9 7BL, UK;
| | - Enrico Bernardi
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 15, CH-3010 Bern, Switzerland; (L.F.D.); (E.B.)
- Department for BioMedical Research, University of Bern, Murtenstrasse 24, CH-3008 Bern, Switzerland
| | - Rodrigo Anguita
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 15, CH-3010 Bern, Switzerland; (L.F.D.); (E.B.)
- Department for BioMedical Research, University of Bern, Murtenstrasse 24, CH-3008 Bern, Switzerland
- Moorfields Eye Hospital, NHS Foundation Trust, London EC1V 2PD, UK;
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Santiago-Alvarado A, Granados-Agustín FS, López-Raymundo BR, Hernández-Mendez A, Huerta-Carranza O. Development of a bio-inspired optical system that mimics accommodation and lighting regulation like the human eye. Appl Opt 2024; 63:193-203. [PMID: 38175021 DOI: 10.1364/ao.506986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 12/02/2023] [Indexed: 01/05/2024]
Abstract
Bio-inspired optical systems have recently been developed using polarizers and liquid or rigid lenses. In this work, we propose a bio-inspired opto-mechatronic system that imitates the accommodation and regulation of light intensity as the human eye does. The system uses a polymeric lens as a cornea, an adjustable diaphragm as an iris, a tunable solid elastic lens as a crystalline lens, and a commercial sensor as a retina. We also present the development of the electronic control system to accommodate and regulate the amount of light that enters the system, for which two stepper motors, an Arduino control system, and light and movement sensors are used. The characterization of the system is presented together with the results obtained, where it can be seen that the system works in an acceptable range as the human eye does.
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Gius I, Tozzi L, De Biasi CS, Pizzolon T, Parolini B, Frisina R. Artificial iris: state of the art. J Cataract Refract Surg 2023; 49:430-437. [PMID: 36719472 DOI: 10.1097/j.jcrs.0000000000001147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 01/22/2023] [Indexed: 02/01/2023]
Abstract
Surgical correction of traumatic aniridia aims to improve the quality of vision, compartmentalize the anterior and posterior chamber, and re-establish a satisfying cosmetic appearance. Various types of prosthetic iris devices (PIDs) are available, which differ in technical difficulty of implant and design: artificial iris (AI)-intraocular lens prosthesis, endocapsular capsular tension ring-based PID, and customized AI. The choice depends on the preexisting clinical condition after severe ocular trauma and on patient functional and cosmetic expectations. This systematic review of the literature compared anatomical and functional outcomes of various types of PIDs. Of 185 articles found in the literature, 70 fulfilled the eligibility criteria. 5 subgroups of PIDs were Ophtec, artificial iris from Ophtec BV, Morcher GmbH, HumanOptics AG, and other prosthesis. Both glare and aesthetic outcome improved postoperatively; in comparison with other PIDs, intraocular pressure rise was higher in the Morcher group (40%), whereas prosthesis dislocation was higher in the Ophtec group (39%).
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Affiliation(s)
- Irene Gius
- From the Department of Ophthalmology, University of Padova, Padova, Italy (Gius); Department of Ophthalmology, Pordenone Hospital, Pordenone, Italy (Tozzi, De Biasi); Department of Ophthalmology, "Ca Foncello" Hospital, Treviso, Italy (Pizzolon); Ophthalmology, Eye Care Clinic, Brescia, Italy (Parolini); Ophthalmology-Surgery Department, Guglielmo da Saliceto Hospital, Piacenza, Italy (Frisina)
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Yao X, Kang Q, Qi W, Liu Y, Zhou X, Wang M, Yang Y, Zhu F, Cao W. A novel pupilloplasty in crescent-shaped suturing pattern for coloboma and traumatic iris defects. BMC Ophthalmol 2023; 23:119. [PMID: 36964554 PMCID: PMC10037883 DOI: 10.1186/s12886-023-02853-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 03/10/2023] [Indexed: 03/26/2023] Open
Abstract
OBJECTIVE PURPOSE: To observe the safety and effect of the C-pupilloplasty for the treatment of iris coloboma and traumatic iris defects. METHODS A total of 21 cases (21 eyes) with iris coloboma or traumatic iris defects who underwent C-pupilloplasty (a single-pass three-throw technique) from Feb. 2016 to Mar. 2020 were analyzed retrospectively. Uncorrected visual acuity, refraction, corneal topographic keratometry and endothelial cell density were examined. RESULTS All the patients were successfully treated, and a central and round pupil was restored. The mean follow-up duration was 8.76 ± 3.58 months (ranging from 2 to 14 months). All patients had round or round-like pupils with a diameter less than or equal to 3 mm after the C-pupilloplasty. Very slightly endothelial loss, negligible symptoms such as glare, distortion, dizziness and photophobia were observed. CONCLUSION We introduced a new technique of pupilloplasty (C-pupilloplasty) which could be a more straight forward and more effective treatment for iris coloboma and traumatic iris defect.
