Original article
Residual Iris Retraction Syndrome After Artificial Iris Implantation

https://doi.org/10.1016/j.ajo.2018.09.001Get rights and content

Highlights

  • Little was known about the long-term effect of artificial iris implantation on the remnant iris.

  • Retraction of the residual iris has been observed after implantation of an artificial iris.

  • In an apparently irreversible process, the residual iris disappears almost completely.

  • There is most risk of iris retraction when the artificial iris is implanted in the ciliary sulcus without suture fixation to the sclera.

Purpose

To evaluate the effect of an artificial iris implant on the remnant iris.

Design

Interventional case series.

Methods

Setting: Single center. Patient Population: Forty-two consecutive patients. Observation Procedures: Morphologic evaluation over 24 ± 14 months. Main Outcome Measures: Remnant pupillary aperture, iris color, visual acuity, intraocular pressure, and endothelial cell count.

Results

In 7 of 42 cases (16.7%), the residual iris aperture dilated from 36.6 ± 15.4 mm2 preoperatively to 61.1 ± 12.5 mm2 1 year postoperatively (66.9% increase). In 5 of 7 affected eyes the artificial iris had been implanted into the ciliary sulcus; in 2 eyes it had been sutured to the sclera. Four of the 7 patients presented with remarkable complications: 2 eyes needed glaucoma shunt surgeries owing to pigment dispersion; 1 suffered from recurrent bleedings; and in 1 case artificial iris explantation was performed owing to chronic inflammation. Anterior chamber depth and angle, endothelial cell count, and visual acuity did not change in this cohort. Changes in color were not observed in the remnant iris.

Conclusions

The implantation of an artificial iris prosthesis can lead to a residual iris retraction syndrome. It is likely that residual iris is trapped in the fissure between the artificial iris and the anterior chamber angle, preventing further pupil constriction. Another possibility could be a constriction or atrophy of the residual iris. A scleral-sutured implant and an implantation in the capsular bag were both found to prevent the iris retraction. The study group number is inadequate to allow statistical comparison of these different implantation methods. As the use of artificial irises increases, we may expect more patients with iris retraction syndrome in the future.

Section snippets

Methods

At the Eye Clinic of the Technical University of Munich, 50 ArtificialIris silicone iris prostheses were implanted between June 2011 and December 2016. The main indication for surgery was intense sensitivity to glare. Secondary reasons were the patients' concerns about cosmetic appearance and decreased visual acuity. We analyzed the morphologic changes of the residual iris 24 ± 14 months after surgical reconstruction (at least 1 year of follow-up). Six patients suffered from complete aniridia

Results

In 7 of 42 eyes (16.7%) we detected a retraction syndrome of the patient's residual iris after implantation of the artificial iris prosthesis (Table). A continuous enlargement of the original pupillary aperture was noted during the follow-up in these patients. None of them complained about disturbing symptoms, especially pain, cosmetic alterations, or visual disturbances owing to the dilated residual iris.

Five of the affected patients were male and 2 female; mean age was 55.9 ± 1.3 years; and 3

Discussion

We describe a previously unrecognized late complication of artificial iris implantation with the ArtificialIris device: Residual Iris retraction Syndrome (RITS), which is an unforeseeable event after artificial iris implantation that is late onset—detectable during a long postoperative follow-up period. RITS is manifest by progressive enlargement of the pupil and retraction of the residual iris.

In 7 patients treated with an artificial iris, we detected morphologic changes in the residual iris.

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