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Anja Nessmann, Julia Wagner, Efdal Yoeruek, Karl Ulrich Bartz-Schmidt, Peter Szurman, Martin Stephan Spitzer; Customized Iris Prosthesis in eyes with post-traumatic aniridia. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):6060.
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Posttraumatic partial or total iris defects often cause significant debilitating glare, photophobia, decreased vision and cosmetic problems. Currently the best cosmetic results can be obtained with a customized silicone iris prosthesis. However, little is known about the functional results and the rate of complication if this type of iris prosthesis is implanted into severely traumatized eyes.
A consecutive series of 36 patients that received a customized silicone iris prosthesis after severe globe injury with total or sub-total iris loss was analyzed retrospectively. In 18 patients, the iris prosthesis insertion was combined with intraocular lens implantation and in 4 patients with corneal transplantation. Mean visual acuity prior to iris prosthesis implantation was 1.1 logMAR units (0.3 - 2.6 logMAR units). Median follow-up was 17.5 months. 3 patients had preexisting glaucoma and 8 patients hypotony.
Postoperative results showed a rather diverse picture. Visual acuity 12 months after surgery was 1.4 LogMAR units (0.2 - 2.6 logMAR units). Patient`s satisfaction increased by reducing glare and enhanced cosmetic appearance. Complications were an increase of intraocular pressure (IOP) requiring new or more pressure lowering therapy in 3 patients, persisting intraocular inflammation or macular edema in 14 patients, and corneal endothelial decompensation (CED) in 5 patients. Moreover, in 5 other cases penetrating keratoplasty was necessary during or after iris prosthesis implantation as a consequence of corneal scarring due to the initial trauma.
The customized silicone iris prosthesis is an individualized treatment approach, which can be tailored to distinct eye properties. Therefore, especially trauma eyes with highly different posttraumatic conditions could benefit. In addition, the customized silicon iris prosthesis is a favorable cosmetic solution for the reconstruction of the iris in posttraumatic eyes. However, in some patients the implantation of this device may cause an increase of IOP, corneal endothelial decompensation or persisting inflammation. Thus, the risks of benefits of implantation must be weighed carefully in patients with high or low IOP as well as pre-existing corneal endothelial damage.
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