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Affiliation(s)
- Xiaoming Yao
- Department of Ocular Surface Disorders and Cornea, Chengdu Aidi Eye Hospital, Sichuan, 610000, China
| | - Qian Kang
- Department of Ocular Surface Disorders and Cornea, Chengdu Aidi Eye Hospital, Sichuan, 610000, China
| | - Wei Qi
- Shenzhen Huaxia Eye Hospital, Guangdong, China
| | - Yuan Liu
- Guizhou Jinglang Eye Hospital, Guiyang, Guizhou, China
| | | | - Mingwu Wang
- Department of Ophthalmology and Vision Science, University of Arizona, Tucson, AZ, USA
| | - Yukun Yang
- Department of Ocular Surface Disorders and Cornea, Chengdu Aidi Eye Hospital, Sichuan, 610000, China.
| | - Fengjiao Zhu
- Shanghai Pudong New Area Eye and Dental Disease Prevention & Treatment Center, Shanghai, 201399, China.
| | - Wenchao Cao
- Shenzhen Eye Hospital, Shenzhen, 518000, Guangdong, China.
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Roman S, Baudouin C. Flexible silicone artificial iris in cases of aniridia and iris deficiencies. J Fr Ophtalmol 2021; 44:1387-1395. [PMID: 34330549 DOI: 10.1016/j.jfo.2021.02.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 02/17/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE To evaluate a customized silicone flexible artificial iris in cases of aniridia or iris deficiencies. SETTING Centre Hospitalier National d'Ophtalmologie, Hôpital des Quinze-Vingts, Paris, France. DESIGN Retrospective case series investigating cosmetic result, photophobia, endothelial cell density and intraocular pressure. METHODS Patients with iris deficiencies requiring cataract surgery or correction of aphakia, or pseudophakic patients, complaining of photophobia or cosmetic disturbances were implanted with the new flexible artificial iris. RESULTS Fifteen eyes of 14 patients were evaluated. Mean age was: 49.5 (±18.5). A total of 50% were aphakic, 22.4% pseudophakic and 28.6% phakic. Etiology was trauma (57.1%), previous surgical trauma (28.6%) and congenital aniridia (14.3%). Three months postoperatively, the mean subjective photophobia score improved by 5.2 points (P=.002) and the mean cosmesis score by 4.7 points (P=.001) on a 0 to 10 scale. Mean endothelial cell loss was 16% (P=.001). There was no further statistically significant endothelial cell loss between the 3-month follow-up and the 1-year follow-up visit (P=.320). Elevated intraocular pressure was the main complication (35.7%). Two patients with pre-existing glaucoma required cyclodestructive procedures. The artificial iris was removed in one eye because of chronic pain, elevated intraocular pressure and inflammation that resolved rapidly after removal. CONCLUSION Implantation of the customized artificial iris is a very good option because of its outstanding cosmetic result. However, patients with pre-existing glaucoma are not good candidates. Patients should also be warned of possible chronic inflammation necessitating explantation.
