Novel Sutureless Combined Artificial Iris Intraocular Lens Implantation Technique

A novel sutureless single step technique for implantation of combined intraocular lens and artificial iris ( Humanoptics AG) is described.  The technique was performed in a series of 4 patients , and evaluated for  ease of surgical technique, visual and refractive outcomes, stability of IOL / artificial iris complex. Advantages of the technique compared to current surgical management strategies for combined aphakia / aniridia are discussed. 

State Funded University hospital tertiary anterior segment reconstructive service in the United Kingdom 

Patients with aphakia and partial or complete aniridia were identified and routinely offered surgical correction of the defect for visual rehabilitation.  The artificial iris was attached to a 3 piece intraocular lens using a tunnel technique whereby the iris was cannulated with a needle and the haptic passed through the iris prosthesis . Once the Iris / IOL complex was prepared, the IOL was folded, and the artificial iris then folded over the IOL. This complex  was then inserted into the eye via a scleral incision, and unfolded , taking care to retain the trailing haptic outside the eye. The IOL was then fixated using the Yamane fixation technique, whereby the IOL haptics were captured into scleral tunnels and thermally fixated.

Details of the surgical technique are described. The artificial iris/ IOL complex was adequately fixated and stable in all cases. Both IOL and Iris were well centred. No perioperative or postoperative complications were noted. Compared to previously described sutured fixation of IOL / Artificial iris complex , the current technique was simpler, and had significantly lower operating time  and lower risk of intraoperative complications such as suture slippage . It also avoids the late complication of suture dehiscence which may occur with suture fixation. Refractive and visual outcomes did not differ from conventional Yamane fixation and were excellent compared to previously described suture fixation. 

Novel single-step sutureless combined modified Yamane fixation of silicon artificial iris and IOL allowed rapid correction of iris defects and aphakia. Due to the rapid operating time this can be combined with catarct extraction in traumatic or aniridic cases under local anaesthesia . The novel technique is simple and  provides stable and lasting fixation of the IOL and artificial iris with predictable refractive outcomes and artificial iris centration.