Artificial Iris Implantation, Various Surgical Techniques, Long Term Safety And Clinical Outcomes

To analyze the clinical outcomes of patients undergoing reconstructive iris surgery with the artificial iris (AI) implantation using various surgical techniques.

Eye Hospital, University Medical Center Ljubljana, Ljubljana, Slovenia

We conducted a retrospective study evaluating clinical outcomes of 18 consecutive patients (13 male and 5 female) undergoing reconstructive iris surgery with the implantation of an AI (HumanOptics) in aphakic or pseudophakic eyes, either with or without capsular support due to partial or total aniridia. All patients were operated by a single surgeon using four different techniques: a) implantation into capsular bag, b) four floating suture technique, c) modified Canabrava and d) dual needle intrascleral fixation technique. BCVA, IOP, AI centration, aesthetic results, absence of inflammation and macular pathology using OCT were evaluated.  Follow up is at least one year and up to 8 years postoperatively (median 5,5 years).

The most common indications for AI implantation were iris defects due to trauma (n=16) and congenital aniridia (n=2). Mean BCVA pre-op was 0.2 (logMAR 0.7), with an IOP of 18 mmHg. Mean postoperative BCVA was 0.5 (logMAR 0.3) with an IOP of 16 mmHg. Postoperative UBM showed appropriate AI position with a good cosmetic outcome in most cases. No macular pathology was detected using OCT. The most common postoperative complications were temporary elevated intraocular pressure 5/18 (28%), corneal decompensation 2/18 (11%), AI decentration in 1/18 (6%), which was successfully repositioned by adjusting 9.0 polypropylene sutures.

The AI implantation is a safe procedure with good functional and aesthetic outcomes. Proper implantation of AI alone or in combination with IOL is essential. There should be no contact between AI and intraocular structures. Long-term monitoring and timely interventions, if indicated, are important.