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Affiliation(s)
- S Roman
- Service 3, Quinze-Vingts National Ophthalmology Hospital, INSERM-DGOS CIC 1423, IHU Foresight, 28, Rue de Charenton, 75012 Paris, France.
| | - C Baudouin
- Service 3, Quinze-Vingts National Ophthalmology Hospital, INSERM-DGOS CIC 1423, IHU Foresight, 28, Rue de Charenton, 75012 Paris, France; Sorbonne Université, INSERM, CNRS, Institut de la Vision, Paris, France; Department of Ophthalmology, Ambroise Paré Hospital, AP-HP, Université de Versailles Saint-Quentin en Yvelines, Boulogne-Billancourt, France
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Mayer CS, Hoffmann AM, Prahs P, Reznicek L, Khoramnia R. Functional outcomes after combined iris and intraocular lens implantation in various iris and lens defects. BMC Ophthalmol 2020; 20:370. [PMID: 32933506 PMCID: PMC7493881 DOI: 10.1186/s12886-020-01621-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 08/20/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To assess the functional outcomes after combined iris and intraocular lens (IOL) repair in aniridia patients. METHODS Retrospective observational study in 59 aniridic and aphakic eyes for ArtificialIris (AI) and IOL reconstruction. The iris prostheses were placed together with the IOL in the capsular bag using an injection system or were fixed by transscleral suturing of the IOL and AI. The primary outcomes measured were visual acuity, contrast and glare sensitivity (Pelli-Robson chart for photopic and dark adaptometer for mesopic conditions), intraocular pressure, endothelial cell density (ECD) and patient impairment. RESULTS Blunt trauma (37 eyes) and penetrating injuries (16 eyes) were observed more frequently than congenital aniridia (1 eye), iatrogenic causes (1 eye), aniridic state after severe iritis (2 eyes) or iris tumor (2 eyes). Monocular CDVA improved significantly (p < 0.0001) from median 0.7 logMAR (0.0-1.98) to 0.3 logMAR (- 0.08-2.0). Median pupillary area could significantly (p < 0.0001) be reduced by 79.3% from 51.27 mm2 (17.91 to 98.23) to 8.81 mm2 (4.16 to 8.84). Median ECD decreased from 2646.0 mm2 to 2497.5 mm2 (p = 0.007). Contrast and glare sensitivity improved significantly (p = 0.008) in photopic light conditions from 0.9 (0.0-1.95) to 1.35 (0.0-1.8). Patients reported to be highly satisfied with the functional improvement. CONCLUSION The flexible ArtificialIris seems to be a safe and effective iris prosthesis in combination with an IOL having functionally and cosmetically exceptional reconstruction options.
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Affiliation(s)
- Christian S Mayer
- Department of Ophthalmology, University Hospital Heidelberg, University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.,Department of Ophthalmology, University Hospital Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Andrea M Hoffmann
- Department of Ophthalmology, University Hospital Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Phillipp Prahs
- Department of Ophthalmology, University of Regensburg, Regensburg, Germany
| | - Lukas Reznicek
- Department of Ophthalmology, University Hospital Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Ramin Khoramnia
- Department of Ophthalmology, University Hospital Heidelberg, University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
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Wang H, Jung J, Lin SR, Olson MD, Miller KM. Safety and Efficacy of Colored Iris Reconstruction Lens Implantation. Am J Ophthalmol 2020; 216:174-185. [PMID: 32278768 DOI: 10.1016/j.ajo.2020.03.036] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 03/21/2020] [Accepted: 03/24/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE We sought to evaluate the 1- to 9-year safety and efficacy of colored iris reconstruction lens implantation in eyes with visual disturbances caused by partial or complete aniridia. DESIGN Prospective, interventional case series. METHODS Thirty-eight patients were implanted with Ophtec 311 colored iris reconstruction lenses at the University of California, Los Angeles as part of a larger U.S. Food and Drug Administration clinical trial. Patients in group 1 lacked corneal pathology. Patients in group 2 patients had corneal pathology, such as endothelial failure, previous transplants, or scarring. Safety measures included loss of corrected distance visual acuity (CDVA), surgical complications, adverse events, secondary interventions, and corneal endothelial cell loss. Efficacy measures included improvement in uncorrected distance visual acuity (UDVA) and subjective visual disturbances. RESULTS Groups 1 (n = 8) and 2 (n = 30) showed improvements in CDVA (P = .155 and .038), UDVA (P = .002 and P < .001), and subjective visual disturbance scores at year 3. Median CDVA and UDVA declined slightly for both groups after 1-2 years. Group 2 experienced more adverse events, surgical complications, and secondary interventions. Endothelial cell loss was greater for group 2 (19.7%) than group 1 (8.05%), although this difference was not statistically significant (P = .067). CONCLUSIONS Colored iris reconstruction lens implantation improved CDVA, UDVA, and subjective visual disturbances 3 years postoperatively and beyond. Adverse events, complications, and subsequent declines in visual acuity were common, however, in these eyes with complex medical and surgical histories.
