Black Diaphragm Intraocular Lens Research Articles

Scleral sutured aniridia intraocular lens (Morcher®): indications and long-term outcomes.

To evaluate the outcomes of trans-scleral sutured posterior chamber black diaphragm intraocular lens (BDIOL) (Morcher®) implantations over 11 years. Retrospective case-series of patients, who underwent BDIOL implantation, identified from electronic patient records system from 2006 to 2016, Moorfields Eye Hospital. Demographics, pre/post-operative, final best-corrected visual acuity (BCVA), diagnosis, symptomatic improvement, intraoperative and postoperative complications immediate or late were collected and analysed to relate outcomes to surgical indication. Forty eyes of 38 patients (F:M 1:2.8) underwent BDIOL implantation with a mean surgical age of 46.6 years and follow-up of 44.5 months (range of 8-132 months). Indications included 23(57%) ocular trauma, 7(17%) congenital aniridia, 7(17%) iatrogenic lens and/or iris loss, and 3(7%) infectious keratitis. Mean preoperative BCVA was 1.64 logMAR and mean final postoperative BCVA was 0.94 logMAR with an average improvement in BCVA of 0.23 logMAR, equivalent to 1.5 lines of Snellen visual acuity. Visual results varied according to indications. Infectious cause patients had the greatest vision improvement (-0.7 logMAR), followed by trauma (-0.3 logMAR), and 25% of these achieved vision of 0.3 logMAR (6/12 in Snellen acuity) or better. Conversely, the aniridia group had the least improvement (worsened vision of 0.01 logMAR), 17 patients (42%) reported subjective improvement. BDIOLs achieve reasonably good visual outcomes in eyes with complex vision threatening pathology. No significant intra-operative complications are documented and most post-operative complications are related to the pre-existing pathology. Post - trauma and iatrogenic aniridia have better outcomes compared to congenital aniridia.

Aniridic scleral fixation of intraocular lens: The answer to vision loss with photophobia!

Aniridia is defined as missing iris tissue which can be partial, subtotal, or total. Characteristic clinical symptoms include photophobia and decreased visual acuity due to an increased light perception. In addition to this, disturbing cosmetic problems are prevalent. Even after implantation of an intraocular lens, patients often tend to be unsatisfied. The answer to this problem lies in the implantation of an aniridic scleral fixation of intraocular lens (SFIOL), which has a central optical axis that acts as the refractive lens and a peripheral rim of a hyperpigmented area that mimics the iris and hence reduces photophobia. The purpose of the video was to demonstrate the use of black diaphragm intraocular lens (BDIOL) implantation, its surgical steps, and its outcomes. We report one such case where a young patient presented with post-traumatic aniridia with subluxated total cataract and spillover vitreous hemorrhage. He was subjected to a vitrectomy, cataract removal, and placement of an aniridic SFIOL with prolene 9-0 using the four-point fixation method. This gave an extremely gratifying outcome and solved both problems, that is, vision and photophobia. Highlight: Before implantation of the SFIOL, the patients had reduced visual acuity from aphakia and intolerable glare from aniridia. In this case-based approach and with relevant example, we tried to provide a solution for tricky scenarios like co-existing traumatic cataract and traumatic aniridia. The patient showed improved visual acuity and marked glare reduction after black diaphragm SFIOL implantation. https://youtu.be/atl60WetFsM.

This issue of ACTA

This issue of ACTA

Over 10-year follow-up outcomes and failure analysis of black diaphragm intraocular lens implantation in traumatic Aniridia.

