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W. E. Sponsel, W. Ayliffe; A Comparision of Traditional and Novel Iris Implant Surgery Methods and New Technique for Insertion of Artificial Irides. Invest. Ophthalmol. Vis. Sci. 2010;51(13):3119.
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© ARVO (1962-2015); The Authors (2016-present)
Iris defects are unsightly and associated with poor vision due to optical aberrations. We describe the use of iris prothetics for functional and cosmetic rehabilitation and describe a new technique for implanting a novel artificial iris using a 1.8mm microincision. This allowed excellent cosmesis and rapid visual rehabilitation with minimal trauma to the eye avoiding previously damaged areas.
Currently available prosthetics require relatively large incisions which may be impractical in eyes with previous trauma or disease. The technique is demanding and poor cosmetic results are frequently obtained, particularly in cases with inferior defects. Recently a new iris prosthesis, with excellent cosmetic appearance has become available (ArtificialIris, Dr. Schmidt, Germany). The device is manufactured from pigmented silicone elastomer. The color and surface topography of the iris is naturalistic, fashioned by producing a copy of a photographic image of the fellow eye onto the silicone disc. Implantation of this device has previously required enlarging of the cataract incision. We developed a technique that allows insertion of this prosthesis through a small incision during cataract surgery. All surgery was performed by WA, in London. All materials were EU marked. The prosthesis and injector are not yet FDA approved. A site in clear cornea not involved with previous trauma or melting was chosen and a self-sealing 1.6mm incision made with a similarly chosen site for a 1mm side port incision on the opposite aspect of the eye. Iris insertion accompanied cataract removal with the StellarisTM system (Bausch and Lomb, B+L).
Case 1: 65 yo F with enlarging amelanotic iris melanoma OS superotemporally. Case 2: 45 yo F who lost most of her iris following a penetrating injury. Case 3: 48 yo F previously treated for scleritis and interstitial keratitis. After remission off all immunotherapy she received a blunt blow to the left eye causing rupture and loss of iris and ciliary body. Improved final visual acuities of 20/20, 20/20, and 20/40, respectively, were obtained with excellent final cosmesis in all three cases.
Repair of eyes with iris and pupil anomalies present significant surgical challenges. The eyes often have other defects such as scarring or zonular dehiscence, and repair must be planned meticulously so that surgical trauma is minimized. Injecting the Dr. Schmidt silicone prosthesis via a 1.8mm wound without enlargement can provide good visual results immediately with excellent cosmetic outcomes.
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