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Romano D, Shimizu T, Kobayashi A, Yamagami S, Romano V, Hayashi T. Descemet Membrane Endothelial Keratoplasty in Aphakic, Aniridic, and Vitrectomized Eyes: A Review. Cornea 2024:00003226-990000000-00625. [PMID: 39023318 DOI: 10.1097/ico.0000000000003630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 06/19/2024] [Indexed: 07/20/2024]
Abstract
PURPOSE The aim of this review is to examine the techniques, complications, and outcomes of Descemet membrane endothelial keratoplasty (DMEK) in aphakic, aniridic, and vitrectomized eyes. METHODS A literature search was conducted in the MEDLINE database (via PubMed), using as keywords "(DMEK) AND (aphakia OR aniridia OR vitrectomy OR vitrectomized)." The research was limited to 10 years (January 2014-March 2024), in view of lack of literature before 2014. Articles, including case reports and case series, were included. RESULTS Twenty articles were included. No randomized controlled trials were found nor comparative studies with more than 1 technique used. Mean rebubbling rate in complex eyes was 29%, whereas mean endothelial cell loss at 6 months was 37%. The mean postoperative visual acuity improved from 1.47 logarithm of the minimal angle of resolution to 0.7 logarithm of the minimal angle of resolution. CONCLUSIONS Despite being more challenging, compared with the techniques reported in literature, DMEK can be considered a valid option for the management of endothelial decompensation in complex eyes, with rebubbling rate and endothelial cell loss at 6 months, which are similar to non-complex eyes.
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Affiliation(s)
- Davide Romano
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, Eye Clinic, ASST Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | - Toshiki Shimizu
- Division of Ophthalmology, Department of Visual Sciences, Nihon University School of Medicine, Itabashi, Tokyo, Japan; and
| | - Akira Kobayashi
- Department of Ophthalmology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Satoru Yamagami
- Division of Ophthalmology, Department of Visual Sciences, Nihon University School of Medicine, Itabashi, Tokyo, Japan; and
| | - Vito Romano
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, Eye Clinic, ASST Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | - Takahiko Hayashi
- Division of Ophthalmology, Department of Visual Sciences, Nihon University School of Medicine, Itabashi, Tokyo, Japan; and
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Snyder ME, Leone AR, Werner L, Bundogji N, Hawn V. Microscopic analysis of preinsertion cutting modalities on custom, flexible iris prostheses. J Cataract Refract Surg 2024; 50:181-186. [PMID: 37853580 DOI: 10.1097/j.jcrs.0000000000001346] [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: 08/01/2023] [Accepted: 10/15/2023] [Indexed: 10/20/2023]
Abstract
PURPOSE To determine the induced edge effects of different clinically used device postmanufacture modification styles and modalities on custom iris implants. SETTINGS An academically affiliated multispecialty private practice group and an academic medical center. DESIGN Laboratory study. METHODS Sample custom iris prostheses were cut using patterns, blades, and surgical instruments described in the literature. The cut edges were evaluated with slitlamp microscopy, light microscopy, and scanning electron microscopy. RESULTS Disposable blades yielded smoother cuts than scissors. Trephine blade brand significantly affected the cut surface smoothness of the silicone matrix. Meshwork-embedded prostheses had some irregular sharp edges where the mesh fibers were cut with all modalities, although these were worse with scissors and one tested trephine brand compared with the other. Pseudoiridectomies and scissor cuts created sharp points and corners in the device periphery. CONCLUSIONS Postmanufacture modifications of iris implants should be minimized. The cut margins of the fiber-free implants have fewer sharp edges and may be preferable for sulcus placement. In-the-bag device placement may mitigate clinical impact of sharp edges and corners. These practices may help to minimize inflammatory sequelae postimplantation.