To determine the over 10-year follow-up outcomes and analyse the reason for failure in patients who underwent black diaphragm intraocular lens (IOL) implantation for the management of traumatic aniridia. Fifty-three patients underwent black diaphragm IOL implantation for the treatment of traumatic aniridia from September 1998 to August 2007. 33 eyes of 33 patients were enrolled in our study, and the mean follow-up period was 185.6±36.2months (range: 126-247months). The primary methods employed for assessment of the safety of the IOL and the causes of failure were the ultrasound biomicroscopy (UBM) and observation during reoperation. In the current study, 13 patients (39.4%) who underwent IOL implantation by means of trans-scleral fixation were observed to maintain a transparent cornea and normal intraocular pressure. 20 patients (60.6%) developed corneal endothelial decompensation, and 14 patients (42.4%) developed secondary glaucoma. 27 patients were examined by means of UBM or reoperation and the position of black diaphragm IOL in 18 patients was observed to be abnormal; the IOL had shifted forward and directly contacted with the anterior chamber and even the corneal endothelium. The forward displacement of black diaphragm IOL is a direct cause of treatment failure. Although the implantation of black diaphragm IOL is an effective method of management of traumatic aniridia, the treatment should be guarded and performed in an appropriate manner. Patients should be informed regarding the need for life-long follow-up, so that the complications can be identified in a timely manner.

Transscleral Fixation of Black Diaphragm Intraocular Lens in Complete Aniridia and Aphakia Due to Posttraumatic Eye Rupture: A Pilot Study

Introduction: To assess long-term outcomes of implantation of black diaphragm intraocular lens (BD IOL) in post-traumatic aniridia and aphakia due to eye rupture. Methods: This is a retrospective consecutive case series of 14 eyes with post-traumatic complete aniridia and aphakia treated with scleral fixation BD IOL. Measurements included ophthalmological comorbidities, best corrected visual acuity (BCVA), complications, and postoperative interventions. The average postoperative follow-up period was 36 months. Results: BCVA improved in 6 cases, was stable in 6 cases and worsened in 2 cases. The lens was well centered in 13 cases. Glaucoma was diagnosed in six cases developed, and three of them required Ahmed valve implantation. One lens developed opacity. The cornea was decompensated in 6 cases, while two of them required penetrating keratoplasty. Conclusion: Implantation of BD IOL in eyes with severely traumatized eyes enables reconstruction of the anterior segment and some functional restoration, although many complications may arise during the longitudinal follow-up.

Black diaphragm intraocular lens implantation in patients with aniridia

Purpose:To review the management outcomes of black diaphragm intraocular (BDI) lens implantation in Arab patients with aniridia.Methods:Patients with aniridia undergone BDI lens implantation at our institution between 2013 and 2014 were included. Uncorrected visual acuity (UCVA), manifest refraction, and best-corrected visual acuity (BCVA) were evaluated before and 6 months and yearly after BDI lens implant surgery until the last visit. Intra- and postoperative complications were noted.Results:Our series comprised 14 patients (8 males) with aniridia. The median duration of follow-up was 30 months (25% quartile). Ocular parameters, refractive status, and vison were all significantly improved at the last follow-up compared to the preoperative values (P < 0.05 for all comparisons). All patients reported a significant decrease in photophobia and glare. Postoperatively, 11 eyes (78%) gained 2 or more lines of UCVA. At the last follow-up, BCVA increased by 2 or more lines in all cases. Early postoperative complications included main wound leakage (one eye) and anterior chamber hyphema (one eye). Late (≥6 months) complications included corneal decompensation (one eye), failed penetrating keratoplasty graft (2 eyes), and subluxation of a scleral fixated BDI lens (one eye). Surgical interventions performed to manage complications included penetrating keratoplasty in 2 eyes with corneal decompensation and failed graft (one each), and re-suturing of a subluxated intraocular lens (one eye).Conclusion:BDI lenses seem to be a safe and effective iris prosthetic with intraocular lens combination surgery for patients with congenital or traumatic aniridia. Periodic evaluation and prompt management of complications are recommended.

The efficacy and complications of black diaphragm intra-ocular lens implantation in patients with congenital aniridia.

