JAN 2013

EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.

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January 2013 Iridodialysis repair Iridodialyses can often be repaired by suture techniques. The surgeon should be aware that the pupil will be drawn in the direction of the iridodialysis, especially if too much peripheral iris tissue is incarcerated in the 10-0 nylon suture bites. Iridodialyses are associated with denervation of the iris in the sector of disinsertion. Post-op, these eyes will often have oval mydriatic pupils (Figure 1). Mydriatic pupil repair A mydriatic pupil can be repaired by a purse string pupilloplasty technique. Although this approach results in a functionally smaller pupil, it is always nonreactive and often stellate upon close inspection (Figure 2). It is important for the surgeon not to pull the sutures down too tightly. Doing so may result in cheese wiring through the pupil sphincter or a pupil that is too small. A few clinical examples will serve to illustrate how artificial iris devices can be used to compensate for other small and large iris defects. Morcher example Morcher manufactures many different artificial iris devices. Some are modified capsule tension rings. Others are iris reconstruction lenses that contain an integrated optic. All feature a black artificial iris that is manufactured from modified polymethylmethacrylate. An example is shown in Figure 3. Figure 5. Large iris defects can also be managed by implanting a HumanOptics artificial iris device into the sulcus space, while a lens implant is fixated within the capsular bag. Although the improvement in cosmesis over Morcher and Ophtec devices is apparent, the color match is not always perfect. Ophtec example Ophtec also manufactures several artificial iris devices. The model 311 iris reconstruction lens comes in blue, green, and brown. These devices can be used to replace the natural iris when there is concomitant aphakia. They can also be used in a piggyback fashion to correct an eye that is pseudophakic but has a residual refractive error. Suture fixation eyelets on the haptics allow for suture fixation to the sclera when capsular bag and zonular support are absent. An example is shown in Figure 4. deficiencies. J Cataract Refract Surg. 2001;27:1732-1740. 3. Price MO, Price FW Jr., Chang DF, Kelley K, Olson MD, Miller KM. Ophtec iris reconstruc- EW CATARACT 21 tion lens United States clinical trial phase I. Ophthalmology. 2004;111:1847-1852. 4. Miller AR, Olson MD, Miller KM. Functional and cosmetic outcomes of combined penecontinued on page 22 Introducing Introducing E\ E\ HumanOptics example HumanOptics sells a silicone wafer device that is manufactured by Dr. Schmidt Intraocularlinsen GmbH (Saint Augustin, Germany). This device has a 12.8 mm overall diameter and a 3.35 mm pupil. It is a custom, hand-painted device that is usually matched to the fellow normal eye, if there is one. It is rollable and can be inserted through a sub-4 mm incision. The cosmetic results that can be obtained with it are usually superior to those that can be obtained with Morcher and Ophtec devices. An example is shown in Figure 5. Summary and conclusion Patients with congenital and acquired defects of the iris are challenging. Sutures can be used to repair iridodialyses, small iris lacerations, colobomatous defects, and mydriatic pupils. Prosthetic iris devices from Morcher, Ophtec, and HumanOptics can be used to correct larger defects. To obtain access to the latter, ophthalmologists in the U.S. have to obtain an FDA compassionate use device exemption or refer their patient to a surgeon who participates in a clinical trial. Caring for these patients is very gratifying. They are usually appreciative of any improvement the ophthalmologist can achieve in reducing the light and glare sensitivity they experience. EW performance The same great performance for less +LJKTXDOLW\UHXVDEOHRSKWKDOPLF +LJKTXDOLW\UHXVDEOHRSKWKDOPLF VXUJLFDOLQVWUXPHQWV VXUJLFDOLQVWUXPHQWV 6XUJLFDOVWDLQOHVVVWHHOWLSVDQGGXUDEOH 6XUJLFDOVWDLQOHVVVWHHOWLSVDQGGXUDEOH KDQGOHVPDGHRIDFRPSRVLWHSRO\PHU KDQGOHVPDGHRIDFRPSRVLWHSRO\PHU 3HUIRUPDQFHHTXLYDOHQWWRWKHEHVW 3HUIRUPDQFHHTXLYDOHQWWRWKHEHVW FRQYHQWLRQDODOOPHWDOLQVWUXPHQWV FRQYHQWLRQDODOOPHWDOLQVWUXPHQWV 6LJQLÀFDQWO\ORZHUSULFHGWKDQDOOPHWDO 6LJQLÀFDQWO\ORZHUSULFHGWKDQDOOPHWDO LQVWUXPHQWV LQVWUXPHQWV (OLPLQDWHWLPHDQGH[SHQVHRIGHDOLQJ (OLPLQDWHWLPHDQGH[SHQVHRIGHDOLQJ ZLWKPLVDOLJQHGEHQWGDPDJHGRUORVW ZLWKPLVDOLJQHGEHQWGDPDJHGRUORVW LQVWUXPHQWV LQVWUXPHQWV References 1. Osher RH, Burk SE. Cataract surgery combined with implantation of an artificial iris. J Cataract Refract Surg. 1999;25:1540-1547. 2. Burk SE, Da Mata AP, Snyder ME, Cionni RJ, Cohen JS, Osher RH. Prosthetic iris implantation for congenital, traumatic, or functional iris 0RULD,QFPRULD#PRULDXVDFRPZZZPRULDVXUJLFDOFRP

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