Eyeworld

EW CATARACT 22 April 2018 Cataract editor's corner of the world by Rich Daly EyeWorld Contributing Writer as much as the right eye was pulled inferonasally." The worst finding was endo- thelial cell counts of 497 cells per square millimeter in the right eye and 529 cells per square mil- limeter in the left eye. At his age, the patient should have had cell counts close to 2,500 or 3,000 cells per square millimeter. Counts of less were present in both corneas, which is a sign of chronic inflammation. Behind the cosmetic pupil in the right eye, the natural pupil was dragged inferonasally. "Something was happening where the cosmetic iris was grabbing the peripheral iris," Dr. Miller said. "The pupil in the left eye was de- centered downward but not nearly How surgeons are treating complications in patients who received artificial iris implants overseas I t was a gift that will keep on giving. Unfortunately, the over- seas iris implant will keep on giving lifelong vision complica- tions to one patient. The 34-year-old male patient first presented in November 2017 at the practice of Kevin M. Miller, MD, professor of clinical ophthal- mology, University of California, Los Angeles (UCLA). It was a year and a half after the patient had received an artificial iris, which a friend paid for him to have implanted in Mexico. The patient had dark irises, and those combined with the tattoo art- ist's generous displays of ink made him feel self-conscious and looked at askance. "He thought if he could change his eye color that might change behaviors," Dr. Miller said. "And he said it did. After he got his new blue irises, people started treating him nicely. Maybe it was his psychology, but that's what he reported." The patient said the February 2015 procedure implanting the irises was uneventful, and he had no recovery problems. About a year and a half after they were implanted, he suffered a trauma and then—not necessarily related to the trauma— started experiencing photophobia, light sensitivity, and redness in both eyes. A local optometrist began treating him with prednisolone and cyclopentolate to dilate the pupils. Referred to a staff ophthalmologist at UCLA, the patient was continued on the prednisolone acetate every 2 hours while awake and referred to Dr. Miller. At Dr. Miller's first exam, the patient was less light sensitive with visual acuities of 20/30 +2 in the right eye and 20/15 –1 in the left eye. However, his IOP was 22 mm Hg in the right eye and 26 mm Hg in the left eye. Keratic precipitates Treating a cosmetic iris implant recipient I n today's world we all face patients with high expectations. We try to manage and reset those expectations to what is available in our current armamen- tarium of technology. Most patients will be reasonable. However, we still have those patients who have unrealistic expectations and seek out cosmetic options that may produce more harm than good. In this "Cataract editor's corner of the world," we hear of an interesting case presented by Kevin Miller, MD, of a patient who wanted to change the color of his eyes permanently and went abroad for artificial iris implants. It is an interesting adven- ture for both the surgeon and the patient, and we also get the perspective of Tal Raviv, MD, on how best to manage these situations. Rosa Braga-Mele, MD, Cataract editor The right eye of a patient with a cosmetic iris in situ. The natural iris is clearly disturbed as the pupil is dragged inferonasally. After cosmetic iris removal, a large superotemporal iris defect and extensive inferonasal synechiae were discovered. The left eye with an anterior chamber cosmetic artificial iris in place. The pupil in the natural iris is displaced inferiorly. After cosmetic iris removal, a generous mid-peripheral temporal iris defect was discovered.

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