To evaluate the efficacy and complications of black diaphragm intra-ocular (BDI) lens implantation in patients with congenital aniridia. Twenty patients underwent BDI lens implantation for the treatment of congenital aniridia from January 1999 to December 2012. Fifteen patients (23 eyes) were enrolled in our study, and the mean follow-up period was 26months. Patient demographics, clinical evaluations [visual acuity (VA), best-corrected visual acuity (BCVA), intra-ocular pressure measurement (IOP), corneal endothelial cell density (ECD) and ultrasound biomicroscopy (UBM)], complications and treatments were analysed for each patient. Sixteen eyes (70.1%) had a BCVA better than 20/200 after BDI lens implantation, and photophobia obviously decreased in all patients. Six eyes (26.09%) developed secondary glaucoma after BDI lens implantation, and one eye underwent glaucoma surgery. Corneal decompensation occurred in two eyes (8.70%), one of which was complicated by glaucoma. Two eyes (8.70%) developed visual axis opacity (VAO) after surgery. One patient (4.35%) had limbal stem cell failure, and another patient (4.35%) had an eccentric BDI lens. Intra-ocular pressure measurement elevation and ECD reduction were found after BDI lens implantation. Black diaphragm intra-ocular lens implantation can effectively improve VA, decrease photophobia and resolve cosmetic issues in most congenital aniridia eyes. Glaucoma, corneal decompensation and VAO were the major long-term complications of BDI lens implantation in patients with congenital aniridia. All patients should be managed attentively because of high risk of complications and followed long term to achieve favourable outcomes.

Long-term efficacy and complications of black diaphragm intraocular lens implantation in patients with traumatic aniridia

AimsTo determine the efficacy and complications of long-term black diaphragm intraocular (BDI) lens implantation in patients with traumatic aniridia.MethodsThis study analysed the demographics, clinical evaluations and treatments of 95 patients...

Modified implantation of black diaphragm intraocular lens in traumatic aniridia

We describe a modified technique of black diaphragm intraocular lens (IOL) implantation in eyes with traumatic aniridia, aphakia, and previous vitrectomy. During black diaphragm IOL implantation, a double-armed 10-0 polypropylene suture is used to fixate the IOL in the ciliary sulcus. Two 10-0 polypropylene sutures are subsequently placed in front of the IOL to block its forward displacement and thus prevent its contact with the anterior chamber angle and corneal endothelium. This modified implantation technique reduces long-term complications following black diaphragm IOL implantation in patients with traumatic aniridia. No author has a financial or proprietary interest in any material or method mentioned.

Black diaphragm intraocular lens implantation and penetrating keratoplasty in aphakic eyes with traumatic aniridia.

To evaluate the long-term outcome of implantation of black diaphragm intraocular (BDI) lens combined with penetrating keratoplasty (PKP) for managing aphakic eyes with traumatic aniridia and corneal damage. Six aphakic eyes of six patients with traumatic aniridia and corneal damage had BDI lens implantation at Qingdao Eye Hospital, Shandong Eye Institute from June 2008 to November 2011. Medical records of the patients were reviewed. Three patients received PKP and after 12-18months were implanted with BDI lens. The other three patients completed PKP and BDI lens implantation at the same time. The corrected visual acuity, intraocular pressure and number of corneal endothelial cells were monitored. The patients were followed up for an average of 24.3±12.1months (range 14-48 months). All BDI lenses were located well. The best corrected visual acuity got improved in 5 patients (0.1-1.0) and decreased in 1 patient from 0.4 to 0.2. Three patients had normal intraocular pressure (IOP) after implantation. Two patients required antiglaucoma medications to control IOP within the normal range and 1 patient implanted Ahmed glaucoma valve to control IOP. The corneal grafts kept transparent in all eyes and the corneal endothelial counting >1 000/mm(2), although two patients experienced acute graft rejection and loss more than 30% corneal endothelial cells. Implantation of BDI lens combined with PKP is an effective option for managing aphakic eyes with traumatic aniridia and corneal damage. Although the results in our study are encouraging, additional studies of the long-term safety and efficacy are required. A larger study population and longer follow-up may be beneficial.

