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Prager AJ, Henning N, Burns L, Ramaprasad A, Basti S, Laronda MM. Utilizing 3D Printing Technology to Create Prosthetic Irises: Proof of Concept and Workflow. Bioengineering (Basel) 2023; 10:1287. [PMID: 38002411 PMCID: PMC10669136 DOI: 10.3390/bioengineering10111287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 10/01/2023] [Accepted: 10/24/2023] [Indexed: 11/26/2023] Open
Abstract
PURPOSE There are currently limited treatment options for aniridia. In this context, 3D printed iris implants may provide a cost-effective, cosmetically acceptable alternative for patients with aniridia. The purpose of this study was to develop a proof-of-concept workflow for manufacturing 3D printed iris implants using a silicone ink palette that aesthetically matches iris shades, identified in slit lamp images. METHODS Slit lamp iris photos from 11 healthy volunteers (3 green; 4 blue; 4 brown) were processed using k-means binning analyses to identify two or three prominent colors each. Candidate silicone inks were created by precisely combining pigments. A crowdsourcing survey software was used to determine color matches between the silicone ink swatches and three prominent iris color swatches in 2 qualifying and 11 experimental workflows. RESULTS In total, 54 candidate silicone inks (20 brown; 16 green; 18 blue) were developed and analyzed. Survey answers from 29 individuals that had passed the qualifying workflow were invited to identify "best matches" between the prominent iris colors and the silicone inks. From this color-match data, brown, blue, and green prototype artificial irises were printed with the silicone ink that aesthetically matched the three prominent colors. The iris was printed using a simplified three-layer five-branch starburst design at scale (12.8 mm base disc, with 3.5 mm pupil). CONCLUSIONS This proof-of-concept workflow produced color-matched silicone prosthetic irises at scale from a panel of silicone inks using prominent iris colors extracted from slit lamp images. Future work will include printing a more intricate iris crypt design and testing for biocompatibility.
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Affiliation(s)
- Alisa J. Prager
- Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA (A.R.); (S.B.)
| | - Nathaniel Henning
- Stanley Manne Children’s Research Institute, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL 60611, USA; (N.H.); (L.B.)
- Division of Endocrinology, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Lauren Burns
- Stanley Manne Children’s Research Institute, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL 60611, USA; (N.H.); (L.B.)
- Division of Endocrinology, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Abhijit Ramaprasad
- Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA (A.R.); (S.B.)
| | - Surendra Basti
- Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA (A.R.); (S.B.)
- Stanley Manne Children’s Research Institute, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL 60611, USA; (N.H.); (L.B.)
| | - Monica M. Laronda
- Stanley Manne Children’s Research Institute, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL 60611, USA; (N.H.); (L.B.)
- Division of Endocrinology, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
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Scharf D, Chychko L, Augustin VA, Khoramnia R, Auffarth GU. [Implantation of an aniridia ring for complicated cataract and iris defects]. DIE OPHTHALMOLOGIE 2023; 120:755-758. [PMID: 35925348 DOI: 10.1007/s00347-022-01682-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 06/08/2022] [Accepted: 06/13/2022] [Indexed: 06/15/2023]
Affiliation(s)
- Debora Scharf
- Universitätsaugenklinik Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Deutschland.
