Simultaneous correction of post-traumatic aphakia and aniridia with the use of artificial iris and IOL implantation

Abstract

Management of post-traumatic aniridia combined with aphakia by haptic fixation of a foldable acrylic IOL on a foldable iris prosthesis appears to be a promising approach which gives the surgeon the possibility to correct a complex lesion with one procedure, which is less traumatic and faster. Existence of foldable materials, both iris and IOL, permits relatively small corneal incisions (4.0-5.0 mm). Moreover, the custom-tailored iris prosthesis gives a perfect aesthetic result.

Combined transscleral fixation of an artificial iris prosthesis with an intraocular lens

“…Aside from esthetic aspects, partial or total loss of iris tissue may also be related to various degrees of glare, photophobia, and visual impairment. In patients with major iris defects, an artificial iris prosthesis provides satisfactory anterior segment reconstruction with a remarkable functional outcome (3)(4)(5)(6)(7)(8)(9)(10) . Various implants have been developed for the treatment of aphakia with aniridia.…”

“…Because the management of aphakia is not possible with such artificial iris implants, the transscleral fixation of IOL has to be scheduled in aphakic eyes with a lack of a sufficient capsular support. Hence, many authors have published an excellent visual prognosis with transsclerally fixated IOLs in aphakic cases without any capsular support (2)(3)(4)(5) . In order to reduce the risk of both corneal decompensation and macular edema, transscleral fixation of a standard IOL in combination with a custom-tailored artificial iris prosthesis in the same surgical session has been published very recently in cases with concomitant aniridia and aphakia (4,5) .…”

“…Hence, many authors have published an excellent visual prognosis with transsclerally fixated IOLs in aphakic cases without any capsular support (2)(3)(4)(5) . In order to reduce the risk of both corneal decompensation and macular edema, transscleral fixation of a standard IOL in combination with a custom-tailored artificial iris prosthesis in the same surgical session has been published very recently in cases with concomitant aniridia and aphakia (4,5) . Forlini et al fixed a monopiece foldable IOL centrally on the back side of the artificial iris prosthesis (4) , and Spitzer et al reported on the implantation of such a custom-tailored prosthesis combined with a three-piece foldable IOL through a superior corneoscleral tunnel with a length of 5 mm (5) .…”

“…In order to reduce the risk of both corneal decompensation and macular edema, transscleral fixation of a standard IOL in combination with a custom-tailored artificial iris prosthesis in the same surgical session has been published very recently in cases with concomitant aniridia and aphakia (4,5) . Forlini et al fixed a monopiece foldable IOL centrally on the back side of the artificial iris prosthesis (4) , and Spitzer et al reported on the implantation of such a custom-tailored prosthesis combined with a three-piece foldable IOL through a superior corneoscleral tunnel with a length of 5 mm (5) . However, we used PMMA IOL that was tightly sutured onto the back side of the artificial iris prosthesis with 9-0 polypropylene looped-sutures in its haptic eyelets in order to provide the best fixation.…”

“…Because corneal endothelial cell density is reduced in eyes with a traumatic cataract, every surgical trauma entails a potential risk of aggravating corneal decompensation (1)(2)(3) . After custom-tailored iris prosthesis became available for ocular implantation, some authors have described a combined surgical approach for treating aphakia and aniridia with haptic fixation of an intraocular lens (IOL) on artificial iris implants prior to intraocular placement (4,5) . Herein we describe a new surgical technique for simultaneously treating aniridia and aphakia.…”