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

Artificial iris: state of the art

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%).

Novel surgical technique of sutureless artificial iris and intraocular lens scleral fixation using Yamane technique

Purpose

To describe a novel surgical technique of a combined implantation of an artificial iris and a scleral fixated intraocular lens (IOL) using flanged IOL haptics (“Yamane” technique).

Observations

The suturelessly implanted artificial iris-IOL-sandwich was stable with good functional as well as aesthetic results. However, our case showed a postoperative intraocular pressure rise.

Conclusions

The presented case demonstrates that a visual as well as cosmetical rehabilitation seems to be possible even after severe, penetrating ocular trauma with profound iris defects.

Importance

The sutureless IOL scleral fixation technique can also be used in combination with a sutureless artificial iris implantation. Further studies are needed to evaluate the long-term safety profile and rates of postoperative complications.

Flexible silicone artificial iris in cases of aniridia and iris deficiencies

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.

Reper intraocular lens with artificial iris: implantation techniques and outcomes

The authors describe the surgical techniques to implant a novel intraocular lens with artificial iris (Reper) in patients affected by traumatic aphakia and aniridia. Two surgical approaches are proposed: implantation by suture-loaded cartridge and "open sky" implantation combined with penetrating keratoplasty. The method of establishing the exact position of the scleral fixation points and the pre-assembly of the suture of Reper before its implantation are the main novel proposed surgical procedures. The rationale is to minimize surgical procedures in the anterior chamber and to prevent knot loosening and lens tilting. The simultaneous treatment of aphakia and aniridia with a single prosthesis, the stability of the Reper and the functional, anatomical and aesthetic outcomes obtained are the highlighted advantages in this study.

[Functional results and prognostic factors in open-globe ocular trauma with presenting visual acuity of no-light perception]

PURPOSE

To analyse the clinical ocular characteristics and determine prognostic factors for functional recovery in eyes presenting with no light perception (NLP) after open globe ocular trauma.

MATERIALS AND METHODS

In this retrospective study were included all the patients with no light perception after open globe trauma who presented to Amiens University Hospital between October 2014 and June 2018.

RESULTS

Fifteen eyes of 15 patients were included in this study. The main mechanism of the trauma was globe rupture (80 %, n=12). The most common location was zone III (66 %, n=10). The wound size was greater than 10mm in 9 patients (60 %). The ocular lesions included expulsion of the crystalline lens or posterior chamber intraocular lens, hyphema, retinal detachment, vitreous hemorrhage and ciliochoroidal lesions. Damage to the ciliary body was a negative prognostic factor for functional recovery (P=0.04). Nine patients remained with no light perception, whereas 6 patients experienced an improvement in visual acuity (2.3 logMAR in 3 patients, 0.7 logMAR in 1 patient, 0.4 logMAR in 1 patient and 0.2 logMAR in 1 patient). These 6 patients had undergone posterior vitrectomy due to vitreoretinal involvement (P<0.001).

CONCLUSION

In the case of open globe trauma with no light perception on presentation, a functional recovery is possible if there is no irreversible anatomical damage.