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Affiliation(s)
- Michael E Snyder
- From the Cincinnati Eye Institute, Cincinnati, Ohio (Snyder); University of Cincinnati College of Medicine, Cincinnati, Ohio (Snyder, Leone); Intermountain Ocular Research Center, Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah (Werner, Bundogji, Hawn)
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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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Riedl JC, Pfeffer N, Giers BC, Schuster AK, Vossmerbaeumer U. Postoperative results after iris reconstruction with an Artificialiris ® implant with consideration of the cause of the iris defects. Eur J Ophthalmol 2023; 33:1946-1951. [PMID: 36788137 DOI: 10.1177/11206721231156204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
PURPOSE To test the hypothesis that severely damaged eyes are more likely to experience postoperative complications after an ArtificialIris® (AI) implantation than other iris defects. METHODS Patients after iris reconstruction with an AI were included in this consecutive case series of the Department of Ophthalmology, University of Mainz, Germany. Best-corrected visual acuity (BCVA), objective refraction (KR 8900 Topcon, Tokyo, Japan) and Scheimpflug imaging of the anterior segment with Pentacam® (Oculus, Wetzlar, Germany)and postoperative complications were evaluated. RESULTS Thirty-two eyes of 32 patients after AI implantation were included, separated in partial or total aniridia in a closed globe (group 1, n = 16) and after perforating globe injury (group 2, n = 16). Two or more previous surgeries in the corresponding eye were found in two patients (12.5%) in group 1 and eleven patients (69%) in group 2 (p = 0.001). The time span between initial trauma or iris defect and AI implantation was not significantly related to the occurrence and severity of postoperative complications (p = 0.89). Postoperative complications were classified into mild and severe and showed no differences between group 1 and group 2 (mild: 1 vs. 0; p = 0.52; severe: 5 vs. 6 p = 0.8). CONCLUSION AI implantation is a treatment option for various iris defects. An individual, case-based decision should be made with strict indication also considering other possible methods for pupil reconstruction. The postoperative outcome is not affected by the time point of AI implantation. So, an implantation is already possible as early as six weeks after the previous trauma.
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Affiliation(s)
- Jana C Riedl
- Department of Ophthalmology, University Medical Center, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Nora Pfeffer
- Department of Ophthalmology, University Medical Center, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Bert C Giers
- Department of Ophthalmology, University Medical Center, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Alexander K Schuster
- Department of Ophthalmology, University Medical Center, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Urs Vossmerbaeumer
- Department of Ophthalmology, University Medical Center, Johannes Gutenberg-University Mainz, Mainz, Germany
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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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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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Nowomiejska K, Haszcz D, Adamczyk K, Brzozowska A, Bonfiglio V, Toro MD, Rejdak R. Visual Outcomes of Pupilloplasty in Ocular Trauma and Iatrogenic Damage. J Clin Med 2022; 11:jcm11113177. [PMID: 35683581 PMCID: PMC9181509 DOI: 10.3390/jcm11113177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/21/2022] [Accepted: 06/01/2022] [Indexed: 11/16/2022] Open
Abstract
Purpose: To report the visual outcomes of different techniques for iris pupilloplasty in eyes after traumatic and iatrogenic damage. Methods: 70 consecutive eyes with posttraumatic (80%) and postoperative (20%) iris damage were included. According to the preoperative diagnosis, the eyes were divided into three groups: mydriasis (50%), partial iris defects (24%), and iridodialysis (26%). Multiple techniques were performed: the Siepser slip-knot technique, the “lasso” technique, and suturing to the sclera. These techniques were combined in some cases. Results: The best improvement of visual acuity was found for the Siepser slip-knot technique with a median of 0.7 (SD ± 0.83) before surgery and 0.52 logMAR (SD ± 0.65) after surgery with regard to the surgical technique, and for mydriasis with a median of 0.7 (SD ± 0.75) before surgery and 0.52 logMAR (SD ± 0.49) after surgery with regard to preoperative diagnosis. Pupilloplasty was combined with additional surgery (corneal suturing, secondary intraocular lens implantation, anterior or pars plana vitrectomy) in 80% of cases. Apart from corneal suturing, all additional procedures ensured improvement in visual acuity. Conclusions: The slip-knot technique was the only suturing technique that resulted in a significant improvement in visual acuity. Other surgical procedures are usually needed in the majority of cases that undergo pupilloplasty, and they also give visual gain.
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Affiliation(s)
- Katarzyna Nowomiejska
- Chair and Department of General and Pediatric Ophthalmology, Medical University of Lublin, 20-079 Lublin, Poland; (D.H.); (K.A.); (M.D.T.); (R.R.)
- Correspondence: ; Tel.: +48-81-53-248-27
| | - Dariusz Haszcz
- Chair and Department of General and Pediatric Ophthalmology, Medical University of Lublin, 20-079 Lublin, Poland; (D.H.); (K.A.); (M.D.T.); (R.R.)
| | - Katarzyna Adamczyk
- Chair and Department of General and Pediatric Ophthalmology, Medical University of Lublin, 20-079 Lublin, Poland; (D.H.); (K.A.); (M.D.T.); (R.R.)
| | - Agnieszka Brzozowska
- Department of Mathematics and Medical Biostatistics, Medical University of Lublin, 20-090 Lublin, Poland;
| | - Vincenza Bonfiglio
- Eye Clinic, Biomedicine, Neuroscience and Advance Diagnostic (BIND) Department, University of Palermo, 90143 Palermo, Italy;
| | - Mario Damiano Toro
- Chair and Department of General and Pediatric Ophthalmology, Medical University of Lublin, 20-079 Lublin, Poland; (D.H.); (K.A.); (M.D.T.); (R.R.)
