Custom Iris Prosthesis for Subtotal Traumatic Aniridia From Combat Ocular Trauma.

Traumatic aniridia from combat ocular trauma can cause visual disability. A 41-year-old male Army Veteran was referred for evaluation of light sensitivity and glare secondary to subtotal traumatic aniridia of his left eye from an improvised explosive device blast. A custom-made artificial iris prosthesis was implanted in the ciliary sulcus and secured using Gore-Tex sutures. After surgery, the patient reported improvement of his light sensitivity and quality of life. The custom iris prosthesis is a surgical option for visual disability resulting from traumatic aniridia from combat ocular trauma.

Postoperative results after iris reconstruction with an Artificialiris® implant with consideration of the cause of the iris defects.

PURPOSE: To test the hypothesis that severely damaged eyes are more likely to experience postoperative complications after an ArtificialIris® (AI) implantation than other iris defects. METHODS: Patients after iris reconstruction with an AI were included in this consecutive case series of the Department of Ophthalmology, University of Mainz, Germany. Best-corrected visual acuity (BCVA), objective refraction (KR 8900 Topcon, Tokyo, Japan) and Scheimpflug imaging of the anterior segment with Pentacam® (Oculus, Wetzlar, Germany)and postoperative complications were evaluated. RESULTS: Thirty-two eyes of 32 patients after AI implantation were included, separated in partial or total aniridia in a closed globe (group 1, n = 16) and after perforating globe injury (group 2, n = 16). Two or more previous surgeries in the corresponding eye were found in two patients (12.5%) in group 1 and eleven patients (69%) in group 2 (p = 0.001). The time span between initial trauma or iris defect and AI implantation was not significantly related to the occurrence and severity of postoperative complications (p = 0.89). Postoperative complications were classified into mild and severe and showed no differences between group 1 and group 2 (mild: 1 vs. 0; p = 0.52; severe: 5 vs. 6 p = 0.8). CONCLUSION: AI implantation is a treatment option for various iris defects. An individual, case-based decision should be made with strict indication also considering other possible methods for pupil reconstruction. The postoperative outcome is not affected by the time point of AI implantation. So, an implantation is already possible as early as six weeks after the previous trauma.

Artificial iris: state of the art.

Surgical correction of traumatic aniridia aims to improve the quality of vision, compartmentalize the anterior and posterior chamber, and re-establish a satisfying cosmetic appearance. Various types of prosthetic iris devices (PIDs) are available, which differ in technical difficulty of implant and design: artificial iris (AI)-intraocular lens prosthesis, endocapsular capsular tension ring-based PID, and customized AI. The choice depends on the preexisting clinical condition after severe ocular trauma and on patient functional and cosmetic expectations. This systematic review of the literature compared anatomical and functional outcomes of various types of PIDs. Of 185 articles found in the literature, 70 fulfilled the eligibility criteria. 5 subgroups of PIDs were Ophtec, artificial iris from Ophtec BV, Morcher GmbH, HumanOptics AG, and other prosthesis. Both glare and aesthetic outcome improved postoperatively; in comparison with other PIDs, intraocular pressure rise was higher in the Morcher group (40%), whereas prosthesis dislocation was higher in the Ophtec group (39%).

Isolated traumatic aniridia with full and partial iris expulsion in pseudophakic eyes.

BACKGROUND: Total aniridia after ocular trauma without disruption of the intraocular lens (IOL) has been reported in patients with a history of small-incisional cataract surgery. We report one case each of total and partial aniridia after accidental falls experienced by two elderly Japanese women. CASE PRESENTATIONS: Case 1. A 76-year-old woman with a history of small-incisional cataract surgery more than 10 years previously fell onto concrete and had a contusion that affected the left side of her face. At the initial visit, the best-corrected visual acuity (BCVA) was hand motions and the intraocular pressure (IOP) was 38 mmHg in her left eye (OS). A blood clot was present in the well-formed anterior chamber and expulsed iris tissue was seen beneath the conjunctiva. Exploratory surgery showed no scleral laceration other than the previous sclerocorneal tunnel. After hyphema removal, total aniridia and an intact in-the-bag fixed IOL were seen. By 4 months, the BCVA was 1.2 and the IOP was 13 mmHg OS. CASE 2: An 88-year-old woman with a history of small-incisional cataract surgery more than 10 years previously had a fall that resulted in right-sided zygomatic and maxillary bone fractures. The BCVA was light perception and the IOP was 29 mmHg in her right eye (OD). Exploratory surgery showed no scleral laceration and the previous sclerocorneal tunnel was found; iris strand prolapsing from the sclerocorneal tunnel was seen. After hyphema removal, partial iris loss and an intact lens position were seen. By 1 week postoperatively, the BCVA was 0.05 OD and the IOP was 12 mmHg OD. CONCLUSIONS: It has been postulated that previously created small-incision tunnels can function as release valves during blunt trauma by preventing further global rupture and limiting IOL prolapse or retinal injury. Our cases suggested this can happen even long periods after cataract surgery. The case with partial aniridia demonstrated the process of the expulsive aniridia, and its findings do not contradict the postulated mechanisms.