Potential Therapeutic Efficacy of a Virtual Pupil Made of Polarizing Plates for Correction of Aniridia

To investigate whether diagonally-placed polarizing plates can mimic a functional pupil using an artificial eye. An artificial eye system was used to evaluate the visibility of the fundus and the quality of vision associated with polarizing plates, an artificial iris with a pupillary hole, or a black-diaphragm intraocular lens. The transparency of various wavelengths of light through each material was also evaluated. The observational field was limited to the same extent through the artificial iris and when one polarizing plate with a pupillary hole and an intact polarizing plate were placed diagonally. The observational field could be widened as by a mydriatic pupil when the intact polarizing plate was removed, leaving the polarizing plate with the pupillary hole at the iris plane. The observational field limited through the black-diaphragm intraocular lens could not be changed. Visual quality was almost the same with the polarizing plates, artificial iris, or black-diaphragm intraocular lens. The strength of the light was slightly reduced when passed through one polarizing plate or two parallel polarizing plates. It was dramatically reduced when passed through two diagonal polarizing plates or a black-diaphragm. Diagonally placed polarizing plates can mimic a functional pupil using an artificial eye. If one polarizing plate with a pupillary hole is placed at the iris plane, a virtual pupil can be created by wearing polarizing glasses, and this system is controllable by wearing or removing the glasses. This system may be a suitable alternative treatment for aniridia.

Long-term outcome of black diaphragm intraocular lens implantation in traumatic aniridia

AimTo evaluate the long-term outcome of black diaphragm intraocular (BDI) lens implantation in traumatic aniridia and investigate the possible cause of long-term complications.MethodsMedical records of 18 patients (18 eyes), who...

Long term complications of black diaphragm aniridia intraocular lens implant in traumatic aniridia

To analyze long-term complications of black diaphragm aniridia intraocular lens (IOL) implant in traumatic aniridia and to investigate the causes and precautionary measures. This is a retrospective consecutive case study. Five traumatic aniridia cases undertaken black diaphragm aniridia IOL implantation in Shandong Eye Institute and Hospital and developed severe complications during long-term follow-up were analyzed, including 4 males and 1 female, averaged 26.8 years old. The follow-up time varied from 42 months to 108 months. Two cases had implantation of a secondary black diaphragm IOL after pars plana vitrectomy. Two cases had implantation of a black diaphragm IOL together with cataract extraction. One case implanted a black diaphragm IOL only. All patients felt well within a short period after the surgery, symptoms of glare and photophobia were improved. A better visual acuity was obtained in a short-term period. However, severely secondary glaucoma and bullous keratopathy occurred in the long-term follow up. Visual acuity decreased to counting finger or hand motion. All cases received penetrating keratoplasty and IOL explantation. Black diaphragm aniridia intraocular lens implantation may induce severe long-term complications. The indications should be selected seriously and closely follow-up is important.

Three Cases of Corneal Tattooing for the Treatment of Traumatic Iris Defect

Purpose: To investigate the effects of corneal tattooing on patients with a traumatic iris defect. Case Summary: Corneal tattooing operation was performed on three patients (3 cases) with a traumatic iris defect. In case 1, the cornea was dyed with Davidson marking dyes (Bradley Products Inc., MN, US) and the amniotic membrane with the central incision was permanently transplanted. In case 2, both corneal dyeing and permanent amniotic membrane transplantation were performed on the area of partial iris loss. In case 3, corneal dyeing was performed after the intrastromal cornea was dissected. Corneal reepithelization was found in the first 2 cases 12 and 9 days after amniotic membrane transplantation, respectively. Three months after the transplantation, all three cases showed an improvement in best corrected visual acuity (BCVA), with an increase of one or more lines on the Snellen Chart. Simultaneously, preoperative monocular contrast and glare were also found to beimproved in all three cases. In both cases 1 and 2, 60% of the initially used dyes still remained in the cornea 6 months after the surgery, and in case 3, 90% of the initial dye remained. Except for the moderate astigmatism found earlier after the surgery in case 3, no serious complications developed. Conclusions: Corneal tattooing can improve the visual acuity and reduce glare in eyes with a traumatic iris defect and is cosmetically pleasing. Furthermore, corneal tattooing can be performed more easily and repeatedly than black diaphragm intraocular lens implantation.

