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Video Report

Iris Reconstruction with Multipiece Endocapsular Prosthesis

Magill Research Center for Vision Correction, Storm Eye Institute, Medical University of South Carolina, Charleston, SC, USA

Correspondence: Dr Luis E. Fernández de Castro
Email: decastro{at}musc.edu Magill Research Center for Vision Correction, Storm Eye Institute - MUSC, 167 Ashley Avenue, Charleston, SC 29425, USA ;Tel: + 001 (843) 792-2305; Fax: + 001 (843) 792-6347

Date of acceptance: 17th August 2006

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Introduction

Penetrating ocular trauma and other conditions such as aniridia, anterior segment dysgenesis, or coloboma result in iris absence or deficiency. The lack of a complete iris diaphragm can be a disabling condition that causes glare, photophobia, and decreased visual acuity.[1]

There are different ways to create an artificial diaphragm of the eye such as contact lenses, corneal tattooing, primary iris repair, and prosthetic iris implants. Multiple surgical techniques and prosthetic iris implants for the restoring the diaphragmatic function of the iris have been described.[1-5] The ultimate goal is restore the eye to a more natural and functional anatomic state. We illustrate a technique for iris reconstruction using the multipiece Iris Prosthetic System (IPS) from Ophtec (Ophtec USA, Inc., Boca Raton, FL).

Technique Section

A patient had a history of surgical iris loss from a partial irido-goniocyclectomy treatment for benign tumor of the iris. Phacoemulsification through a temporal corneal approach proceeded uneventfully. Following cortical cleanup and posterior capsule polishing, a capsular tension ring (CTR) was placed achieving adequate bag stabilization and recentration. A single-piece hydrophobic acrylic intraocular lens (IOL) SN60AT (Acrysof Natural, Alcon Laboratories, Ft. Worth, TX, USA) was then implanted in the capsular bag. The wound was enlarged to approximately 4.0 mm. Two green Ophtec type DE1 double-element iris prosthesis devices were serially implanted in the capsular bag in front of the IOL, and the elements were then dialed orthogonally, establishing a complete iris diaphragm. A green Ophtec fixation component was then placed to lock the DE1 pieces together. Through the paracentesis openings the viscoelastic material was aspirated with an irrigation/aspiration unit, the wound was sutured, and stromal hydration was used to seal any leaking paracentesis openings.

Comment

The IPS from Ophtec is a modular system planned for capsular bag placement for iris reconstruction and includes single-element and dual-element iris pieces, a capsular tension ring, and a locking device to hold the pieces in place. This multipiece device, available in colored polymethyl-methacrylate (PMMA) material, has been available in Europe for several years but is not approved by the Food and Drug Administration in the United States. The available colors are blue, green, brown, and black providing satisfactory cosmesis.

Damaged iris tissue often can be retrieved and sutured with excellent results. However, not all cases are amenable to such treatment. As in our case, the patient was referred for cataract extraction evaluation and iris reconstruction for disabling glare and gradual deterioration of visual acuity in the right eye. The patient had a history of surgical iris loss from a partial irido-goniocyclectomy treatment for benign tumor of the iris. At the initial evaluation, we felt there was not sufficient iris tissue to permit a good result from suture repair and it was confirmed at the time of surgery. The artificial iris device was used since iris repair was not a suitable option. Postoperatively, the visual acuity and glare improved considerably, and the patient was satisfied with both the functional and the cosmetic results. Additionally, in cases were the defect is extensive or if the iris defect is associated with progressive comorbid conditions that likely will continue to worsen the iris defect such as iridocorneal endothelial (ICE) syndrome a prosthetic iris could be considered.[4]

There is no single treatment that is best in all situations, and we have found that in cases of insufficient quality or quantity of iris stroma for suture repair the implantation of an artificial iris device appears to be a safe and effective method to rehabilitate the eye, reducing the subjective perception of glare resulting from iris diaphragm deficiency. Advancement of prosthetic iris implants in association with increasing experience using these devices result in overall improvement of the surgical outcomes.

Acknowedgement

The authors thank James P. Byrnes, Storm Eye Institute, MUSC, for his expert contribution in the video editing of this case.

Conflict of Interest Statement

Supported in part by NIH/NEI EY-014793 and an unrestricted grant to MUSC-SEI from Research to Prevent Blindness, New York, NY, USA.
None of the authors have a proprietary interest in any product mentioned.

References

• Burk SE, Da Mata AP, Snyder ME, et al. Prosthetic iris implantation for congenital, traumatic, or functional iris deficiencies. J Cataract Refract Surg 2001;27:1732-1740.
• Mavrikakis J, Mavrikakis E, Syam PP, et al. Surgical management of iris defects with prosthetic iris devices. Eye 2005;19:205-209.
• Rosenthal KJ, Sutureless phacotrabeculectomy and insertion of an iris diaphragm ring in a patient with the Axendeld-Reiger syndrome: first reported case. Video Cataract Refract Surg 1997;13(2)
• Khng C, Snyder ME. Iris reconstruction with a multipiece endocapsular prosthesis in iridocorneal endothelial syndrome. J Cataract Refract Surg 2005;31:2051-2054.
• Hermeking H. Iris prosthetic system. Video Cataract Refract Surg 1999;15(4).