Iridodialysis repair - A simplified approach.

BACKGROUND: Iris root is the thinnest and weakest portion of the iris stroma. It can detach easily due to blunt trauma or accidental engagement of the iris during intraocular surgery resulting in glare, photophobia and monocular diplopia. Multiple techniques described for iridodialysis repair such as hang back technique, stroke and dock technique and sewing machine technique are technically challenging. PURPOSE: To describe an simplified approach of iridodialysis repair using 9-0 prolene suture. SYNOPSIS: We demonstrate the technique of iridodialysis repair using animation for better understanding. Scleral flap is made adjacent to the iridodialysis area and a paracentesis is made oppsite to the iridodialysis. One arm of the double armed straight needle with 9-0 prolene suture is passed through the paracentesis into the iris root and docked in the 26G needle which is passed underneath the scleral flap 1.5mm posterior to the limbus. Then the needle is pulled out underneath the scleral flap and the manoeuvre is repeated for the second arm as well. The sutures are secured with 5-6 knots under the scleral flap. Intra-operative surgical videos of two patients with traumatic cataract and iridodialysis following blunt trauma are shown. After stabilizing the detached iris using iris hooks, phacoemlsification is done with implantation of foldable acrylic IOL, followed by iridodialysis repair as described above. Both the patients were relieved of their pre-operative symtoms and had good visual recovery. HIGHLIGHTS: We describe a simplified approach of iridodialysis repair that can significantly reduce the patient's troublesome symptoms such as glare and monocular double vision. ONLINE VIDEO LINK: https://youtu.be/-axYnSfWSb0.

Quiste de iris. A propósito de un caso / Iris cysts. About a case

Introducción: Los quistes de iris son lesiones benignas encapsuladas de contenido líquido que se pueden localizar en el epitelio pigmentario del iris o en su estroma, se clasifican de acuerdo con su etiología en primarios cuando no tienen una causa conocida y secundarios cuando se forman como consecuencia de traumatismos, fármacos, tumores malignos, uveítis, parásitos o trastornos sistémicos.Los síntomas incluyen obstrucción del eje visual, visión borrosa e incluso descompensación corneal, el diagnóstico se realiza mediante la observación directa a través de la lámpara de hendidura y con estudios de imagen como la ultrasonografía, una vez establecido el diagnóstico su tratamiento sigue siendo controversial e incluyen iridectomía, drenaje del conteni-do quístico, uso de láser argón y YAG láser.Presentación del caso: Paciente femenina de 28 años con antecedente de traumatismo ocular derecho, posteriormente presenta lesión quística en iris, valorada mediante biomicroscopía y estudios de imagen (ultrabiomicroscopía), confirmando el diagnóstico de quiste de iris, para lo cual se realiza drenaje quirúrgico con evolución favorable. Conclusión: Los quistes de iris son lesiones poco frecuentes que podrían comprometer el campo visual dependiendo de su localización y tamaño por lo que el drenaje quirúrgico del contenido quístico iridiano es una opción terapéutica eficaz.

Introduction: Iris cysts are benign encapsulated lesions of liquid content that can be located in the pigment epithelium of the iris or in its stroma, they are classified according to their etio-logy as primary when they do not have a known cause and secondary when they form as a consequence from trauma, drugs, malignant tumors, uveitis, parasites or systemic disorders.Symptoms include visual axis obstruction, blurred vision and even corneal decompensation. The diagnosis is made by direct observation through the slit lamp and with imaging studies such as ultrasonography. Once the diagnosis is established, its treatment remains contro-versial and include iridectomy, drainage of cystic contents, use of argon laser and YAG laser.Case presentation: A 28-year-old female patient with a history of right ocular trauma, subse-quently presenting a cystic lesion in the iris, assessed by biomicroscopy and imaging studies (ultrabiomicroscopy) confirming the diagnosis of iris cyst, for which surgical drainage was performed with a favorable evolution.Conclusion: Iris cysts are rare lesions that could compromise the visual field depending on their location and size, which is why surgical drainage of the iris cyst content is an effective therapeutic option.

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

PURPOSE: 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. METHODS: 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 ± 36.2 months (range: 126-247 months). 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. RESULTS: 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. CONCLUSION: 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.

Cystoid macular edema secondary to intraocular lens sub-luxation and iris perforation by iol haptic / Edema macular cistóide secundário a subluxação de lente intraocular e perfuração da íris por haptico da lente

Abstract We present a case of 50-years-old, man with vision loss, dysmorphopsia and micropsy in the right eye with for 6 months. Ocular history included uncomplicated cataract surgery 10 years before. Best corrected visual acuity was 20/100 in the right eye and 20/20 in the left eye. Anterior segment OD demonstrated intra-ocular lens (IOL) haptic in the anterior chamber with iris perforation. Fundus examination revealed cystoid macular edema in right eye. Surgical approach with reposition of the IOL and triamcinolone acetonide intravitreal injection were performed with visual and tomographical improvement.