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Affiliation(s)
- Hongxing Wang
- Stein Eye Institute and the Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA; Department of Ophthalmology, Beijing Chuiyangliu Hospital, Tsinghua University, Beijing, China
| | - JooYeon Jung
- Stein Eye Institute and the Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Shawn R Lin
- Stein Eye Institute and the Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Michael D Olson
- Stein Eye Institute and the Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Kevin M Miller
- Stein Eye Institute and the Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
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Mayer CS, Laubichler AE, Masyk M, Prahs P, Zapp D, Khoramnia R. Residual Iris Retraction Syndrome After Artificial Iris Implantation. Am J Ophthalmol 2019; 199:159-166. [PMID: 30236771 DOI: 10.1016/j.ajo.2018.09.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 09/03/2018] [Accepted: 09/06/2018] [Indexed: 11/27/2022]
Abstract
PURPOSE To evaluate the effect of an artificial iris implant on the remnant iris. DESIGN Interventional case series. METHODS Setting: Single center. PATIENT POPULATION Forty-two consecutive patients. OBSERVATION PROCEDURES Morphologic evaluation over 24 ± 14 months. MAIN OUTCOME MEASURES Remnant pupillary aperture, iris color, visual acuity, intraocular pressure, and endothelial cell count. RESULTS In 7 of 42 cases (16.7%), the residual iris aperture dilated from 36.6 ± 15.4 mm2 preoperatively to 61.1 ± 12.5 mm2 1 year postoperatively (66.9% increase). In 5 of 7 affected eyes the artificial iris had been implanted into the ciliary sulcus; in 2 eyes it had been sutured to the sclera. Four of the 7 patients presented with remarkable complications: 2 eyes needed glaucoma shunt surgeries owing to pigment dispersion; 1 suffered from recurrent bleedings; and in 1 case artificial iris explantation was performed owing to chronic inflammation. Anterior chamber depth and angle, endothelial cell count, and visual acuity did not change in this cohort. Changes in color were not observed in the remnant iris. CONCLUSIONS The implantation of an artificial iris prosthesis can lead to a residual iris retraction syndrome. It is likely that residual iris is trapped in the fissure between the artificial iris and the anterior chamber angle, preventing further pupil constriction. Another possibility could be a constriction or atrophy of the residual iris. A scleral-sutured implant and an implantation in the capsular bag were both found to prevent the iris retraction. The study group number is inadequate to allow statistical comparison of these different implantation methods. As the use of artificial irises increases, we may expect more patients with iris retraction syndrome in the future.
