14.1 Introduction

Cosmetic color implants are employed for iris color change by individuals who are unsatisfied with the current color of their iris and aim to go for a change for purely cosmetic reasons often being unaware of the hazardous complications associated with the procedure. Cosmetic iris implants are anterior chamber (AC) implants that are placed on to the anterior surface of the iris. They are made of silicon-graded material and are available in a single size with 15-mm diameter.

Since the implantation of cosmetic iris implants, significant complications have been reported in the postoperative period that range from corneal degeneration to AC angle structure involvement with raised intraocular pressure (IOP), inflammation, uveitis, and cataract formation. ^{1 , 2 , 3} Significant complications have also been reported even during the explantation of these cosmetic iris implants with the requirement of secondary procedures for the correction of these defects. ^{1 , 2}

Theories have been formulated that cite the possible cause for the damage caused by these implants to be the peripheral edges of the implants mounted in the AC angle that lead to constant friction and mechanical trauma to the corneal endothelium and the angle structures. ⁴ This leads to pigment dispersion and development of peripheral anterior synechiae that eventually leads to raised IOP and development of glaucoma. The hazardous effects of these implants often cause irreversible changes in the eye with the depletion of endothelial cell counts, cataract formation, raised IOP, uveitis-glaucoma-hyphema syndrome, and neovascular glaucoma. ^{1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21}

Surgical procedures such as cataract removal, Descemet’s stripping endothelial keratoplasty, ⁴ Descemet’s stripping automated endothelial keratoplasty (DSAEK), ^{1 , 2} penetrating keratoplasty, ¹ trabeculectomy ^{1 , 8} and shunt operations ¹ have been described to rectify the complications. It is essential to remove the iris implants atraumatically and it is also essential to perform additional surgical procedures to optimize the potential visual outcomes.