Pretty In Pictures, But Iris-Sponsible

To describe the complex management and successful visual rehabilitation of bilateral secondary glaucoma and corneal endothelial failure secondary to cosmetic BrightOcular iris implants in a young patient.

Tertiary referral glaucoma and anterior segment service, Liverpool Hospital, Sydney, Australia.

A 29‑year‑old Iranian female presented with progressive visual loss and elevated intraocular pressures (IOPs: 32 mmHg right, 36 mmHg left) following bilateral cosmetic BrightOcular anterior chamber iris implants. Humphrey visual fields revealed arcuate defects consistent with advanced mixed glaucoma. Despite maximal topical therapy and extensive counselling regarding implant removal, the patient initially declined surgery. Bilateral trabeculectomies were subsequently required, with the right eye developing refractory IOP elevation (peak 46 mmHg) despite intra‑operative needling, multiple post‑operative revisions, and eventual cyclodiode therapy, culminating in hypotony. Both eyes developed visually significant cataracts. With renewed consent, staged reconstruction included cataract extraction and exchange of BrightOcular implants for HumanOptics iris prostheses. The right eye developed corneal decompensation requiring Descemet Membrane Endothelial Keratoplasty (DMEK), achieving corneal clarity and stable IOP. The left eye underwent similar implant exchange, regaining best‑corrected vision of 6/12 on minimal therapy. No glaucoma progression occurred following exchange. Corneal oedema of the left eye is currently being monitored with the possibility of requiring endothelial keratoplasty in the future. 

Cosmetic iris implants pose serious risks of endothelial failure and secondary glaucoma. Sequential surgical planning—including explantation, cataract surgery, endothelial keratoplasty, and medical‑grade iris prosthesis implantation—can achieve structural and functional recovery. Early recognition and multidisciplinary anterior segment care are critical to prevent irreversible vision loss.