Artificial Iris Implantation In A Case Of Iatrogenic Iris Coloboma

To present a challenging and unusual case in which a large iris defect caused iatrogenically during a complicated cataract surgery was corrected using a foldable iris prosthesis (CUSTOMFLEX® ARTIFICIALIRIS Fiber Free).

Ophthalmology Department of Hospital Professor Doutor Fernando da Fonseca, Lisbon, Portugal.

A 92-year-old male patient was submitted to phacoemulsification surgery with monobloc intraocular lens (IOL) implantation complicated with iris prolapse through the main incision at the end of the surgery. As a result, a 3-hour temporal iatrogenic iridectomy was performed. In the postoperative period the patient complained of photophobia and diplopia. Due to the size of the defect and the atrophy of the iris borders, the choice was made to perform an anterior segment reconstruction with a foldable iris prosthesis, after clinical stability was achieved. The anterior chamber was filled with an ophthalmic viscosurgical device (OVD) and the artificial iris was injected using a Monarch II injector. It was then placed in the ciliary sulcus without suture fixation. Atrophic segments of the original iris were cut and removed through the incision sites. After the procedure the patient reported an absence of photophobia and diplopia and a very satisfactory visual and aesthetic outcome, with a 2-month follow-up period.

Some iris colobomas reduce optical quality causing photophobia, glare and aberration errors that may significantly influence the patient’s day-to-day activities and life quality. Not only visual function but aesthetics is also a concern in patients with iris defects. The use of a customized foldable iris prosthesis with impressively realistic results is a good option in these situations as it allows for very satisfactory visual and aesthetic results.