Implantation of the Black Diaphragm Intraocular Lens in Congenital and Traumatic Aniridia

To evaluate the biometry accuracy, visual outcomes, and long-term changes in intraocular pressure after implantation of the black diaphragm intraocular (BDI) lens in cases of aniridia. Retrospective, interventional case series. Forty eyes of 35 patients with aniridia (15 eyes of congenital origin and 25 as a result of trauma). Patient demographics, clinical evolution, and treatment were analyzed for each case undergoing implantation with the Morcher 67F BDI lens (Morcher GmBH, Stuttgart, Germany). Biometry accuracy, visual outcome, and the development of glaucoma and other complications in these eyes over a mean of 3.5 years. Using the recommended A constant of 118.7, the mean biometry prediction error was -0.12+/-0.44 diopters (D), with a mean absolute error of 1.47+/-0.29 D, equivalent to 80% of target eyes being within 2 D of predicted refraction. The prevalence of glaucoma increased from 10 (25%) of 40 eyes before surgery, to 22 (55%) of 40 eyes at 1 year after surgery. The best-corrected visual acuity in logarithm of the minimum angle of resolution (logMAR) units improved significantly in the 25 eyes with traumatic aniridia, from 1.34+/-0.22 to 0.54+/-0.16 (20/400 to 20/70; P<0.001). In contrast, no significant improvement was seen in the 15 eyes with congenital aniridia, whose preoperative logMAR visual acuity of 1.17+/-0.14 improved to 1.01+/-0.21 (20/300 to 20/200; P = 0.20). Biometry is reasonably accurate when implanting the BDI lens for aniridia. Glaucoma is the main complication and occurred immediately after surgery, suggesting a possible direct mechanical effect of the large BDI lens. Significantly better visual outcomes were seen when using the 67F BDI lens for traumatic aniridia compared with congenital aniridia. Implantation of the BDI lens in congenital aniridia therefore should be approached with caution, because the recreation of an iris diaphragm does not confer the expected optical benefits in these eyes.

Black Diaphragm Intraocular Lens for Traumatic Aniridia: Long-term Follow-up

Purpose: This is a report on the long-term follow-up of patients who had received black diaphragm intraocular lens implantation after traumatic aniridia. Methods: This is a retrospective study on the long-term follow-up for more than 50 months of six patients who had received black diaphragm intraocular lens implantation after traumatic aniridia. Results: An improvement in visual acuity of more than two letters, according to the Snellan chart, occurred in three out of six eyes that were available for follow-up studies after an average period of 7 years and 8 months (50-115 months) after the operation, and no visual acuity decline groups were present. Early complications of black diaphragm intraocular lens implantation consisted of cystoid macular edema and transient intraocular pressure rise. The complications late occurred included bullous keratopathy in four eyes, glaucoma in three eyes, and exotropia in three eyes. We performed penetrating keratoplasty in two of the four eyes suffering from bullous keratopathy, and an Ahmed valve implantation in two of the three eyes suffering from glaucoma. There were signs of reduced visual acuity in four eyes due to complications of the surgery. Conclusions: The authors of this report recommend care in use of black diaphragm intraocular lens implantation, by studies done with an average follow-up period of 7 years and 8 months post operatively. Also reported were severe complications with this treatment such as bullous keratopathy and glaucoma.

