Iris Surgery

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:

1.

(Partial) iris defect (Figs. 6.5 and 6.6)?
2.

Old traumatic mydriasis (Figs. 6.7 and 6.8)?
3.

Aniridia and aphakia (Figs. 6.9, 6.10 and 6.11)?
4.

Recent traumatic mydriasis (Figs. 6.12 and 6.13)?

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).