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Affiliation(s)
- Christian S Mayer
- Department of Ophthalmology, Technical University of Munich, Munich, Germany; David J. Apple Center for Vision Research, Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany.
| | - Andrea E Laubichler
- Department of Ophthalmology, Technical University of Munich, Munich, Germany
| | - Michael Masyk
- Department of Ophthalmology, Technical University of Munich, Munich, Germany
| | - Philipp Prahs
- Department of Ophthalmology, University of Regensburg, Regensburg, Germany
| | - Daniel Zapp
- Department of Ophthalmology, Technical University of Munich, Munich, Germany
| | - Ramin Khoramnia
- David J. Apple Center for Vision Research, Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany
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Mayer CS, Laubichler AE, Khoramnia R, Tandogan T, Prahs P, Zapp D, Reznicek L. Challenges and Complication Management in Novel Artificial Iris Implantation. J Ophthalmol 2018; 2018:3262068. [PMID: 30345111 DOI: 10.1155/2018/3262068] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 08/19/2018] [Indexed: 01/19/2023] Open
Abstract
Purpose Evaluation of postoperative artificial iris prosthesis-related complications. Design Retrospective cohort study. Methods Fifty-one consecutive patients underwent pupillary reconstruction using an artificial iris implant made from silicone between 2011 and 2015. Quantity and quality of complications were subclassified into three groups including mild, moderate, and severe complications. Their management and the learning curve were evaluated. Results In total, 13 (25.5%) of 51 included artificial iris implantations showed unexpected events in various degrees: mild complications: recurrent bleeding (n=1, 2.0%), slight but stable iris deviation (n=1, 2.0%), capsular fibrosis (n=2, 3.9%); moderate complications: suture cutting through the residual iris (n=1, 2.0%), glaucoma (n=3, 5.9%), and corneal decompensation (n=3, 5.9%); severe complications: artificial iris suture loosening (n=2, 3.9%) and dislocation (n=3, 5.9%), synechiae (n=2, 3.9%), glaucoma (n=2, 3.9%), and corneal decompensation (n=5, 9.8%) with the need for surgery, cystoid macular edema (n=3, 5.9%) and retinal detachment (n=1, 2.0%). The complication rate decreased from 83.3% (5 of 6 implantations) in the first year to 13.3% (2 of 15 implantations) in the 4th year. Nineteen of 45 evaluated patients showed a significant gain in best-corrected visual acuity (BCVA) from 1.09 ± 0.56 logMAR to 0.54 ± 0.48 logMAR (p < 0.001), and 13 of 45 eyes had a significant BCVA loss from 0.48 ± 0.39 logMAR to 0.93 ± 0.41 logMAR after surgery (p < 0.001). Conclusions The artificial iris is a feasible option in the treatment of iris defects with a wide spectrum of postoperative complications. The significant reduction of complications after twelve implantations implicates that the procedure is not to be recommended in low volume settings.
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Doroodgar F, Jabbarvand M, Niazi F, Niazi S, Sanginabadi A. Implantation of ArtificialIris, a CustomFlex irisprosthesis, in a trauma patient with an Artisan lens: A case report and review. Medicine (Baltimore) 2017; 96:e8405. [PMID: 29137026 PMCID: PMC5690719 DOI: 10.1097/md.0000000000008405] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To evaluate probable complications of ArtificialIris implantation with iris fixated intraocular lens. METHOD Development of photophobia, glare, and psychological strain during face-to-face communication in a 23-year-old man with a widespread traumatic iris defect terminate to make a decision for performing implantation of an ArtificialIris (Humanoptics, Erlangen, Germany) under the remnant iris without removing the patient's existing Artisan lens. RESULTS Without any intraoperative or postoperative complications, the patient's visual acuity increased by 1 line, the endothelial cell loss was comparable with the cell loss associated with standard cataract surgery, and the anterior-chamber depth and anterior-chamber anatomy did not change. At the final follow-up examination, the mean intraocular pressure did not differ from baseline, and we achieved high level of patient satisfaction and subjective vision improvement. We discuss the particular importance of considering the patient's expectations, the appropriate measurements, ways to perfect color evaluation, and the types of ArtificialIris products. CONCLUSION The implantation of the ArtificialIris in patients with aphakic iris-supported lenses (ie, pre-existing Artisan lenses) is a feasible approach and a useful option for patients with thin irises and iris hypoplasia who are at risk of subluxation or the dislocation of the posterior-chamber intraocular lens (PCIOL), and also those with sclerally fixed PCIOLs.