- Eye Clinic, Public Health Department, University of Naples “Federico II”, 80131 Naples, Italy
| | - Robert Rejdak
- Chair and Department of General and Pediatric Ophthalmology, Medical University of Lublin, 20-079 Lublin, Poland; (D.H.); (K.A.); (M.D.T.); (R.R.)
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Novel surgical technique of sutureless artificial iris and intraocular lens scleral fixation using Yamane technique. Am J Ophthalmol Case Rep 2022; 26:101502. [PMID: 35387386 PMCID: PMC8978273 DOI: 10.1016/j.ajoc.2022.101502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 03/16/2022] [Accepted: 03/20/2022] [Indexed: 11/21/2022] Open
Abstract
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.
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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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Veselý Ľ, Holubová L, Pluhovský P, Studený P. ARTIFICIAL COSMETIC IRIS - POTENTIAL RISK OF VISUAL IMPAIRMENT. A CASE REPORT. CESKA A SLOVENSKA OFTALMOLOGIE : CASOPIS CESKE OFTALMOLOGICKE SPOLECNOSTI A SLOVENSKE OFTALMOLOGICKE SPOLECNOSTI 2022; 78:36-43. [PMID: 35300502 DOI: 10.31348/2022/7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
In this paper, the authors present a case report of a 46-year-old patient with decompensated pigmentary glaucoma and anterior uveitis after unilateral implantation of a BrightOcular artificial cosmetic iris (Stellar Devices, New York, USA). Postoperatively, there was a decrease of endothelial cells (ECD) down to 1216 cells/mm2, a uveal reaction in the anterior chamber and a significant decompensation of intraocular pressure (IOP). During the first examination at our clinic, the explantation of the artificial cosmetic iris was indicated. However, despite all warnings, the patient repeatedly refused this procedure. The patient later decided to undergo the artificial cosmetic iris explantation due to persistent elevation of IOP with intense eye pain. The cosmetic iris implant was removed almost five months after its implantation. Postoperatively, the anterior uveitis resolved, but there was a further decrease in ECD of 130 cells/mm2 and also an increase in IOP, despite maximal antiglaucoma therapy. Nearly one month after removal of the artificial cosmetic iris, the patient underwent implantation of the Express P50 drainage shunt (Alcon Inc, Fort Worth, TX, USA). After the drainage procedure, IOP was normalized and remained within physiological limits during the first year after surgery. Thereafter, there was a recurrence of elevated IOP, which subsided to normal, after initiation of a combination of two antiglaucoma therapies. Four years after surgery the eye was quiescent, ECD stationary, the optic nerve head was stable, and the visual field remained within the physiological norm. This case report highlights a potentially harmful procedure that is presented as a relatively safe alternative for an iris colour change, representing a deceptive marketing strategy for companies trading in these implants.
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Mayer C, Baur ID, Storr J, Khoramnia R. Complete anterior segment reconstruction: Corneal transplantation and implantation of an iris prosthesis and IOL in a single surgery. Eur J Ophthalmol 2021; 31:3300-3308. [PMID: 33508973 PMCID: PMC8606946 DOI: 10.1177/1120672121991052] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 01/03/2021] [Indexed: 12/22/2022]
Abstract
PURPOSE Patients who have suffered an ocular trauma may present with varying degrees of injury to the anterior segment. In this retrospective interventional case series, we report the outcome of seven patients who underwent complete anterior segment reconstruction in a single surgery. METHODS All patients with posttraumatic corneal decompensation or scar, aphakia, and iris defect underwent human donor corneal graft transplantation and implantation of an intraocular lens combined with a flexible silicone iris prosthesis. Postoperative examinations included assessment of best corrected distance visual acuity, objective refraction, and intraocular pressure. Sensitivity to glare and subjective discontent with the eye's appearance was rated on a scale from 1 to 10, with 1 standing for low and 10 for high severity. RESULTS Mean best corrected distance visual acuity (BCDVA) was 1.51 ± 0.26 logMAR preoperatively and 1.29 ± 0.36 logMAR postoperatively. Mean IOP was 15.71 ± 8.94 mmHg pre-surgery and 13.57 ± 6.52 mmHg post-surgery. The mean sensitivity to glare was reduced from 7.17 ± 2.91 to 3.80 ± 3.43 and subjective cosmetic disfigurement was reduced from 5.33 ± 3.35 to 1.80 ± 1.60. CONCLUSIONS A single surgery technique for entire anterior segment reconstruction in trauma patients can effectively reduce glare and patient discontent with the eye's appearance.
