The artificial iris – Analysis of various implantation techniques after ocular trauma

Abstract

Purpose: The aim of this study is to analyze the outcome of various techniques for a custom-made iris prosthesis implantation as part of reconstructive anterior segment surgery following traumatic aniridia. Methods: This retrospective interventional study was done for 6 eyes that received an artificial iris as secondary reconstructive measure for photophobia and unsatisfactory vision following initial globe repair. Different implantation techniques were employed. These included simple sulcus implantation, implantation of a composite (iris prosthesis with attached intraocular lens) implant, and combinations with phacoemulsification, vitrectomy, and penetrating keratoplasty. Results: In all cases, the artificial iris was implanted successfully. In the follow-up period (1–48 months), postoperative complications included rhegmatogenous retinal detachment, prolonged intraocular inflammation, and corneal transplant decompensation due to graft rejection. There was no case of secondary glaucoma. Complications could be managed successfully. All patients showed improved best-corrected visual acuity and were satisfied with functional and cosmetic results. Conclusion: This case series highlights the different implantation techniques for reconstruction of the anterior segment after ocular trauma. The versatility of the custom-made iris implant accounts for a wide range of applications and the foldable material reduces the need for large incisions in the already traumatized eye.

Structural effects on custom, flexible iris prostheses passing through injector systems

“…1 Those made with the fiber meshwork have increased tensile strength and are thought to be preferable for suture fixation, although, clinically, suture fixation has been effectively accomplished without device cheesewiring even with fiber-free units. 3–5…”

“…2 Artificial irides are made of silicone and custom colored by pigment embedded within the elastomer matrix to match the residual or fellow iris of the patient. 3 The silicone material gives surgeons the ability to fold the devices such that they can be implanted through much smaller wounds than legacy rigid devices. Implantations can be performed either with forceps or through a typical intraocular lens injection system.…”

“…Implantations can be performed either with forceps or through a typical intraocular lens injection system. 3 Artificial irides can be manufactured either with or without an embedded polyester fiber meshwork integrated into the silicone. 1 Those made with the fiber meshwork have increased tensile strength and are thought to be preferable for suture fixation, although, clinically, suture fixation has been effectively accomplished without device cheesewiring even with fiber-free units.…”

“…1 Those made with the fiber meshwork have increased tensile strength and are thought to be preferable for suture fixation, although, clinically, suture fixation has been effectively accomplished without device cheesewiring even with fiber-free units. [3][4][5] Fiber-free implants have greater elasticity and are thus easier to fold for insertion and easier to manipulate intraocularly. 5 During the U.S. Food and Drug Administration (FDA) investigational device exemption study, the Johnson & Johnson Vision Silver Series injection system was used when injection through a small wound was deemed appropriate; this device was found to be suitable when used in the clinical trial with both fiber-free and meshworkembedded artificial irides, and neither permanent distortion nor tearing of the tested devices was reported.…”