Artificial Iris Restores Perfect Vision

Associate Professor Andrew White from personalEYES Canberra performed the surgery on the patient, who had experienced significant vision impairment following complications from a previous medical procedure. The patient achieved a visual acuity of 6/6, marking a dramatic improvement in both his eyesight and quality of life.

Evolution of Artificial Iris Implants

Artificial iris transplants aim to address severe iris deformities caused by trauma, genetic disorders, inflammatory diseases, or degenerative eye conditions. They can also be used for congenital conditions such as aniridia, where individuals are born with an underdeveloped or absent iris, and ocular albinism, which affects pigmentation in the eye and often results in vision problems.¹ In some cases, iris deformities can lead to secondary conditions like glaucoma.

Artificial irises have undergone remarkable advancements and transformations since their original development. Initially, these innovative devices were rudimentary and limited in their design and functionality. However, since the first prosthetic iris was successfully implanted in 1956 by the pioneering ophthalmologist Professor Peter Choyce, continuous research and technological progress have led to the creation of highly sophisticated prosthetic irises that closely mimic the appearance and function of natural irises.

Assoc Prof White said clinical data demonstrates consistently high patient satisfaction rates and significant improvements in quality of life

In 1994, Sundmacher et al. and Reinhard et al. made significant advancements in the development of these specialised implants that are used in the intricate process of iris reconstruction. Their work involved refining the design and functionality of the implants to improve the outcomes for patients requiring iris reconstruction, thereby enhancing both the aesthetic appearance and functional performance of the eye. This advancement marked an important milestone in ophthalmic surgery, as it offered new hope for individuals with iris defects or damage, contributing to improved vision and quality of life.² Consequentially, artificial irises began being used cosmetically in the early 2000s, despite lacking approval of the United States Food and Drug Administration (FDA).^3,4

Complications like glaucoma, causing optic nerve damage, and corneal decompensation, where the cornea swells and loses transparency, have been reported. These issues can cause significant discomfort and long-term vision problems, highlighting the need for caution in using these procedures for cosmetic purposes, as the risks may outweigh the benefits.^1,3

In 2018 CustomFlex – a tailor-made, flexible silicone iris implant designed to address the complete or partial absence of the iris – became the first standalone artificial iris approved by the FDA for treating children and adults suffering iris defects.^5,6 

For Canberra Microsurgery, conducting Australia’s first artificial iris implantation procedure using the CustomFlex technology was a significant milestone. Assoc Prof White reported that initial outcomes have been highly encouraging, with the patient experiencing notable improvements in both functional and aesthetic results.

He said the long-term success of the procedure hinges on comprehensive follow-up care, encompassing regular monitoring of intraocular pressure, precise assessment of device positioning, and detailed evaluation of endothelial cell counts.

Assoc Prof White said clinical data demonstrates consistently high patient satisfaction rates and significant improvements in quality of life, validating this intervention’s therapeutic value.

“The technology will continue to evolve with technological advancements, particularly in implant materials, patient-specific customisation options, and refined surgical techniques.

“When combined with rigorous patient selection criteria, meticulous surgical planning, and structured post-operative care protocols, artificial iris implantation has emerged as an effective and reliable solution for patients presenting with iris defects,” he concluded.

References 

1. Shweikh Y, Ameen S, Mearza A. Complications secondary to cosmetic artificial iris anterior chamber implants: a case report. BMC Ophthalmol. 2015 Aug 8;15:97. doi: 10.1186/s12886-015-0084-1.
2. Chaurasia S. Devastating complication of cosmetic iris implants. Indian J Ophthalmol. 2017 Aug;65(8):771-772. doi: 10.4103/ijo.IJO_537_16.
3. Saade J, Patel AS, Ryburn C, et al., Prosthetic iris devices. American Academy of Ophthalmology. Available at eyewiki.org/Prosthetic_Iris_Devices [accessed Oct 2024].
4. Taylor R. The artificial iris: Technically challenging and unusually rewarding. EyeNet Magazine May 2022. Available at aao.org/eyenet/article/the-artificial-iris-challenging-and-rewarding [accessed Oct 2024].
5. Voelker R. First artificial iris ok’d. JAMA. 2018;320(1):23. doi: 10.1001/jama.2018.8563
6. Srinivasan S., Yuen C., Watts, M. et al. Endocapsular iris reconstruction implants for acquired iris defects: a clinical study. Eye 2007;21:1109-1113. doi: 10.1038/sj.eye.6702472.