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Affiliation(s)
- Christian Mayer
- Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany
| | | | - Julia Storr
- Ophthalmology Clinic and Polyclinic, Technical University of Munich, Munich, Germany
| | - Ramin Khoramnia
- Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany
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Traumatischer Irisverlust: Implantation einer künstlichen Iris zur Wiederherstellung von Funktion und Ästhetik. SPEKTRUM DER AUGENHEILKUNDE 2021. [DOI: 10.1007/s00717-021-00504-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Zusammenfassung
Ziel
Wir berichten über den Fall eines Patienten mit traumatischem Irisdefekt, der sich 4 Monate nach dem initialen Trauma im Rahmen eines Fahrradunfalls einer chirurgischen Irisrekonstruktion mit einer CUSTOMFLEX ArtificialIris (AI, HumanOptics AG, Erlangen, Deutschland) unterzog.
Beobachtungen
Bei der Erstvorstellung zeigte sich eine gedeckte Bulbusruptur, die notfallmäßig mittels Vorderkammerspülung, Vitrektomie, Skleranaht und C3F8 Gastamponade versorgt wurde. Nach extern durchgeführter sekundärer IOL-Implantation klagte der Patient über eine erhöhte Blendempfindlichkeit und Visusminderung am rechten Auge. Der bestkorrigierte Fernvisus betrug 1,4 logMAR für das rechte Auge und 0,10 logMAR für das linke Auge. Die klinische Untersuchung zeigte einen großen Irisdefekt mit Restirisgewebe von 4 bis 8 Uhr. Beide Augen waren pseudophak, der fundoskopische Befund war unauffällig. Der Patient unterzog sich einer AI-Implantation v. a. zur Linderung seiner Blendempfindlichkeit am rechten Auge. Die Sehschärfe stieg auf 0,30 logMAR an. Die subjektive Blendempfindlichkeit verbesserte sich deutlich. Die Kontrastempfindlichkeit, gemessen mit einer Pelli-Robson-Tafel, stieg von 0,15 logarithmischen Einheiten präoperativ auf 1,05 logarithmische Einheiten postoperativ.
Schlussfolgerungen
Wir beobachteten nach chirurgischer Irisrekonstruktion mit einer künstlichen Iris ein sehr gutes ästhetisches und funktionelles Ergebnis mit hoher Patientenzufriedenheit. Dieser Fall demonstriert, wie die Reduktion der Blendempfindlichkeit gleichzeitig auch zu einer deutlichen Verbesserung der Funktion mit Anstieg von Sehschärfe und Kontrastsehen führen kann.
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Bonnet C, Vazirnia P, Deng SX, Aldave AJ, Miller KM. Sutured Custom Foldable Silicone Artificial Iris Implantation Combined With Intraocular Lens Implantation and Penetrating Keratoplasty: Safety and Efficacy Outcomes. Cornea 2021; 40:1236-1247. [PMID: 33086281 PMCID: PMC8423143 DOI: 10.1097/ico.0000000000002564] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 08/27/2020] [Accepted: 08/28/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE To assess safety and efficacy outcomes of sutured custom silicone artificial iris and intraocular lens implantation combined with penetrating keratoplasty (triple procedure). METHODS Prospective consecutive surgical case series of patients who underwent the triple procedure between 2010 and 2019 at Stein Eye Institute, UCLA, followed up for 1 year minimum. Safety outcomes were changes from preoperative to last follow-up in corrected distance visual acuity (CDVA), endothelial cell count, intraocular pressure (IOP), and postoperative complications. Efficacy outcomes included changes in subjective glare (none to severe), cosmetic appearance (worse to very much improved), and visual function as assessed by the Visual Function Questionnaire-25 at 1-year follow-up. RESULTS Among 82 eyes implanted with an artificial iris, 14 eyes (17.1%) underwent the triple procedure. The median follow-up was 18.1 months (range 12.0-54.9 months). The median CDVA improved from 2.0 log of minimum angle of resolution (logMAR) (range 0.9-2.3 logMAR) to 0.7 logMAR (range 0.2-2.6 logMAR) (P = 0.02). Average endothelial cell count decreased 57.6% (P < 0.01). Six eyes (42.9%) experienced IOP elevations, 13 eyes (92.3%) developed iritis, and 11 eyes (78.6%) underwent secondary surgery. Graft rejection or secondary graft failure occurred in 7 eyes each (50.0%). Cosmesis improved in 12 eyes (85.7%; P < 0.01). The Visual Function Questionnaire-25 score improved from 72 to 77 (P < 0.01). Glare symptoms did not change significantly. CONCLUSIONS The triple procedure was effective at improving CDVA, cosmesis, and quality of life; however, it was associated with frequent postoperative complications, of which iritis, IOP elevation, and secondary graft failure were the most common.
