Functional outcomes after combined iris and intraocular lens
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Iris defects either from congenital, traumatic or other causes come in various dimensions and may lead to considerable visual impairment. Photophobia, increased glare from bright light, decreased visual acuity and contrast sensitivity are the most common symptoms in aniridic patients. These patients may also suffer extensively from the unaesthetic appearance of their eyes, particularly in case of substantial iris loss. A study was done to assess the functional outcomes after combined iris and intraocular lens (IOL) repair in aniridia patients.

Retrospective observational study in 59 aniridic and aphakic eyes for ArtificialIris (AI) and IOL reconstruction. The iris prostheses were placed together with the IOL in the capsular bag using an injection system or were fixed by transscleral suturing of the IOL and AI. The primary outcomes measured were visual acuity, contrast and glare sensitivity (Pelli-Robson chart for photopic and dark adaptometer for mesopic conditions), intraocular pressure, endothelial cell density (ECD) and patient impairment.

Blunt trauma (37 eyes) and penetrating injuries (16 eyes) were observed more frequently than congenital aniridia (1 eye), iatrogenic causes (1 eye), an aniridic state after severe iritis (2 eyes), or iris tumor (2 eyes). Monocular CDVA improved significantly from a median of 0.7 logMAR to 0.3 logMAR. The median pupillary area could significantly be reduced by 79.3% from 51.27 mm2 to 8.81 mm2. Median ECD decreased from 2646.0 mm2 to 2497.5 mm2. Contrast and glare sensitivity improved significantly in photopic light conditions from 0.9 to 1.35. Patients reported being highly satisfied with the functional improvement.

To sum up, the implantation of an ArtificialIris in combination with an individual IOL can be a life-enhancing procedure. Glare disability is significantly decreased, severe photophobia is eliminated and refractive disorders are corrected. The described approach offers an additional option to surgeons to treat partial or total aniridia as well as aphakia in one single surgery. Finally, our observational case series confirmed the findings of previous reports showing very few severe adverse events regarding ArtificialIris implantation, if cautious handling and application is warranted.