Transscleral fixation of a black diaphragm intraocular lens in severely traumatized eyes requiring vitreoretinal surgery

The records of 4 eyes of 4 patients who had transscleral fixation of black diaphragm intraocular lenses (IOLs) after vitreoretinal surgery due to complications of severe perforating trauma were retrospectively reviewed. The transscleral fixation was performed 4 to 13 months after the vitreoretinal surgery. All patients reported a subjective decrease in glare and photophobia, with improved visual acuity in 2 eyes during a mean follow-up of 3 years. Cystoid macular edema was noted in 1 eye and transitory intraocular pressure elevation due to intraocular silicone oil in 1 eye. Severe perforating eye injury is frequently associated with extensive iris defects and lenticular and vitreoretinal complications. Although visual acuity may not be the primary concern in these eyes, favorable visual rehabilitation can be achieved following proper management of the retinal complications and transscleral fixation of black diaphragm IOLs to overcome glare and photophobia.

Black-diaphragm intraocular lens implantation in management of traumatic aniridia combined with aphakia

目的 探讨虹膜型人工晶状体对外伤性无虹膜无晶状体眼的治疗作用.方法观察31例(31眼)虹膜型人工晶状体植入术后的视力情况及并发症.结果术后患者视力有不同程度提高,畏光症状明显改善.结论虹膜型人工晶状体对治疗外伤性无虹膜无晶状体眼具有较好的临床价值。

Implantation of Iris Devices in Congenital and Traumatic Aniridias: Surgery Solutions and Complications

Purpose To show surgical solutions in patients with traumatic and congenital aniridia, to evaluate the clinical improvement of these patients when iris prosthesis are implanted, and to examine safety and complications of these implants in a long-term follow-up. Methods Eight patients were included in this retrospective noncomparative case series. Nine eyes had an artificial iris implantation for traumatic or congenital aniridia. Three eyes received a black diaphragm intraocular lens (IOL) in capsular bag after phacoemulsification. An aniridia prosthesis, sulcus sutured, in front of a previous IOL was implanted in two eyes. A black diaphragm IOL, sulcus sutured, in two eyes; two iris diaphragm rings, in front of the previous IOL, in one eye; and a sector iris prosthesis in front of an IOL in the last eye were implanted. Mean follow-up was 22.5 months (range 16 to 44 months). Results All patients had improved visual acuity (VA) and visual comfort after surgery. The glare disability was subjectively better in all cases. Two patients developed new ocular hypertension after surgery; one of them was controlled by medical treatment and the other needed cyclodiode. Two of the patients with glaucoma preoperatively also needed cyclodiode procedure and one of them an Ahmed valve. Conclusions Several kinds of artificial iris implants are available. In all our patients with aniridia, iris artificial prostheses improved VA and diminished visual discomfort. Glaucoma is the most important complication after artificial iris implant. It is possible to implant the iris prosthesis in the capsular bag, but this requires a large capsulorrhexis and presents a surgical challenge.

Black diaphragm aniridia intraocular lens for aniridia and albinism

Our aim was to assess the safety and efficacy of primary and secondary implantation of a black diaphragm aniridia intraocular lens (IOL) in patients that lacked a complete iris diaphragm. This was a retrospective non-comparative study of six eyes in five patients with iris defects. The causes of such defects included congenital aniridia, traumatic aniridia, and oculocutaneous albinism. Three eyes underwent primary implantations of a black diaphragm IOL, and three eyes were given secondary implantations. The visual acuity, subjective severity of glare, postoperative anatomical outcome and any intraoperative or postoperative complications were reviewed. The mean follow-up period was 20.6 months (range 3-29 months). All patients showed stable or improvement in best-corrected visual acuity postoperatively. Glare and photophobia had improved subjectively in all patients after implantation of the black diaphragm IOL. Intraoperative complication included one case of hyphaema and iris damage during insertion of the IOL. Postoperative complications included intraocular inflammation with choroidal detachment, secondary glaucoma, and persistent epithelial defect after surgery. None of the patients developed decentration of IOL after surgery. The black diaphragm aniridia IOL is useful in the management of the condition in patients with iris deficiency including oculocutaneous albinism. Intraoperative and postoperative complications are not uncommon, and patients should be monitored carefully in the perioperative period.