Resumo Apresentamos o caso de um homem de 50 anos, com queixa de perda de visão, dismorfopsia e micropsia em olho direito (OD) há 6 meses. A história ocular incluiu cirurgia de catarata sem complicações 10 anos antes. A melhor acuidade visual corrigida foi 20/100 em OD e 20/20 em olho esquerdo. O segment anterior do OD demonstrou háptica da lente intraocular (LIO) na câmara anterior com perfuração da íris. A fundoscopia revelou edema macular cistoide em OD. A abordagem cirúrgica com reposição da LIO e injeção intravítrea de triancinolona acetonida foi realizada com melhora visual e tomográfica.

Pupil cerclage technique for treatment of traumatic mydriasis.

AIM: The aim of this study is to evaluate the efficacy of pupil cerclage and a new variant of sliding knot technique for repairing traumatic mydriasis. DESIGN: This is a observational case series study. SETTING/METHODS: A series of consecutive patients affected by traumatic permanent mydriasis who underwent pupil cerclage were recruited at the Department of Ophthalmology of the University of Padova, Italy. Best-corrected visual acuity, measured in logarithm of minimum angle of resolution (logMAR), and intraocular pressure at 1, 3, 6, and 12 months were monitored. Postoperative pupil size and anterior chamber angle were measured. Postoperative cystoid macular edema (CME) and glaucoma were evaluated. RESULTS: Twelve patients were recruited. Phakic patients (7) underwent cataract surgery combined with pupil cerclage. Vitrectomy was performed in nine patients. Best-corrected visual acuity improved from 2.9 ± 1.1 logMAR at baseline to 0.3 ± 0.8 logMAR at 12th month. No significant difference between the preoperative and postoperative intraocular pressure was demonstrated. Mean pupil size at 12th month was 2.82 ± 0.5 mm with round shape. Anterior chamber angle mean was 47° ± 4.5°. Six patients developed a CME, and two patients a glaucoma. CONCLUSION: Pupil cerclage technique reestablishes the pupil with a precise regulation of the pupil size without distortion of its natural round shape. New sliding knot allows surgeon to reduce the risk of iatrogenic iris damage and to make a security permanent knot.

Risk Factors for Cystoid Macular Edema After Descemet Membrane Endothelial Keratoplasty.

PURPOSE: To investigate factors associated with cystoid macular edema (CME) after Descemet membrane endothelial keratoplasty (DMEK) in Asian eyes. METHODS: In this retrospective, interventional, consecutive case series, 77 eyes of 65 patients who underwent DMEK were evaluated; in 53 eyes, cataract surgery was performed 1 month before DMEK (staged DMEK), and 24 eyes underwent DMEK alone (simple DMEK). Central retinal thickness, incidence of CME, postoperative best-corrected visual acuity, central corneal thickness, and corneal endothelial cell density were assessed at 1, 3, and 6 months after surgery. Multiple regression analysis and stepwise variable selection were performed for parameters such as type of surgery, iris damage scores, age, sex, axial length, preoperative visual acuity, rebubbling, air volume in the anterior chamber on postoperative day 1, history of diabetes, and endothelial cell density loss rates at 6 months after surgery. RESULTS: CME occurred in 12 (15.6%) of 77 eyes. There was no significant difference in best-corrected visual acuity between eyes with and without CME (P = 0.27). Multivariable analysis revealed that the difference in iris damage scores between before and after DMEK (P < 0.001), air volume in the anterior chamber (P = 0.012), simple DMEK (P = 0.020), and rebubbling (P = 0.036) were significantly associated with CME. Stepwise variable selection indicated that iris damage (P < 0.001) was the most important risk factor for CME. CONCLUSIONS: Iris damage due to DMEK might be a possible risk and aggravating factor for the development of CME after DMEK. Surgeons should attempt to minimize damage to the iris.

Xtra focus pinhole IOL (Morchers GMBH) a novel approach to tackle irregular astigmatism and large pupillary defects with a single step surgery.

A 69-year-old patient presented to us with traumatic mydriasis with irregular pupil measuring 7 mm, with superior loss of iris tissue and large inferior peripheral iridotomy and pseudophakia. The patient had history of blunt trauma 3 years ago in a fire cracker injury. He was operated elsewhere primarily after the trauma for cataract surgery with intraocular lens implantation and had suboptimal visual outcome with glare and photophobia. He presented to us with irregular pupil and inferior iridectomy with pseudophakia. The uncorrected visual acuity was 20/150 improving to 20/50 with glasses. He had a history of cataract surgery with intraocular lens (IOL) implantation done elsewhere several years back. The patient was not a diabetic or hypertensive. There was a para central corneal scar causing irregular corneal astigmatism. Extra focus pinhole IOL was implanted in sulcus having a pinhole aperture 1.36 mm. Preoperative total corneal higher-order aberrations were 3.3 µ and total corneal coma was 0.97 µ. Postoperatively uncorrected distance visual acuity improved to 20/40 intermediate uncorrected visual acuity improved to 20/30 and uncorrected near visual acuity was J3.