Abstract
Purpose Evaluation of postoperative artificial iris prosthesis-related complications. Design Retrospective cohort study. Methods Fifty-one consecutive patients underwent pupillary reconstruction using an artificial iris implant made from silicone between 2011 and 2015. Quantity and quality of complications were subclassified into three groups including mild, moderate, and severe complications. Their management and the learning curve were evaluated. Results In total, 13 (25.5%) of 51 included artificial iris implantations showed unexpected events in various degrees: mild complications: recurrent bleeding (n=1, 2.0%), slight but stable iris deviation (n=1, 2.0%), capsular fibrosis (n=2, 3.9%); moderate complications: suture cutting through the residual iris (n=1, 2.0%), glaucoma (n=3, 5.9%), and corneal decompensation (n=3, 5.9%); severe complications: artificial iris suture loosening (n=2, 3.9%) and dislocation (n=3, 5.9%), synechiae (n=2, 3.9%), glaucoma (n=2, 3.9%), and corneal decompensation (n=5, 9.8%) with the need for surgery, cystoid macular edema (n=3, 5.9%) and retinal detachment (n=1, 2.0%). The complication rate decreased from 83.3% (5 of 6 implantations) in the first year to 13.3% (2 of 15 implantations) in the 4th year. Nineteen of 45 evaluated patients showed a significant gain in best-corrected visual acuity (BCVA) from 1.09 ± 0.56 logMAR to 0.54 ± 0.48 logMAR (p < 0.001), and 13 of 45 eyes had a significant BCVA loss from 0.48 ± 0.39 logMAR to 0.93 ± 0.41 logMAR after surgery (p < 0.001). Conclusions The artificial iris is a feasible option in the treatment of iris defects with a wide spectrum of postoperative complications. The significant reduction of complications after twelve implantations implicates that the procedure is not to be recommended in low volume settings.
Highlights
Patients with iris defects suffer from severe visual impairment with especially increased glare sensitivity and cosmetic disturbances
Postoperative changes, abnormalities, complications, and unexpected events associated with the artificial iris implantation were noted in standardized full ophthalmic examinations. e development of best-corrected visual acuity (BCVA, Snellen chart) was classified into three groups: BCVA improvement (>2 lines), unchanged BCVA (±2 lines), and decrease in BCVA (>2 lines). e unexpected events and complications during the follow-up period were grouped into “none”, “mild”, “moderate”, and “severe”
We were able to evaluate the complications of 51 patients, who had received an artificial iris implantation performed by one single surgeon in a university eye clinic setting between 2011 and 2015. irtyfour (66.7%) were male and 17 (33.3%) were female
Summary
Patients with iris defects suffer from severe visual impairment with especially increased glare sensitivity and cosmetic disturbances. In addition to those iris defects, these eyes show corneal and scleral scars, aphakia, retinal changes, and glaucoma depending on the initial trauma. Several surgeons have presented different cases or small case series of pupil and iris reconstruction using this novel type of silicone iris implant with good results [10,11,12,13,14,15,16]. We were able to present good functional outcomes in pupillary reconstruction after artificial iris implantation in a larger series with 36 eyes [17]. E purpose of this retrospective cohort study was to describe the learning curve of the implantation surgery, limitations, pitfalls, and associated unexpected events and their potential solutions for the use of this iris prosthesis
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