Arslan Osman Sevki, Toker Mustafa Ilker, Yildirim Rengin, Arslan Osman Sevki, Toker Mustafa Ilker, Yildirim Rengin, Ozdamar Akif, Sevim Okay, Gursoy Huseyin, Ozkok AhmetOzdamar Akif, Sevim Okay, Gursoy Huseyin, Ozkok Ahmet

Department of Ophthalmology Department of Ophthalmology Istanbul University Cerrahpasa Medical SchoolIstanbul University Cerrahpasa Medical School

Istanbul, TURKEYIstanbul, TURKEY

The iris prosthesis applications in

aniridic or wide iris defective patients

Pupil and iris work separately or together and make Pupil and iris work separately or together and make functions asfunctions as

1-1- Regulating light dosageRegulating light dosage

2-2- Preventing eyes from extreme amount of light Preventing eyes from extreme amount of light

3-3- Contributing fluid circulation between the chambersContributing fluid circulation between the chambers

4-4- Contributing anterior chamber angle structure Contributing anterior chamber angle structure and its function and its function

5-5- Allowing intraocular lens implantationAllowing intraocular lens implantation

Pupil and IrisPupil and Iris

Absence/damage Absence/damage ofof subtotal or totalsubtotal or total

iris tissueiris tissue

Pupil shape and Pupil shape and function disordersfunction disorders

Congenital and acquired (trauma, surgery) Congenital and acquired (trauma, surgery) factors can be responsible.factors can be responsible.

Traumatic and Traumatic and nnon-on-traumatic traumatic factorsfactors

Subtotal / totalSubtotal / totaldamage in damage in pupil and iris pupil and iris tissuestissues

Loss or decrease of Loss or decrease of functionfunction

Indication of surgical Indication of surgical treatmenttreatment

Congenital aniridiaCongenital aniridia

It is generally found together with the other It is generally found together with the other abnornalities and nystagmus. abnornalities and nystagmus.

In best cases, the visual acuity stays at 1-In best cases, the visual acuity stays at 1-2/10 level with Snellen chart2/10 level with Snellen chart..

In all iris defective cases, the most In all iris defective cases, the most important symptom is light discomfort.important symptom is light discomfort.

Congenital aniridiaCongenital aniridia

When intraocular surgery indication is When intraocular surgery indication is concluded for the other ocular pathologies concluded for the other ocular pathologies (cataract, corneal opacity, etc.) together (cataract, corneal opacity, etc.) together with iris-pupil pathology, the surgery for iris with iris-pupil pathology, the surgery for iris defect can be performed at the same defect can be performed at the same session or iris – pupil reparation can be session or iris – pupil reparation can be done in next session.done in next session.

In this study, 54 patients who had iris defect with several In this study, 54 patients who had iris defect with several reasons, and who were applied iris prosthesis during reasons, and who were applied iris prosthesis during the other surgeries for other indications were included.the other surgeries for other indications were included.

SexSex

31 male (57%)31 male (57%)

23 female (43%)23 female (43%)

AgeAge

Min 2 yearsMin 2 years

Max 79 yearsMax 79 years

Mean age 36.4Mean age 36.4 12.7 years 12.7 years

CasesCases

Follow-up timeFollow-up time

Min 6 monthsMin 6 months

Max 7 yearsMax 7 years

Mean (3.27 Mean (3.27 1.62 years)1.62 years)

Etiopathologic causes of the surgeriesEtiopathologic causes of the surgeries

Congenital aniridia Congenital aniridia →→22

Traumatic iris-pupil defect Traumatic iris-pupil defect (including operative cases) → (including operative cases) → 3636

Silicon keratopaty associated iris and/or Silicon keratopaty associated iris and/or pupil damage → pupil damage → 1010

Fixed dilated pupil due to Urres-Zavalia syndrome → 5Fixed dilated pupil due to Urres-Zavalia syndrome → 5

Fixed dilated pupilFixed dilated pupil due to glaucoma surgery →due to glaucoma surgery → 11

Total 54Total 54

CasesCases

Pupil and iris tissue reparations were performed Pupil and iris tissue reparations were performed in combination with other surgical proceduresin combination with other surgical procedures. .

SurgerySurgery

The aims of The aims of pupil and/or iris tissue reparationspupil and/or iris tissue reparations::

1-1- Prevention of light discomfortPrevention of light discomfort

2-2- ContributingContributing visual clarity visual clarity

3-3- Blocking passage of silicon oil to anterior chamberBlocking passage of silicon oil to anterior chamber

4-4- Cosmetic purposeCosmetic purpose

Surgical procedureSurgical procedure

Reparation techniques performed with several Reparation techniques performed with several prosthetic implants designed for the management of prosthetic implants designed for the management of damaged iris and pupil.damaged iris and pupil.

Surgical TechniqueSurgical Technique

Iris – pupil diaphragmIris – pupil diaphragm

+ +

peripheric iridectomyperipheric iridectomy

+ +

Reconstruction with the implants havingReconstruction with the implants having intraocular lens function intraocular lens function

Pupil reconstruction with the colored-opaque Pupil reconstruction with the colored-opaque implants during cataract surgeryimplants during cataract surgery..

Iris colored big optic scleral fixation lens Iris colored big optic scleral fixation lens implantation during keratoplasty with implantation during keratoplasty with indications such asindications such as

- OpticOptic

- Restoration of iris functionRestoration of iris function

- CosmeticCosmetic

Prosthetic iris implantation in capsular Prosthetic iris implantation in capsular bagbag

- During cataract surgeryDuring cataract surgery

- During keratoplastyDuring keratoplasty

Any toxic reactions associated with the used Any toxic reactions associated with the used prosthetic iris implantation were not seen in the prosthetic iris implantation were not seen in the patients during follow-up. Any findings related to patients during follow-up. Any findings related to bio-discrepancy were not occurred.bio-discrepancy were not occurred.

Postoperative EvaluationPostoperative Evaluation

The positive effects below were detectedThe positive effects below were detected

1-1- Reducing light disaster Reducing light disaster

2-2- Increasing visual acuityIncreasing visual acuity

3-3- Preventing from silicon oil damagesPreventing from silicon oil damages

4-4- Cosmetic improvement of the patientsCosmetic improvement of the patients

Postoperative EvaluationPostoperative Evaluation

In iris defective cases, the appropriate iris prostheses In iris defective cases, the appropriate iris prostheses

selected according to iris defect type and its size selected according to iris defect type and its size

increase the visual success and postoperative patient increase the visual success and postoperative patient

comfort during surgeries performed for another comfort during surgeries performed for another

pathology. pathology.

The cosmetic benefit is an additional positive side of the The cosmetic benefit is an additional positive side of the

prostheses.prostheses.

Conclusion Conclusion