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Affiliation(s)
- Clemence Bonnet
- Department of Ophthalmology, Stein Eye Institute, David Geffen School of Medicine, University of California, Los Angeles, CA; and
- Université de Paris, AP-HP Hôpital Cochin, Paris, France
| | - Parsia Vazirnia
- Department of Ophthalmology, Stein Eye Institute, David Geffen School of Medicine, University of California, Los Angeles, CA; and
| | - Sophie X. Deng
- Department of Ophthalmology, Stein Eye Institute, David Geffen School of Medicine, University of California, Los Angeles, CA; and
| | - Anthony J. Aldave
- Department of Ophthalmology, Stein Eye Institute, David Geffen School of Medicine, University of California, Los Angeles, CA; and
| | - Kevin M. Miller
- Department of Ophthalmology, Stein Eye Institute, David Geffen School of Medicine, University of California, Los Angeles, CA; and
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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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Safety and efficacy of custom foldable silicone artificial iris implantation: prospective compassionate-use case series. J Cataract Refract Surg 2021; 46:893-901. [PMID: 32176161 DOI: 10.1097/j.jcrs.0000000000000172] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To assess the preliminary safety and efficacy of custom silicone artificial iris implantation. SETTING Stein Eye Institute. DESIGN Prospective consecutive case series. METHODS Medical records of patients implanted with the artificial iris were reviewed and followed for 1 year. Safety measures included corrected distance visual acuity (CDVA), intraocular pressure (IOP), endothelial cell count (ECC), surgical complications, secondary interventions, and adverse events (AEs). Efficacy measures included CDVA with glare, subjective daytime and nighttime glare graded from 0 to 10 (very significant), and subjective cosmetic appearance graded from 0 to 10 (very satisfied). RESULTS Twenty eyes (19 patients) were implanted. Safety data were mixed. CDVA improved in 13 eyes and worsened in 6. ECC decreased from 1918 ± 870 to 1405 ± 705 cells/mm (P = .02). Eight eyes experienced postoperative complications. There were 4 IOP elevations, 2 corneal decompensations, 1 case of cystoid macular edema, and 1 device dislocation. Four eyes underwent secondary surgical interventions including 2 AEs (1 glaucoma surgery and 1 device dislocation). Efficacy outcomes were excellent. CDVA with glare improved from 1.5 ± 0.6 to 0.7 ± 0.8 logarithm of the minimum angle of resolution (P < .01). Mean subjective daytime glare decreased from 8.9 ± 1.8 to 2.7 ± 2.6 (P < .01) and nighttime glare decreased from 7.9 ± 1.8 to 2.5 ± 2.7 (P < .01). Mean cosmesis improved from 2.2 ± 1.6 to 8.8 ± 2.1 (P < .01). CONCLUSIONS Custom artificial iris implantation was moderately risky but very effective at reducing light and glare sensitivity and in improving ocular cosmesis.