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Affiliation(s)
| | | | - Feizollah Niazi
- Shahid Beheshti University of Medical Sciences and Health Services, Tehran, Iran
| | - Sana Niazi
- Shahid Beheshti University of Medical Sciences and Health Services, Tehran, Iran
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Miller KM, Nicoli MC, Olson MD, Shah M, Masket S. Outcomes of implantation of modified capsule tension rings with multiple black occluder paddles for eyes with congenital and acquired iris defects: Report 3. J Cataract Refract Surg 2016; 42:870-8. [DOI: 10.1016/j.jcrs.2016.03.035] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 02/26/2016] [Accepted: 03/01/2016] [Indexed: 11/15/2022]
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Mayer CS, Reznicek L, Hoffmann AE. Pupillary Reconstruction and Outcome after Artificial Iris Implantation. Ophthalmology 2016; 123:1011-8. [DOI: 10.1016/j.ophtha.2016.01.026] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 01/15/2016] [Accepted: 01/20/2016] [Indexed: 11/23/2022] Open
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Spitzer MS, Nessmann A, Wagner J, Yoeruek E, Bartz-Schmidt KU, Szurman P, Szurman GB. Customized humanoptics silicone iris prosthesis in eyes with posttraumatic iris loss: outcomes and complications. Acta Ophthalmol 2016; 94:301-6. [PMID: 26805757 DOI: 10.1111/aos.12946] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2015] [Accepted: 11/07/2015] [Indexed: 11/26/2022]
Abstract
PURPOSE Posttraumatic partial or total iris defects often cause significant debilitating glare, photophobia, decreased vision and cosmetic problems. Currently, the best cosmetic results can be obtained with a customized silicone iris prosthesis. However, little is known about the functional results and the rate of complication if this type of iris prosthesis is implanted into severely traumatized eyes. The aim of this study is to analyse the functional and cosmetic outcomes as well as complications after Artificial Iris implantation. METHODS A consecutive series of 34 patients who received a customized silicone iris prosthesis after severe globe injury with total or sub-total iris loss was analysed retrospectively. Additionally, patients were interviewed regarding change in subjective complaints. RESULTS Median follow-up was 24 months (range 12.0-48.8). Mean visual acuity prior to Artificial Iris implantation was 1.1 logMAR (range 0.3-2.6). Five patients (15%) had pre-existing glaucoma and eight patients (24%) had pre-existing hypotony. Visual acuity 12 months after surgery was 1.4 logMAR (range 0.2-2.6). Complications included newly diagnosed glaucoma in three eyes (9%) and hypotony in three eyes (9%), persisting intraocular inflammation or macular oedema in seven patients (21%), and corneal endothelial decompensation requiring corneal transplantation in six patients (18%). Patients' satisfaction increased by reducing glare and enhanced cosmetic appearance. CONCLUSION The customized silicone iris prosthesis is an individualized treatment approach with appealing cosmetic results. Therefore, especially traumatized eyes with highly different posttraumatic conditions could benefit. However, in some patients, the implantation of this device may cause an increase of intraocular pressure, corneal endothelial decompensation or persisting inflammation.
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Affiliation(s)
| | - Anja Nessmann
- University Eye Hospital Tuebingen; Tuebingen Germany
| | - Julia Wagner
- University Eye Hospital Tuebingen; Tuebingen Germany
| | - Efdal Yoeruek
- University Eye Hospital Tuebingen; Tuebingen Germany
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Fernández-López E, Pascual FP, Pérez-López M, Quevedo AM, Martínez CP. Sutureless artificial iris after phacoemulsification in congenital aniridia. Optom Vis Sci 2015; 92:S36-9. [PMID: 25738840 DOI: 10.1097/OPX.0000000000000527] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE This article reports the first case of a sutureless artificial iris prosthesis used in combination with cataract surgery for congenital aniridia with successful visual and cosmetic results. CASE REPORT A 15-year-old woman with congenital bilateral partial aniridia, cataracts, and intense photophobia presented to the Cornea and Refractive Surgery Unit of the Ophthalmology Department. She was managed with an artificial iris implant (ArtificialIris, Dr. Schmidt Intraocularlinsen GmbH, Human Optics) fixed in the ciliary sulcus without any sutures after small-incision cataract surgery. At the 1-year follow-up, subjective complaints of glare and photophobia as well as binocular near visual acuity improved significantly. The cosmetic result was excellent. No postoperative complications have been recorded within this period. CONCLUSIONS The ArtificialIris is a promising device for treating photophobia in congenital aniridia. ArtificialIris does not require suture fixation with adequate capsular support and iris remnants.
