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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] [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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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] [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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Joussen AM, Müller B, Kirchhof B, Stappler T, Zeitz O. Rupture of the Globe: What to Do, What not to Do. Klin Monbl Augenheilkd 2020; 237:1070-1078. [PMID: 32967031 DOI: 10.1055/a-1233-8997] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Due to their complexity, globe ruptures are highly compromising traumas for the patient. This is due on the one hand to the eye injury itself with the accompanying loss of vision and on the other hand due to the need for extended treatment with uncertain prognosis and the resulting psychological stress. Globe ruptures are among the prognostically most unfavorable injuries due to the force and peak pressure impacting the eye. Furthermore, contusional retinal necrosis may be of significance prognostically. In the present review, we discuss treatment of globe ruptures involving retinal surgery. We discuss the primary sugery, its chronological planning and extent as well as the necessity for follow-up interventions. We also discuss the origin of traumatic retinal detachment with differential diagnosis of giant retinal tear versus oradialysis as well as secondary sequelae of traumas such as formation of macular holes and their treatment. On this basis, the use of buckling surgery versus pars-plana vitrectomy is discussed. Further focus is set on the role of the iris lens diaphragm in surgery of globe ruptures.
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Affiliation(s)
| | - Bert Müller
- Klinik für Augenheilkunde, Charité - Universitätsmedizin Berlin
| | - Bernd Kirchhof
- Netzhauterkrankungen und vitreoretinale Chirurgie, Augenklinik, Universität Köln
| | - Theodor Stappler
- Rétine chirurgicale, Hôpital Ophtalmique Jules Gonin, Lausanne, Schweiz
| | - Oliver Zeitz
- Klinik für Augenheilkunde, Charité - Universitätsmedizin Berlin
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Joussen AM, Helbig H. Augenverletzungen. Klin Monbl Augenheilkd 2020; 237:1043-1044. [DOI: 10.1055/a-1218-6619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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