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Mayer C, Scharf D, Khoramnia R. [Exchange of aniridia IOLs for customized iris IOL implants]. Ophthalmologe 2021; 119:181-189. [PMID: 34236489 PMCID: PMC8813724 DOI: 10.1007/s00347-021-01447-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 06/08/2021] [Accepted: 06/10/2021] [Indexed: 11/02/2022]
Abstract
BACKGROUND Three groups of iris prostheses can be distinguished for the surgical treatment of iris defects: (1) segmental iris implants, (2) combined iris diaphragm intraocular lenses (IOL) and (3) pure iris implants. Most iris reconstructions are accompanied by aphakia correction with secondary IOL implantation. Although the primary goal is to create a pupil and to improve glare perception, contrast sensitivity and visual acuity, the esthetic result is also a relevant component. OBJECTIVE Functional and esthetic results after replacement of an aniridia IOL implant with a custom-made artificial iris with IOL. MATERIAL AND METHODS In this retrospective study with seven eyes from seven patients, an iris diaphragm IOL (Morcher GmbH, Stuttgart, Germany) was exchanged for medical reasons (subluxation) against a custom-made artificial iris made of silicone (ArtificialIris, HumanOptics, Erlangen, Germany) in combination with a sutured IOL. The follow-up period was at least 3 months. Best corrected distance visual acuity (BCVA), endothelial cell count (ECC), complications, glare perception as well as esthetic outcome and patient satisfaction were evaluated. RESULTS The BCVA and ECC showed no statistically significant change between the preoperative and postoperative values (p > 0.05). There was a decentration of the iris IOL implant of 0.27 ± 0.19 mm three months postoperatively. On a visual analogue scale (VAS) from 1 to 10 (1 = not satisfied at all, 10 = extremely satisfied), satisfaction with the overall result was rated 8.6 ± 2.5. Subjective glare perception improved to 5.6 ± 3.5 and subjective esthetic impairment improved to 2.4 ± 2.0 on the VAS (1 = none, 10 = extremely strong). Postoperative complications included transient intraocular hypotonia in two eyes, intraocular pressure increase in two eyes, retinal detachment and transient vitreous hemorrhage in one eye each. Of the seven patients six would repeat the procedure. CONCLUSION Compared to a rigid aniridia IOL implant, replacement with a custom-made artificial iris in combination with an IOL provides not only a good functional result but simultaneously also an esthetically pleasing result.
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Affiliation(s)
- C Mayer
- Universitätsaugenklinik Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Deutschland.
| | - D Scharf
- Universitätsaugenklinik Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Deutschland
| | - R Khoramnia
- Universitätsaugenklinik Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Deutschland
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17
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[Pupil reconstruction with an artificial iris]. Ophthalmologe 2021; 119:3-12. [PMID: 34181062 PMCID: PMC8763738 DOI: 10.1007/s00347-021-01406-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 04/15/2021] [Accepted: 04/25/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Patients with iris defects suffer from severe visual impairment, especially increased glare sensitivity, and cosmetic disturbances. This can constitute a great psychological strain for patients. In the recent past the treatment consisted of iris print contact lenses, sunglasses and simple iris prostheses. The indications for surgical treatment are colobomas of the iris, aniridia, traumatic iris defects and persistent mydriasis. The aim of this review article is to investigate the surgical approaches, complications, functional and aesthetic outcome after implantation of an individual artificial iris prosthesis made from silicone. OBJECTIVE Analysis of the literature on the topic of surgical iris reconstruction with an artificial iris in combination with the own experience in more than 120 patients treated by the author in the last 10 years. MATERIAL AND METHODS The custom-made flexible silicone iris prosthesis ArtificialIris (HumanOptics, Erlangen, Germany) assessed in this review is an innovative and versatile option for surgical treatment of iris defects. Patients were examined before and after iris reconstruction with respect to feasibility, complications and outcome. RESULTS Change of best corrected visual acuity, intraocular pressure, pupillary opening, glare, contrast sensitivity, endothelial cell count, anterior chamber depth, anterior chamber angle and patient satisfaction were assessed. Furthermore, complications and color match to the residual and fellow iris were assessed. CONCLUSION The implantation of an artificial iris is an effective option for the treatment of extensive traumatic iris defects and leads to an individual aesthetically appealing and good functional outcome as well as high patient satisfaction; however, this is an intervention that should not be underestimated because of a flat learning curve and various complications that can occur.
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18
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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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Mayer CS, Baur ID, Storr J, Khoramnia R. Bilateral Artificial Iris implantation in patients with bilateral iris defects. Am J Ophthalmol Case Rep 2021; 22:101108. [PMID: 34027229 PMCID: PMC8121880 DOI: 10.1016/j.ajoc.2021.101108] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 02/02/2021] [Accepted: 04/04/2021] [Indexed: 12/19/2022] Open
Abstract
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.
