Combined penetrating keratoplasty and implantation of iris prosthesis intraocular lenses after ocular trauma

Purpose: To report the outcomes of implantation of intraocular lenses (IOLs) with a prosthetic iris to correct traumatic iris deficiency. Setting: Department of Ophthalmology, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada. Design: Case series. Methods: The medical records of consecutive patients who had had implantation of an Ophtec or Morcher IOL combined with corneal transplantation were retrospectively reviewed. Preoperative data collected included demographics, etiology of the iris deficiency, previous surgeries, preoperative eye pathology, and visual acuity. Operative data and postoperative outcomes included visual acuity, subjective perception of glare and photophobia, and postoperative complications. Results: The records of 11 patients were reviewed. The corrected distance visual acuity improved from 2.39 logMAR ± 0.53 (SD) preoperatively to 1.50 ± 1.11 logMAR postoperatively (P=.0037). Four (36.4%) of 9 patients reported an improvement in glare sensation; 5 (45.5%) reported no change in glare (P=.99). Postoperative complications included 2 graft rejection episodes in 2 patients during the first year after surgery, 1 case of increased inflammation that required removal of the IOL, and 2 cases of new-onset glaucoma. At the last follow-up visit, the centration and positioning of the IOLs were excellent. There were no cases of IOL dislocation, macular edema, or retinal detachment. Conclusions: Implantation IOLs with a prosthetic iris in traumatic aniridia improved visual acuity significantly in most patients and reduced photophobia and glare symptoms in many cases. Graft rejection, glaucoma, and postoperative inflammation are possible complications.