Abstract
Background
The custom-made, flexible artificial iris developed by HumanOptics and Koch can reconstruct the anterior segment of patients with aniridia. The aim of this study was to evaluate the long-term clinical outcome and complication spectrum after artificial iris implantation and the role of the embedded fiber mesh in view of specific complications.
Methods
In this retrospective interventional case series, patients received an artificial iris between 2004 and 2013. Only eyes with a minimum follow-up period of 2 years were included. Indications were congenital, traumatic, or iatrogenic aniridia. The artificial iris was used either with or without embedded fiber mesh for partial or full prostheses.
Results
We included 34 patients (mean age 48.8 years; SD ±17.2) with a mean follow-up of 50.0 months (SD ±18.9 months). No repositioning of prostheses was necessary. In cases of keratopathy (17.6 %) visual function increased from baseline mean 1.6 logMAR (SD ±0.7) to 1.2 logMAR (SD ±0.7) after artificial iris implantation. The remaining iris tissue darkened during the follow-up in 23.5 % (83.3 % with and 10.7 % without mesh), 8.8 % developed glaucoma (50 % with and 0 % without mesh) and 14.7 % needed consecutive surgery after prostheses implantation (50 % with and 7.1 % without mesh). In three out of seven trauma cases (42.9 %) silicone oil was spilled into the anterior chamber after 2.5 years on average.
Conclusion
The artificial iris prosthesis revealed a good clinical outcome in terms of long-term stability, cosmetic appearance, visual function, and represents a good functional iris diaphragm for compartmentalisation. Complications such as glaucoma, darkening of iris tissue, and need for consecutive anterior segment surgery are clearly associated with implants with integrated fiber mesh, but not to those without. Hence, the use of full iris prostheses without embedded fiber mesh, even in cases with remnant iris, and the use of slightly smaller implants than officially recommended may be beneficial.
Similar content being viewed by others
References
Brauweiler P (2011) Iris sutures. Ophthalmologe 108(8):710–713
Mavrikakis I, Mavrikakis E, Syam PP, Bell J, Casey JH, Casswell AG, Brittain GP, Liu C (2005) Surgical management of iris defects with prosthetic iris devices. Eye 19:205–209
Srinivasan S, Ting DS, Snyder ME, Prasad S, Koch HR (2014) Prosthetic iris devises. Can J Ophthalmol 49(1):6–17
Wolff J (2011) Prosthetic iris devices. Ophthalmologe 108(8):714–719
Koch HR (2008) A new foldable artificial iris Indications, surgical techniques and first results. Clin Exp Ophthalmol 36(s1):A1–A61
Jonsson NJ, Sahlmüller MC, Ruokonen PC, Torun N, Rieck P (2011) Complications after cosmetic iris implantation. Ophthalmologe 108:455–458
Forlini C, Forlini M, Cavallini GM (2013) Simultaneous correction of post-traumatic aphakia and aniridia with the use of artificial iris and IOL implantation. Graefes Arch Clin Exp Ophthalmol 251(10):2493–2494
Burk SE, Da Mata AP, Snyder ME, Cionni RJ, Cohen JS, Osher RH (2001) Prosthetic iris implantation for congenital, traumatic, or functional iris deficiencies. J Cataract Refract Surg 27:1732–1740
Thomas BC, Rabsilber TM, Auffarth GU (2013) Aniridia-IOL and artificial iris reconstruction. Klin Monatsbl Augenheilkd 230(8):786–790
Szurman P, Jaissle G (2011) Artificial iris. Ophthalmologe 108:720–727
Smiddy WE, Sawusch MR, O’Brian TP, Scott DR, Huang SS (1990) Implantation of scleral-fixated posterior chamber intraocular lenses. J Cataract Refract Surg 16:691–696
Engels T (1998) Irisnähte in der geschlossenen Vorderkammer. Ophthalmol Chirurgie 10:21–28
Szurman P, Petermeier K, Aisenbrey S, Spitzer MS, Jaissle G (2010) Z-suture - a new knotless technique for transscleral suture fixation of intraocular implants. Br J Ophthalmol 94:167–169
Szurman P, Petermeier K, Grisanti S, Jaissle GB, Bartz-Schmidt KU (2007) A new small-incision technique for injector implantation of transsclerally sutured foldable lenses. Ophthalmic Surg Lasers Imaging 38:76–80
Koch KR, Heindl LM, Cursiefen C, Koch HR (2014) Artificial iris devices: benefits, limitations, and management of complications. J Cataract Refract Surg 40(3):376–382
Mayer CS, Hoffmann AE (2015) Surgical treatment with an artificial iris. Ophthalmologe 112(10):865–868
Spitzer MS, Nessmann A, Wagner J, Yoeruek E, Bartz-Schmitz KU, Szurman P, Szurman G (2016) Customized humanoptics silicone iris prosthesis in eyes with posttraumatic iris loss: outcomes and complications. Acta Ophthalmol (Copenh). doi:10.1111/aos12946
Hermann MM, Muether PS, Kuhn L, Kirchhof B, Fauser S (2012) Clinical outcome of the artificial iris diaphragm in silicone oil surgery. Br J Ophthalmol 96(7):1008–1011
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Informed consent
For this type of study formal consent is not required.
Funding
No funding was received for this research.
Conflict of interest
All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.
Rights and permissions
About this article
Cite this article
Rickmann, A., Szurman, P., Januschowski, K. et al. Long-term results after artificial iris implantation in patients with aniridia. Graefes Arch Clin Exp Ophthalmol 254, 1419–1424 (2016). https://doi.org/10.1007/s00417-016-3292-3
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00417-016-3292-3