Dr. Haider Manzar (MBBS, BSc (Hons), PGCert (MedEd), AKC)

Southend University Hospital NHS Foundation Trust, Essex, UK

Background

Iris implants are used in the repair of defects secondary to trauma, congenital abnormalities or complicated surgery (Brown et al., 2005). Traditional iris implants that are commonly available are rigid, requiring large incisions with associated risks of scarring, astigmatism, infection and poor healing (Thiagalingam et al., 2008). Furthermore, they do not replicate the patient’s natural eye colour and are therefore less desirable from a cosmetic point of view. Custom made iris implants are now growingly available and provide an exciting alternative.

Case Report

A 60-year-old gentleman who works as an electrician presented with blunt trauma sustained at work to his right eye. This resulted in vitreous prolapse into the anterior chamber, high intraocular pressure (IOP) >50mmHg and traumatic mydriasis. He underwent pars plana vitrectomy (PPV) to lower the IOP but developed subsequent retinal detachment, needing further PPV, cryo and gas. He then developed cataract, requiring phacoemulsification with the help of a capsular tension device to stabilise the capsular bag. The intraocular lens (IOL) was successfully implanted with a good outcome. There was, however, continuing discomfort due to the traumatic mydriasis. Damage to the iris sphincter resulted in a fixed dilated pupil, causing severe photophobia. The patient was not happy to have a masking contact lens or rigid iris implant and ultimately decided on an ArtificialIris implant (Human Optics®).

Outcome

Given the patient’s occupation, a contact lens was not tolerable and he opted against a rigid implant due to poor cosmesis.

The traumatic mydriasis can be clearly seen in figure 1, with figure 2 showing the eye after insertion of the iris implant. The patient’s original eye colour has been replicated very well, giving him excellent post-operative satisfaction.

Discussion

Post-operative visual acuity was 6/6 (LogMAR 0) as well as an excellent aesthetic result. Most implants are made of flexible silicon and hand crafted to match the fellow eye (Mayer et al., 2016). Furthermore, unlike the traditional rigid implants, they are easy to insert given their flexible nature. This allows for a smaller incision, quicker recovery and it is also a reversible procedure. The reversibility of the implant is important, as there have been cases of adverse effects requiring explantation (Thiagalingam et al., 2008). Still a relatively new procedure, more research is needed on its safety as one can develop uveitis, corneal decompensation and ocular hypertension (Thiagalingam et al., 2008). It is therefore important to ensure that the procedure is medically indicated with the benefits outweighing the risks, as was the case with the patient in this report. Cosmetic iris implants may carry greater risk of complication, as patients require surgery on both eyes. The use of artificial iris implants such as the one used here has been particularly useful in cases of aniridia secondary to penetrating ocular trauma (Brown et al., 2005).

Disclaimers: The authors have no financial interest. Consent gained from patient for publication of images.

References

Brown, M. J., Hardten, D. R., & Knish, K. (2005). Use of the artificial iris implant in patients with aniridia. Optometry-Journal of the American Optometric Association, 76(3), 157-164.

Mayer, C. S., Reznicek, L., & Hoffmann, A. E. (2016). Pupillary reconstruction and outcome after artificial iris implantation. Ophthalmology, 123(5), 1011-1018.

Thiagalingam, S., Tarongoy, P., Hamrah, P., Lobo, A. M., Nagao, K., Barsam, C., Bellows, R & Pineda, R. (2008). Complications of cosmetic iris implants. Journal of Cataract & Refractive Surgery, 34(7), 1222-1224.