A novel technique for sutureless fixation of an iris prosthesis

Session Details

Session Title: Cataract Surgery Equipment/Instrumentation/Surgical Devices

Session Date/Time: Monday 09/10/2017 | 16:30-18:00

Paper Time: 17:21

Venue: Room 4.4

First Author: : U.Vossmerbaeumer GERMANY

Co Author(s): :                        

Abstract Details

Purpose:

Reconstructive surgery of the anterior segment may encompass secondary implantation of an intraocular lens and of a diaphragm replacing the iris. Silicone iris prosthesis with customized hues (Artificial Iris®, Human Optics, GER) may be used to substitute total or partial loss of iris tissue. Minimizing the surgical trauma while assuring optimal visual rehabilitation is the challenge of such procedures. We developed a novel sutureless method of combined iris fixation of an intraocular lens and an iris prosthesis.

Setting:

case series, academic hospital setting University of Mainz, Germany, Department of Ophthalmology, Division of Cataract and Refractive Surgery

Methods:

Five patients with partial aniridia due to penetrating globe injury or with wide posttraumatic mydriasis and aphakia without capsular structures presented for reconstruction surgery. Following 25g pars plana vitrectomy, iris-fixated iris-claw IOL (Artisan®, Ophtec, NL) were implanted through a 5.5 mm clear cornea tunnel incision. Fiber-free Artificial Iris® (AI, Human Optics, Erlangen, GER) was tailored to clasp around the enclavation sites of the IOL and to shield only the area of the iris defect. Surgical efficiency, postoperative stability and centration of the implants and impact on visual perception of the patients were assessed.

Results:

Two 3x1 mm openings were trephined symmetrically into the AI, opposite each other on both sides of the artificial pupil to form receptacles around the enclavation sites of the IOL in the iris. Channels were cut from these openings to the outer rim of the implant. The implant was positioned to embrace the enclavation sites of the IOL. All implants remained stable and without decentration. Patients experienced a significant gain in visual quality. No pupillary block was observed. Surgical time was reduced by 50% percent compared to conventional combined surgery.

Conclusions:

Artificial Iris® is approved for various ways of intraocular positioning including suture fixation at residual iris tissue. We report a new technique for sutureless iris fixation in connection with an iris-fixated IOL. It is a novel concept to anchor two implants riding piggyback simultaneously in the iris. If sufficient iris tissue is present at 180° opposing sites of the circumference to safely anchor the IOL, this method may offer a less traumatic approach than four-point scleral fixation. Especially in severely traumatized eyes, this approach may be beneficial for rehabilitation.

Financial Disclosure:

NONE