Kevin M. Miller
SAN FRANCISCO — While small iris defects can be treated with sutures, patients with large iris defects who have poor cosmetics and light sensitivity can be successfully treated with artificial irises, according to a speaker here.
“Not only do these devices reduce light and glare sensitivity, but what they do for a person’s psychology, their emotional state, their ability to interact with people is beyond study,” Kevin M. Miller, MD, said as he delivered the Charles D. Kelman Lecture at the American Academy of Ophthalmology annual meeting.
Four companies currently produce artificial irises worldwide, yet only devices produced by HumanOptics are approved and available in the United States. There are currently no insurance companies or governmental agencies that pay or reimburse for iris implantation, as there are no codes, Miller said.
The HumanOptics artificial iris contains a template on its surface of a photograph of the normal fellow eye, if there is one available, and has a 12.8 mm outer diameter and a fixed 3.35 mm pupil. Unlike other artificial irises available outside of the U.S., the HumanOptics artificial iris does not contain an integrated optic, he said.
The device can be fixated passively into the capsular bag or the sulcus, or it can be sutured to the sclera, sutured to an IOL, which is in turn sutured to the sclera, or sutured to the residual iris.
“There are different ways of inserting this. You can insert with an injector or with forceps,” he said.
In general, the color match is not always perfect, and the iris does not always center in the eye, particularly if it is suture fixated. Additionally, the pupils of the two eyes will not match under all lighting conditions, and many implanted eyes will require subsequent strabismus surgery, he said.
“Glaucoma will continue to be a problem for eyes that had it preoperatively, but we’re not generating a lot of new glaucoma with this. On a positive note, the view of the retina and the optic nerve through that artificial pupil is excellent,” Miller said. – by Robert Linnehan
Miller KM. Artificial iris implantation. Presented at: American Academy of Ophthalmology annual meeting; October 11-15, 2019; San Francisco.
Disclosure: Miller reports no relevant financial disclosures.