Prosthetic iris implantation for congenital, traumatic, or functional irisdeficiencies

Purpose: To determine the efficacy and safety of surgical implantation of p rosthetic iris devices in patients with anatomic or functional iris deficie ncies. Setting. Cincinnati Eye Institute, Cincinnati, Ohio, USA. Methods: Twenty-five patients were enrolled in an interventional prospectiv e noncomparative case series. Twenty-eight eyes had prosthetic iris diaphra gm implantation for traumatic iris defects, congenital aniridia or iris col oboma, herpetic iris atrophy, surgical ids loss, or ocular albinism. Prosth etic iris implantation was performed with phacoemulsification and intraocul ar lens (IOL) implantation in 20 eyes, secondary IOL implantation in 6 eyes , and IOL exchange in 1 eye. A single pseudophakic eye with disabling glare secondary to traumatic aniridia had secondary prosthetic iris implantation alone. The surgical ease of insertion, intraoperative and postoperative co mplications, postoperative anatomic results, visual acuity, and subjective glare reduction were evaluated. Results: Patients were followed postoperatively for a mean of 10.2 months ( range 1.4 to 25.7 months). All eyes achieved the desired anatomic result. V isual acuity was improved in 22 of 28 eyes (79%), unchanged in 5 eyes, and worsened by a single line in 1 eye. Patients were surveyed postoperatively to determine the change in glare disability. The severity of glare disabili ty was subjectively improved in 23 of 24 patients (96%) who responded to th e survey. Intraoperative complications included 3 fractured implants as wel l as an incomplete or torn capsulorhexis in 3 eyes. Postoperative complicat ions included transient hypotony in 2 eyes, mild persistent inflammation in 1 eye, and macular edema followed by a retinal detachment in 1 eye with re cent severe trauma. Conclusions. Implantation of prosthetic iris devices improved postoperative outcomes by reducing glare disability and, in selected cases, by correctin g aphakia. Although operating on traumatized, congenitally aniridic, or uve itic eyes presents special challenges, implantation of prosthetic iris devi ces appears to be a safe and effective method for reducing the ubiquitous g lare in patients with iris deficiency. (C) 2001 ASCRS and ESCRS.