| | - Lizaveta Chychko
- Universitätsaugenklinik Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Deutschland
| | - Victor A Augustin
- Universitätsaugenklinik Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Deutschland
| | - Ramin Khoramnia
- Universitätsaugenklinik Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Deutschland
| | - Gerd U Auffarth
- Universitätsaugenklinik Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Deutschland
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Results of the United States FDA Clinical Trial of the CustomFlex Artificial Iris. Ophthalmology 2022; 129:614-625. [DOI: 10.1016/j.ophtha.2022.01.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 01/28/2022] [Accepted: 01/31/2022] [Indexed: 12/11/2022] Open
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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] [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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Ghaffari R, Aldave AJ, Al-Hashimi S, Miller KM. Complications of Cosmetic Artificial Iris Implantation and Post Explantation Outcomes. Am J Ophthalmol 2021; 226:156-164. [PMID: 33493470 DOI: 10.1016/j.ajo.2021.01.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 01/04/2021] [Accepted: 01/12/2021] [Indexed: 11/15/2022]
Abstract
PURPOSE To report complications of cosmetic artificial iris implantation and explantation outcomes. DESIGN Retrospective case series. METHODS Medical records of 12 patients (24 eyes) who presented to us after being implanted with cosmetic artificial irises elsewhere were reviewed. Data collected included baseline demographics, presenting symptoms, examination findings, and management outcomes. RESULTS Eight eyes had NewColorIris implants and 16 had BrightOcular implants. The mean interval from cosmetic iris implantation to presentation was 61.7 ± 60.0 months. The mean follow-up after explantation was 35.5 ± 38.1 months. Complications at presentation included iris abnormalities (11 eyes, 45.8%), elevated intraocular pressure (8 eyes, 33.3%), corneal edema (6 eyes, 25%), intraocular inflammation (5 eyes, 20.8%), and cataract (4 eyes, 16.7%). Surgical interventions included cosmetic iris removal (19 eyes, 79.2%), cataract extraction (7 eyes, 29.2%), corneal transplantation (7 eyes, 29.2%), and glaucoma surgery (4 eyes, 16.7%). Complications at the last follow-up examination included native iris defects (11 eyes, 45.8%), persistent glaucoma (7 eyes, 29.2%), cataract (5 eyes, 20.8%), corneal edema (4 eyes, 16.7%), and intraocular inflammation (2 eyes, 8.3%). The mean logarithm of the minimum angle of resolution was 0.56 ± 0.47 at presentation and 0.78 ± 0.88 at the last examination (P = .30). The mean intraocular pressure was 22.7 ± 15.8 mm Hg at presentation and 13.4 ± 6.99 mm Hg at the last examination (P = .02). CONCLUSION Cosmetic iris implantation was associated with serious complications at the time of presentation, and adverse sequelae persisted for years after explantation.
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Affiliation(s)
- Reza Ghaffari
- Stein Eye Institute and Department of Ophthalmology, David Geffen School of Medicine at the University of California, Los Angeles (UCLA), Los Angeles, California, USA
| | - Anthony J Aldave
- Stein Eye Institute and Department of Ophthalmology, David Geffen School of Medicine at the University of California, Los Angeles (UCLA), Los Angeles, California, USA
| | - Saba Al-Hashimi
- Stein Eye Institute and Department of Ophthalmology, David Geffen School of Medicine at the University of California, Los Angeles (UCLA), Los Angeles, California, USA
| | - Kevin M Miller
- Stein Eye Institute and Department of Ophthalmology, David Geffen School of Medicine at the University of California, Los Angeles (UCLA), Los Angeles, California, USA.
