March 02, 2020
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Nightmare cases: The artificial iris

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Amar Agarwal
Priya Narang

Cosmetic iris implants are non-FDA-approved procedures that can result in severe, potentially blinding complications.

Patients who undergo the cosmetic procedure can experience increased IOP, cataracts, injury to the cornea, or reduced vision or blindness, according to the American Academy of Ophthalmology.

Amar Agarwal, MS, FRCS, FRCOphth, and Priya Narang, MS, discussed treating a 20-year-old female patient who underwent cosmetic lens implantation with Healio/OSN.

 

Q: What did you face when this young patient came to your clinic?

A: An ophthalmologist referred a female patient aged 20 years who had main complaints of dimness of vision associated with pain and redness in both eyes. She had underwent cosmetic lens implantation 2 years back, as she had wanted to change the color of her eyes. Post-lens implantation, the patient was asymptomatic for 6 months but slowly developed raised IOP of 40 mm Hg and 30 mm Hg for the right and left eyes, respectively. The cosmetic lenses were removed by the referring surgeon from both eyes, but her symptoms failed to subside. The patient presented with cataract, endothelial decompensation, raised IOP and irregular iris architecture with patches of atrophy (Figures 1 and 2). The persistently dilated pupil failed to constrict even after lowering the IOP with medications. This was probably due to mechanical trauma induced by the iris implant and sphincter damage due to raised IOP. The patient was on topical anti-glaucoma drugs and nonsteroidal anti-inflammatory drops.

Figure 1. Right eye before PDEK in cosmetic iris implant complication. Cosmetic iris implant in eye (a). Cosmetic iris implant removed shows cataract with closed-angle glaucoma and corneal decompensation. IOP was 40 mm Hg (b). Postop vision 20/20, IOP 17 mm Hg (c).

Q: How did you treat the patient?

A: Specular microscopy was performed. The preoperative specular count could not be assessed for the right eye, whereas the endothelial cell count for the left eye was 1,750 cells/mm2.

The right eye underwent phacoemulsification with single-pass four-throw pupilloplasty and pre-Descemet’s endothelial keratoplasty as a single-stage procedure. The left eye underwent phacoemulsification with pupilloplasty. PDEK was not considered initially for the case, but eventually the left eye also underwent endothelial decompensation, and PDEK was performed 6 months after the initial surgery.

Figure 2. Left eye before PDEK in cosmetic iris implant complication. Cosmetic iris implant in eye (a). Cosmetic iris implant removed shows cataract with closed-angle glaucoma and corneal decompensation (b). Postop vision 20/20, IOP 15 mm Hg (c).

Q: What were the outcomes of the procedure?

A: Postoperatively, there was a dramatic improvement in the visual acuity and raised IOP.

The preoperative best corrected visual acuity improved from 20/800 and 20/400 on Snellen’s chart to 20/20 in both eyes at 3 months’ follow-up and persisted thereafter. At 1-month follow-up, there were no signs of active inflammation with deep anterior chambers. The postoperative IOP in both eyes was recorded to be 17 mm Hg and 15 mm Hg in the right eye and left eye, respectively. Intraoperatively, difficulty was observed while performing pupilloplasty due to thin, friable iris tissue that gaped during the procedure. However, gentle handling of the iris tissue, along with a second attempt at the procedure, facilitated the completion of the procedure. No other major complications such as graft detachment or failure were observed. Currently, the patient is on no topical medication. – by Robert Linnehan

Reference:

Cosmetic iris implants carry risk of permanent eye damage, vision loss. www.aao.org/eye-health/tips-prevention/iris-implants-risk-eye-damage. Published Oct. 29, 2014. Accessed Feb. 2, 2020.

Disclosures: Agarwal and Narang report no relevant financial disclosures.