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Affiliation(s)
| | | | - Julia Storr
- Ophthalmology Clinic and Polyclinic, Technical University of Munich, Munich, Germany
| | - Ramin Khoramnia
- Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany
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20
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[Traumatic aniridia: conservative or surgical therapeutic approach?]. Ophthalmologe 2021; 119:395-399. [PMID: 33779827 PMCID: PMC9005440 DOI: 10.1007/s00347-021-01367-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 02/28/2021] [Indexed: 01/16/2023]
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21
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Ang M, Tan D. Anterior segment reconstruction with artificial iris and Descemet membrane endothelial keratoplasty: a staged surgical approach. Br J Ophthalmol 2021; 106:908-913. [PMID: 33637621 DOI: 10.1136/bjophthalmol-2020-317906] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 12/31/2020] [Accepted: 02/05/2021] [Indexed: 11/04/2022]
Abstract
PURPOSE To describe a surgical approach that involves anterior segment reconstruction with CustomFlex Artificial Iris (CAI; HumanOptics, Erlangen, Germany) followed by Descemet membrane endothelial keratoplasty (DMEK) in complex eyes with corneal decompensation. METHODS Restrospective case series of eyes that underwent anterior segment restoration involving (1) synechiolysis of peripheral anterior synechiae and excision of iris remnants, (2) securing a well-fixated posterior chamber intraocular lens and (3) suture-fixated or capsular bag placement of CAI. All eyes then underwent DMEK using a pull-through technique with the DMEK EndoGlide (Network Medical Products, Ripon, UK). Main outcomes were successful anterior segment restoration and corneal clarity with central corneal thickness (CCT). RESULTS Five eyes of five patients (median age 61 years, range 27-69 years; 60% female) underwent anterior segment reconstruction with CAI implantation (4 suture-fixated), followed by successful DMEK surgery (median 2 months later, range 1-5 months). There were no major intraoperative complications or primary graft failure, with one peripheral graft detachment that underwent a successful re-bubble at 1 week. All eyes had stable CAI implants and DMEK grafts remained clear at last follow-up with reduction in mean central corneal thickness (preoperative: 658±86 µm vs postoperative: 470±33 µm, p=0.005). CONCLUSION This pilot study highlights a feasible approach of initial anterior segment reconstruction with CAI implantation, prior to DMEK, in eyes with significant anterior segment abnormalities such as iris damage or extensive peripheral anterior synechiae and corneal decompensation.
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Affiliation(s)
- Marcus Ang
- Singapore National Eye Centre, Singapore.,Singapore Eye Research Institute, Singapore.,Ophthalmology and Visual Sciences, Duke - NUS Graduate Medical School, Singapore
| | - Donald Tan
- Singapore National Eye Centre, Singapore .,Singapore Eye Research Institute, Singapore.,Ophthalmology and Visual Sciences, Duke - NUS Graduate Medical School, Singapore
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22
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Baur ID, Mayer CS, Storr J, Khoramnia R. [Artificial Iris Implantation in a Patient with Iatrogenic Iris Defect Following Cataract Surgery]. Klin Monbl Augenheilkd 2021; 238:875-877. [PMID: 33607679 DOI: 10.1055/a-1353-5548] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
| | | | - Julia Storr
- Klinik und Poliklinik für Augenheilkunde, Klinikum rechts der Isar der Technischen Universität München, Deutschland
| | - Ramin Khoramnia
- International Vision Correction Research Centre (IVCRC) und David J Apple International Laboratory for Ocular Pathology, Universitäts-Augenklinik Heidelberg, Deutschland
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23
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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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Long-term follow-up of a custom-made prosthetic iris device in patients with congenital aniridia. J Cataract Refract Surg 2020; 46:879-887. [PMID: 32176163 DOI: 10.1097/j.jcrs.0000000000000175] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To investigate the effectiveness and safety of a custom-made iris prosthetic device used to reduce photic symptoms in patients with congenital aniridia. SETTING Cincinnati Eye Institute, Cincinnati, Ohio, USA. DESIGN Retrospective single-surgeon case series. METHODS The charts of all eyes of patients diagnosed with congenital aniridia syndrome who underwent implantation of the custom-made iris prosthesis at the setting institution between 2008 and 2018 were reviewed. Eyes with more than 6 months of follow-up were included in evaluation. Charts were carefully reviewed for comorbid conditions, interventions, and outcomes. RESULTS Ninety-six eyes of 50 patients were included in the study. Subjective reduction in photophobia and glare was reported in 95.7% and 95.2% of cases, respectively. The incidence of aniridia fibrosis syndrome (AFS) in this study (3.1%; 95% confidence interval, 0.6%-8.9%) was similar to previous studies in the literature. CONCLUSIONS The custom-made iris prosthesis was an effective and safe option to reduce photic symptoms in patients with congenital aniridia. The custom, flexible iris implant does not appear to alter the risk for AFS. These highly complex eyes with significant comorbid pathologies demand an individualized approach and careful long-term follow-up.