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Aggarwal H, Kumar P, Singh RD, Chand P, Alvi HA. Ocular rehabilitation following socket reconstruction with amniotic membrane transplantation with failed primary hydroxyapatite implant post enucleation. Cont Lens Anterior Eye 2015; 38:64-9. [DOI: 10.1016/j.clae.2014.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Revised: 08/28/2014] [Accepted: 09/11/2014] [Indexed: 11/29/2022]
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Jusufovic V, Cabric E, Popovic-Beganovic A, Musanovic Z, Zvornicanin J. Treatment of congenital aniridia associated with subluxated infantile cataract. Med Arch 2014; 68:212-4. [PMID: 25568537 PMCID: PMC4240328 DOI: 10.5455/medarh.2014.68.212-214] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Accepted: 04/15/2014] [Indexed: 11/03/2022] Open
Abstract
A 5 year old boy was presented at Eye clinic University clinical center Tuzla with congenital aniridia in both eyes. Clinical examination revealed visual acuity of 0,08 without correction in right and 0.7 with -5.0 Dsph and -1.0 Dcyl Axx 109° in left eye. Opthalmologic examination showed bilateral aniridia associated with moderate cataract in the right and incipient cataract in the left eye. In the right eye, zonular weakness with incipient capsular displacement and esotropia of Δ6º, were noted. The patient underwent phacoemulsification, implantation of capsular tension ring and Artificial Iris implant in the capsular bag. Phacoemulsification went uneventful and early postoperative recovery was successful with no signs of aniridia-associated keratopathy development and normal values of intra ocular pressure. Patient was not motivated for operation of the left eye and it was corrected with soft contact lens. Six month after the operation visual acuity in the right eye improved to 0.9 with +1.25Dsph and maintained stable in left eye, with complete elimination of esotropia and signs of binocular vision restoration. Small incision cataract extraction with IOL and Artificial Iris implantation in one procedure can be used to correct congenital aniridia and cataract with significant visual function improvement.
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Affiliation(s)
- Vahid Jusufovic
- Eye Clinic, University Clinical Centre Tuzla, Tuzla, Bosnia and Herzegovina
| | - Emir Cabric
- Public Health Care Institution Doboj-Jug, Matuzici, Bosnia and Herzegovina
| | | | - Zlatko Musanovic
- Eye Clinic, University Clinical Centre Tuzla, Tuzla, Bosnia and Herzegovina
| | - Jasmin Zvornicanin
- Eye Clinic, University Clinical Centre Tuzla, Tuzla, Bosnia and Herzegovina
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Koch KR, Heindl LM, Cursiefen C, Koch H. Artificial iris devices: Benefits, limitations, and management of complications. J Cataract Refract Surg 2014; 40:376-82. [DOI: 10.1016/j.jcrs.2013.08.051] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Revised: 08/16/2013] [Accepted: 08/17/2013] [Indexed: 11/19/2022]
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Srinivasan S, Ting DS, Snyder ME, Prasad S, Koch HR. Prosthetic iris devices. Can J Ophthalmol 2014; 49:6-17. [DOI: 10.1016/j.jcjo.2013.10.001] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Revised: 10/08/2013] [Accepted: 10/18/2013] [Indexed: 02/03/2023]
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