ESCRS - PO005 - Novel Surgical Technique Of Fiber Free Artificial Iris And Intraocular Lens Scleral Fixation In A Post-Keratopigmentation Patient With Traumatic Aniridia And Luxated Iol

Novel Surgical Technique Of Fiber Free Artificial Iris And Intraocular Lens Scleral Fixation In A Post-Keratopigmentation Patient With Traumatic Aniridia And Luxated Iol

Published 2024 - 42nd Congress of the ESCRS

Reference: PO005 | Type: Case Report | DOI: 10.82333/hzhh-8f97

Authors: Alexander II Lanzuela Gonzales* 1 , Jorge Alió del Barrio 2

1Department of Ophthalmology,Ospital ng Makati,Makati,Philippines;Cornea, Cataract and Refractive Surgery Unit,Shinagawa Lasik and Aesthetics Center,Taguig,Philippines;Research, Development and Innovation Department,Vissum Grupo Miranza,Alicante,Spain, 2Cornea, Cataract and Refractive Surgery Unit,Vissum Grupo Miranza,Alicante,Spain;Department of Ophthalmology,Universidad Miguel Hernández,Alicante,Spain

Purpose

To report the outcome of scleral fixation of an iris-intraocular lens (IOL) complex in a patient with a displaced IOL, traumatic aniridia, and extensive keratopigmentation. A closed loop four eyelet acrylic aspheric monofocal lens (Micropure, BVI) and a fiber-free artificial iris (Human Optics) were utilized in the procedure, which was secured with a scleral four flanged IOL fixation technique.

Setting

Vissum (Miranza Group), Alicante, Spain. 
A 77-year-old pseudophakic woman suffered a penetrating injury to her right eye in 2020 and was diagnosed with traumatic aniridia and subluxated IOL (left in place due to a satisfactory CDVA). Because of invalidating photophobia and subjective cosmetic dissatisfaction with the eye appearance (she had a light green iris color on the healthy contralateral eye) she underwent green keratopigmentation. 

Report of case

In 2023, the patient experienced blurred vision in the right eye and was referred to our clinic. Visual acuity had decreased from CDVA of 0.98 to 0.2, a green 360o keratopigmentation with only 3.2 mm of central clear cornea was noted, as well as an anteriorly luxated plateau IOL with peripheral corneal contact and secondary early endothelial decompensation signs. Four flanged iris-IOL complex intrascleral fixation was recommended. This case used a fiber-free artificial iris and a closed loop four-eyelet acrylic aspheric monofocal lens. The luxated pseudophakic IOL was explanted through a 5mm superior scleral incision, and anterior vitrectomy was performed. A 30-gauge thin wall needle was inserted transsclerally 2mm posterior to the limbus at 2,4,8, and 10o clock hours. After suturing the IOL to the posterior surface of the artificial iris, two 6-0 prolene sutures were looped through the eyelets on both sides. The needle was externalized from the scleral tunnel after passing 6-0 Prolene through its lumen. Iris-IOL complex was inserted through the scleral tunnel and Prolene suture ends were heated by thermocautery to create a flange. Adjusting four flange tension centered the iris-IOL complex in the central clear corneal area. The iris-IOL complex is centered and tilt-free after 6 months. No flange erosion or dehiscence was discovered, and photophobia was reduced.  From 0.20 to 0.60, CDVA and corneal decompensation improved, leaving mainly early DM folds.

Conclusion/Take home message

The use of a four-eyelet IOL sutured to the artificial iris, allows to fixate the IOL and not the iris directly to the sclera, which opens the possibility of using fiber free models of artificial iris, that have demonstrated less long-term complications and are easier to handle intraoperatively. The four scleral flanged technique (with suture loop on both IOL sides without knots or flanges) enhances and simplifies the current fixation methods. This case reports shows the feasibility of sulcus fixating an artificial iris-IOL complex on a keratopigmented cornea with small central aperture by simplifying the current surgical techniques.