Iris reconstruction: A perspective on the modern surgical armamentarium

Abstract

The surgical reconstruction of eyes with iris defects is almost invariably complex and challenging. A number of prosthetic iris devices are available including large-incision, rigid diaphragm, aniridic intraocular lens style devices, small-incision devices incorporating a capsular ring, and flexible, customized, small-incision iris prostheses. The surgical techniques for rehabilitation are dictated by the configuration of the iris defect, the presence of concurrent ocular pathology, and the functional complaint of the patient. Successful rehabilitation requires careful surgical planning and appropriate patient selection. Nonetheless, endowed with the modern surgical armamentarium, the reconstructive surgeon may achieve significant functional and cosmetic improvement.

Keywords: Artificial iris; iris reconstruction; pupilloplasty.

Figure 1

(a) a case of severe traumatic mydriasis in floppy iris syndrome treated by five prolene sutures using a McCannell type approach to reduce pupil size from 8 mm to around 4 mm. (b) Single suture inferior pupilloplasty combined with a black capsular tension ring iris segment (with overlying capsular fibrosis) in an eye with an iris defect following excision of an iris tumour

Figure 2

A scleral sutured Type 67G Morcher aniridia implant with intraocular lens in an eye that was rendered aniridic and aphakic following globe rupture in a road traffic accident. The rigid intraocular lens and iris prosthesis requires a large limbal incision

Figure 3

(a) Intraoperative image showing one Type 50.F Morcher capsular tension ring within the capsular bag in front of the intraocular lens and the second device immediately before insertion in a case of longstanding, severe traumatic mydriasis. (b) The second identical endocapsular ring is dialed in front of the first ring within the capsular bag. The fins of the two devices overlap creating a completely opaque peripheral zone and a small artificial pupil at the end of the procedure (note minimal contraction of the natural pupil despite intracameral acetylcholine). (c) Image showing (in a pharmacologically dilated pupil) two overlapping, temporal sited, Type 96F Morcher segments plus an intraocular lens in the capsular bag, in an eye with an area of asymmetric traumatic mydriasis following previous trauma. (d) Image of the same eye demonstrating functional pupillary aperture in the resting ambient state of iris constriction

Figure 4

Intraoperative video image of insertion and unfurling of a HumanOptics CustomFlex® artificial iris (10 mm diameter) through a temporal corneal incision into the capsular bag in front of the intraocular lens, in a case with almost six clock hours of iris deficit (from approximately 1–7 clock hours) following wide-iridectomy treatment of a pigmented iris lesion

Figure 5

This is the same case as Figure 4, 1 day postoperatively, showing repair of a large iris defect in the right eye following lens extraction and insertion of an intraocular lens and a HumanOptics® artificial iris into the capsular bag. Visual acuity was 6/9 unaided and patient was pleased with cosmesis