Fig. 6.1
A foldable and hand painted iris prosthesis from Human Optics (Germany). The material is Goretex. The body is 12 mm in diameter
Fig. 6.2
A non foldable and not hand painted iris + IOL prosthesis from Ophtec (Netherlands). The material is PMMA. The body is 12 mm in diameter
Fig. 6.3
(a–d) Hattenbach iris instruments from Geuder (Germany) (a). It includes a needle holder (b), an iris holder (c) and scissors (d). The instruments are very easy to use
Fig. 6.4
A special suture with short needle for iris sutures (Onatec, Geuder, Germany)
There are several important features which determine the surgical planning:
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Fig. 6.5
A sector iris defect after complicated phacoemulsification
Fig. 6.6
After implantation of a hand painted Human Optics iris prosthesis into the sulcus
Fig. 6.7
An eye with an old traumatic mydriasis and natural lens
Fig. 6.8
After implantation of a hand painted Human Optics iris prosthesis together with a 3-piece IOL into the lens capsule
Fig. 6.9
An aniridia and aphakia after a blunt perforation with an i-pad
Fig. 6.10
Scleral fixation of a combined Human Optics iris prosthesis + 3-piece IOL
Fig. 6.11
Scleral fixation of a hard Opthec iris-IOL prosthesis (12 mm diameter)
Fig. 6.12
Intraoperative view on an eye with a recent traumatic mydriasis and aphakia after blunt trauma. The Hattenbach iris instruments in action
Fig. 6.13
After performing a purse string suture a retropupillar iris-claw IOL is implanted. Postoperative VA=1.0
Eyes with aniridia and aphakia secondary to trauma can be provided with an iris prosthesis and with/without an IOL prosthesis. The company Human Optics (Germany) produces a foldable iris prosthesis, which is hand painted (Fig. 6.1). It has a diameter of 12 mm and needs to be customized to the eye with a trephine (Opthec).
Prosthesis size for Human optic iris prosthesis:
Sulcus implantation: 10.0 mm
In the bag implantation: 9.0 mm
The companies Morcher (Germany) and Ophtec (The Netherlands) offer a combined iris and IOL prosthesis made from PMMA and are therefore not foldable (Fig. 6.11). Whereas Morcher produces a hand painted iris prosthesis offers Ophtec a range of four colours. The Morcher and Ophtec iris – IOL prosthesis require a 10.0 mm broad main incision.
The foldable iris prosthesis from Human Optics can be implanted with an IOL injector into the sulcus (Figs. 6.14, 6.15, 6.16, 6.17, 6.18, 6.19, and 6.20). For eyes with aniridia and aphakia the iris prosthesis from Human Optics can be combined with a 3-piece IOL: The iris prosthesis is fixated into the haptics of a 3-piece IOL (MA60AC, Alcon). I call this a combo iris and IOL prosthesis. It is implanted through a 2.4 mm main incision with an IOL injector (Alcon).
Fig. 6.14
Cutting the Human Optics iris prosthesis (12 mm body) with a 10 mm trephine for sulcus implantation
Fig. 6.15
A 3-piece IOL (Alcon, AMO) will be combined with the foldable prosthesis
Fig. 6.16
The haptics of the 3-piece IOL were inserted into the iris prosthesis
Fig. 6.17
The preoperative status after an explosive trauma. A healed corneal perforation, partial aniridia and aphakia
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