Functional outcomes after combined iris and intraocular lens implantation in various iris and lens defects
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RESEARCH ARTICLE
Open Access
Functional outcomes after combined iris and intraocular lens implantation in various iris and lens defects Christian S. Mayer1,2, Andrea M. Hoffmann2, Phillipp Prahs3, Lukas Reznicek2 and Ramin Khoramnia1*
Abstract Background: To assess the functional outcomes after combined iris and intraocular lens (IOL) repair in aniridia patients. Methods: 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. Results: Blunt trauma (37 eyes) and penetrating injuries (16 eyes) were observed more frequently than congenital aniridia (1 eye), iatrogenic causes (1 eye), aniridic state after severe iritis (2 eyes) or iris tumor (2 eyes). Monocular CDVA improved significantly (p < 0.0001) from median 0.7 logMAR (0.0–1.98) to 0.3 logMAR (− 0.08–2.0). Median pupillary area could significantly (p < 0.0001) be reduced by 79.3% from 51.27 mm2 (17.91 to 98.23) to 8.81 mm2 (4.16 to 8.84). Median ECD decreased from 2646.0 mm2 to 2497.5 mm2 (p = 0.007). Contrast and glare sensitivity improved significantly (p = 0.008) in photopic light conditions from 0.9 (0.0–1.95) to 1.35 (0.0–1.8). Patients reported to be highly satisfied with the functional improvement. Conclusion: The flexible ArtificialIris seems to be a safe and effective iris prosthesis in combination with an IOL having functionally and cosmetically exceptional reconstruction options. Keywords: Aniridia, Pupillary reconstruction, Ocular trauma, Eye injury, IOL
Background 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
* Correspondence: [email protected] 1 Department of Ophthalmology, University Hospital Heidelberg, University of Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany Full list of author information is available at the end of the article
the unaesthetic appearance of their eyes, particularly in case of substantial iris loss. The management of congenital aniridia can be very challenging because of the complexity of the disease and the association with severe ocular comorbidities [1]. More often, iris abnormalities result from traumatic injury, e.g. blunt trauma or penetrating eye injuries. Posttraumatic eyes may also present morphological and functional alterations due to ocular injuries, for example corneal damage and lens lesion [2]. In respect of the high rate of secondary impairme
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