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Riedl JC, Schuster AK, Vossmerbaeumer U. [Indications and surgical techniques for implantation of the Artificial Iris®]. Ophthalmologe 2020; 117:786-790. [PMID: 32060610 DOI: 10.1007/s00347-020-01043-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 12/18/2019] [Accepted: 01/13/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND The implantation of the Artificial Iris® (Human Optics AG, Erlangen, Germany) is used for pupil and iris reconstruction in patients with partial or complete aniridia. So far, only a few case reports and short-term results are available in the literature. OBJECTIVE The aim of this analysis is to present the various indications as well as the functional result. MATERIAL AND METHOD This retrospective consecutive case study included 51 eyes of 50 patients with implantation of an Artificial Iris® for pupillary reconstruction. All operations were performed by the same ophthalmic surgeon (UV) at the University Eye Clinic Mainz. The initial findings were placed in relation to the indications and the functional results were investigated. RESULTS In this study 51 eyes of 50 patients with a mean age of 57 ± 16.5 years (16 women and 34 men) were analyzed. While the majority of the patients suffered from a traumatic partial or complete aniridia, the minority showed congenital defects. The visual acuity could be improved in 53% of the patients (p = 0.0001) postoperatively. CONCLUSION This analysis highlights the various and diverse indications for implanting the Artificial Iris®. Hereby, a gain in visual acuity is not invariably the primary objective but more often reduction of glare as well as cosmetic rehabilitation, as the eyes are severely damaged in many cases. The long-term results are currently being analyzed in a study and will soon be published.
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Affiliation(s)
- Jana C Riedl
- Augenklinik und Poliklinik, Universitätsmedizin Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland.
| | - Alexander K Schuster
- Augenklinik und Poliklinik, Universitätsmedizin Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland
| | - Urs Vossmerbaeumer
- Augenklinik und Poliklinik, Universitätsmedizin Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland
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Challenges and Complication Management in Novel Artificial Iris Implantation. J Ophthalmol 2018; 2018:3262068. [PMID: 30345111 PMCID: PMC6174745 DOI: 10.1155/2018/3262068] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [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] [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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Long-term results after artificial iris implantation in patients with aniridia. Graefes Arch Clin Exp Ophthalmol 2016; 254:1419-24. [PMID: 26892143 DOI: 10.1007/s00417-016-3292-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 02/03/2016] [Accepted: 02/08/2016] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND The custom-made, flexible artificial iris developed by HumanOptics and Koch can reconstruct the anterior segment of patients with aniridia. The aim of this study was to evaluate the long-term clinical outcome and complication spectrum after artificial iris implantation and the role of the embedded fiber mesh in view of specific complications. METHODS In this retrospective interventional case series, patients received an artificial iris between 2004 and 2013. Only eyes with a minimum follow-up period of 2 years were included. Indications were congenital, traumatic, or iatrogenic aniridia. The artificial iris was used either with or without embedded fiber mesh for partial or full prostheses. RESULTS We included 34 patients (mean age 48.8 years; SD ±17.2) with a mean follow-up of 50.0 months (SD ±18.9 months). No repositioning of prostheses was necessary. In cases of keratopathy (17.6 %) visual function increased from baseline mean 1.6 logMAR (SD ±0.7) to 1.2 logMAR (SD ±0.7) after artificial iris implantation. The remaining iris tissue darkened during the follow-up in 23.5 % (83.3 % with and 10.7 % without mesh), 8.8 % developed glaucoma (50 % with and 0 % without mesh) and 14.7 % needed consecutive surgery after prostheses implantation (50 % with and 7.1 % without mesh). In three out of seven trauma cases (42.9 %) silicone oil was spilled into the anterior chamber after 2.5 years on average. CONCLUSION The artificial iris prosthesis revealed a good clinical outcome in terms of long-term stability, cosmetic appearance, visual function, and represents a good functional iris diaphragm for compartmentalisation. Complications such as glaucoma, darkening of iris tissue, and need for consecutive anterior segment surgery are clearly associated with implants with integrated fiber mesh, but not to those without. Hence, the use of full iris prostheses without embedded fiber mesh, even in cases with remnant iris, and the use of slightly smaller implants than officially recommended may be beneficial.
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