Clinical and Functional Outcomes of Lens-Iris Diaphragm Implantation with Simultaneous Subtotal Penetrating Keratoplasty: a 15-Year Follow-Up Case Report

Combined traumatic injuries of the anterior eye segment are attributed to the severe consequences of the injured organ of vision. Iris defects result in spherical and chromatic aberrations, diplopia, flares, severe photophobia, cosmetic defects, and significantly reduced visual acuity after the injury. The literature describes various methods to restore visual functions impaired as a result of aniridia. Use of an artificial iris together with an intraocular lens pathology results in optimal reconstruction and recovery of normal anterior segment anatomy and topography. In this paper, we provide a report on a patient followed up for 15 years after combined reconstruction eye surgery for an off-the-job penetrating eye injury sustained in 2003. A complex intervention was required due to the involvement of the cornea, iris, and lens. In 2004, the patient underwent a lens-iris diaphragm implantation combined with penetrating keratoplasty. The diaphragm implantation was followed by an improvement in visual acuity and elimination of photophobia and flares. There were no intra- or postoperative complications. Two years later, LASIK refractive surgery was performed on the corneal transplant to eliminate induced ametropia. The patient retained good eye function, with a stable position of the lens-iris diaphragm, for many years after the diaphragm implantation, keratoplasty, and refractive surgery. In 2018, he had an intravitreal implant impregnated with dexamethasone, as changes in the retina had developed. The long-term follow-up in this case demonstrates that the implantation of a lens-iris diaphragm resulted in an elimination of undesirable optical events associated with aniridia and produced an optimal functional result, while also improving the patient’s quality of life with a good aesthetic effect.

1. Khodzhaev N.S., Sobolev N.P., Mushkova I.A., Izmaylova S.B., Karimova A.N. Visual rehabilitation of patients with large post-traumatic defects of the anterior eye segment through iris-lens diaphragm implantation. Annals of Ophthalmology = Vestnik oftal’mologii. 2017;133:23–29 (In Russ.). DOI: 10.17116/oftalma2017133623-29

2. Pozdeyeva N.A., Pashtayev N.P., Lukin V.P., Batkov Y.N. Artificial iris-lens diaphragm in reconstructive surgery for aniridia and aphakia. J Cataract Refract Surg. 2005;31:1750–1759. DOI: 10.1016/j.jcrs.2005.02.037

3. Hanumanthu S., Webb L.A. Management of traumatic aniridia and aphakia with an iris reconstruction implant. J Cataract Refract Surg. 2003;29: 1236–1238.

4. Thompson C.G., Fawzy K., Bryce I.G., Noble B.A. Implantation of a black diaphragm intraocular lens for traumatic aniridia. J Cataract Refract Surg. 1999;25:808–813.

5. Dong X., Xu H., Yu B., Ying L., Xie L. Long-term outcome of black diaphragm intraocular lens implantation in traumatic aniridia. Br J Ophtalmol. 2010;94:456–459. DOI: 10.1136/bjo.2008.154385

6. Neuhann I.M., Neuhann T.F. Cataract surgery and aniridia. Curr Opin Ophtalmol. 2010; 21:60–64. DOI: 10.1097/ICU.0b013e328333ea49

7. Uusitalo R.J., Uusitalo H.M. Traumatic Aphakia Treated with an Iris Prosthesis/Intraocular Lens or Epikeratophakia. J Refract Surg 1997;13:382–387.

8. Agrawal S., Verma A. Coloured diaphragm scleral fixated IOL in patients with traumatic aniridia and cataract. IJRTSAT. 2013;7:36–39.

9. E.I. Mekkawi T.F. Scleral fixation of iris diaphragm intraocular lens in patients with traumatic aniridia. JCEO 2011;2:184. DOI: 10.1016/j.tjo.2016.04.001

10. Sobolev N.P., Anisimova N.S., Gromova E.G. The femtosecond laser accompanied by phacoemulsification with implantation of an artificial iris in patients with traumatic and congenital aniridia. Modern technologies in ophthalmology = Sovremennye tekhnologii v oftal’mologii. 2016;5(13):79–81 (in Russ.).

11. Mavrikakis I., Mavrikakis E., Syam P.P., Bell J., Casey J.H., Caswell A.G. Surgical management of iris defects with prosthetic iris devices. Eye. 2005;19:205. DOI: 10.1038/sj.eye.6701448

12. Pozdeeva N.A., Pashtaev N.P., Treushnikov V.M., Viktorova E.A., Starostina O.V. A novel model of artificial iris-lens diaphragm for reconstruction of extensive iris defects (experimental rationale). Annals of Ophthalmology = Vestnik oftal’mologii. 2013;129(3):521–526 (in Russ.).

13. Qiu X., Ji Y., Zheng T., Li Y. The efficacy and complications of black diaphragm intra-ocular lens implantation in patients with congenital aniridia. Acta Ophtalmol. 2016;94:340–344. DOI: 10.1111/aos.12923

14. Aslam S.A., Wong S.C., Ficker L.A., MacLaren R.E. Implantation of the black diaphragm intraocular lens in congenital and traumatic aniridia. Ophtalmology. 2008;115:1705–1712. DOI: 10.1016/j.ophtha.2008.03.025

15. Schmitz K., Viestenz A., Meller D., Behrens-Baumann W., Steuhl K.P. Aniridia intraocular lenses in eyes with traumatic iris defects. Ophtalmologe. 2008;105:744–752. DOI: 10.1007/s00347-007-1666-y

16. Malcles A., Dot C., Voirin N., Vie A.L., Agard E., Bellocq D., Denis P., Kodjikian L. Safety of intravitreal dexamethasone implant (Ozurdex): The SAFODEX study. Incidence and Risk Factors of Ocular Hypertension. Retina. 2017;37:1352–1359. DOI: 10.1097/IAE.0000000000001369.

17. Pozdeeva N.A., Pashtaev N.P. Artificial iriodal lens diaphragm in the surgical treatment of aniridia. Cheboksary, 2012. 160 p. (In Russ.).

18. Ioshin I.E., Novikov S.V., Sobolev N.P., Leontiev D.G., Tagiyeva R.R., Selifanov Y.V. Collapsible design of the iris-lens diaphragm in reconstructive surgery of combined pathology of the iris and lens. Ophthalmosurgery = Oftal’mokhirurgiya. 2006;3:15–19 (In Russ.).

19. Mayer C., Tandogan T., Hoffman A.E., Khoramnia R. Artificial iris implantation in various iris defects and lens conditions. J Cataract Refract Surg. 2017;43:724–731. DOI: 10.1016/j.jcrs.2017.06.003

20. Rickmann A., Szurman P., Januschowski K., Waizel M., Spitzer M.S., Boden K.T., Szurman G.B. Long-term results after artificial iris implantation in patients with aniridia. Graefes Arch Clin Exp Ophthalmo.l 2015;254:1419–1424. DOI: 10.1007/s00417-016-3292-3