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Parikakis E, Batsos G, Kontomichos L, Peponis V, Christodoulou E, Karagiannis D. Traumatic Aniridia and Aphakia Management with Iris Reconstruction Lens Using Gore-Tex Sutures, an Ab-Externo Approach. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e924706. [PMID: 32958739 PMCID: PMC7521177 DOI: 10.12659/ajcr.924706] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Patient: Male, 55-year-old Final Diagnosis: Aphakia Symptoms: Decreased visual acuity • photophobia Medication:— Clinical Procedure: Lens implantation • vitrectomy Specialty: Ophthalmology
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Affiliation(s)
- Efstratios Parikakis
- Second Department of Ophthalmology, Ophthalmiatreio Eye Hospital of Athens, Athens, Greece
| | - Georgios Batsos
- Second Department of Ophthalmology, Ophthalmiatreio Eye Hospital of Athens, Athens, Greece
| | - Loukas Kontomichos
- Second Department of Ophthalmology, Ophthalmiatreio Eye Hospital of Athens, Athens, Greece
| | - Vasileios Peponis
- First Department of Ophthalmology, Ophthalmiatreio Eye Hospital of Athens, Athens, Greece
| | | | - Dimitrios Karagiannis
- Second Department of Ophthalmology, Ophthalmiatreio Eye Hospital of Athens, Athens, Greece
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Abstract
PURPOSE To describe the indications, motivations, and outcomes of artificial iris exchange. SETTING Stein Eye Institute. DESIGN Consecutive case series. METHODS Review of medical records of patients implanted with an artificial iris device who underwent a subsequent artificial iris exchange. RESULTS Five patients were identified: 4 women and 1 man. Their ages ranged from 19 to 58 years at the time of the exchange. One patient had congenital aniridia; the other 4 had acquired iris defects. Three exchanges were simultaneous; 2 were consecutive. Corneal decompensation was the most common indication for the surgery precipitating the exchange. Explanted iris devices included models from Ophtec, Morcher, BrightOcular, and HumanOptics. Replacement models were from Morcher and HumanOptics. Three of the original irides were passively fixated in the capsular bag or ciliary sulcus. All of the replacement irides were suture-fixated to the sclera, either directly or secondarily by way of an intraocular lens. The motivation for the exchange was improved cosmesis in 4 patients and sustained cosmesis in 1 patient. Final visual acuities were 20/25 for 2 patients, 20/100 for 1 patient, and hand motion for 2 patients. CONCLUSIONS No 2 iris exchanges were similar. Clinical indications and outcomes varied considerably from patient to patient. A common thread was each patient's motivation to maintain or improve on the functional and cosmetic benefits of having been previously implanted with an artificial iris device. Final visual acuity results were often poor because of the effects of comorbidities, especially glaucoma and corneal decompensation.
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Miller KM, Kuo A, Olson MD, Masket S. Safety and efficacy of black iris diaphragm intraocular lens implantation in eyes with large iris defects: Report 4. J Cataract Refract Surg 2018; 44:686-700. [DOI: 10.1016/j.jcrs.2018.03.033] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Revised: 03/22/2018] [Accepted: 03/29/2018] [Indexed: 10/28/2022]
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Lin SR, Miller KM. Lessons Learned from Implantation of Morcher 50D and 96S Artificial Iris Diaphragms. Case Rep Ophthalmol 2017. [PMID: 29515428 PMCID: PMC5836171 DOI: 10.1159/000484128] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
<b><i>Purpose:</i></b> To discuss problems associated with the implantation of two Morcher iris diaphragm models. <b><i>Methods:</i></b> We describe the history, intraoperative complications, and postoperative complications of 5 patients with specific Morcher iris implants. <b><i>Results:</i></b> We implanted Morcher 50D devices in 1 patient and Morcher 96S devices in 4 patients. Complications included postoperative rotation, device mis-sizing, difficult intraoperative rotation, zonular dehiscence, and intraoperative hemorrhage. <b><i>Conclusion:</i></b> Artificial iris implantation has a steep learning curve. With widespread availability on the horizon in the United States, the sharing of surgical experiences is key to achieving the best outcomes for patients.
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Affiliation(s)
| | - Kevin M. Miller
- *Kevin M. Miller, MD, Stein Eye Institute, 300 Stein Plaza, Second Floor, Los Angeles, CA 90095 (USA), E-Mail
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Villemont AS, Kocaba V, Janin-Manificat H, Abouaf L, Poli M, Marty AS, Rabilloud M, Fleury J, Burillon C. Prise en charge de l’aphakie et de l’aniridie post-traumatiques. Étude rétrospective de 17 patients opérés d’implants intraoculaires suturés à la sclère à iris artificiel. Gestion de l’aphakie-aniridie par implants suturés à la sclère à iris artificiel. J Fr Ophtalmol 2017; 40:592-605. [DOI: 10.1016/j.jfo.2017.03.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 03/25/2017] [Indexed: 12/19/2022]
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