Abstract
Introduction A 78-year-old male patient with a background of angle-closure glaucoma underwent left cataract surgery in May 2021, during which zonular dehiscence and vitreous prolapse were noted. This required an anterior vitrectomy and insertion of a GORE-TEX®-sutured IOL (Akreos Adapt AO, Bausch & Lomb). In August 2021 trauma to the same eye resulted in complete aniridia and a vitreous haemorrhage which resolved with conservative management. Complete aniridia reduced the patient’s vision to 6/30, and caused constant glare symptoms.
Iris Replacement A Scleral-fixated HumanOptics artificial iris (CustomFlex®) was inserted in September 2023. As the pre-existing sutured IOL was sutured approximately 2.8 mm posterior from the limbus, the iris implant was fixated at 1.8 mm posterior to the limbus. The surgery achieved excellent anatomical results and improved symptoms. However, there was a persistently high intraocular pressure (IOP) (maximal IOP = 50 mmHg) despite maximal medical management necessitating Ahmed valve implantation in November 2023. Visual acuity improved from 6/30 pre-op to 6/19 postoperatively and at last review IOP was 8 on no medications.
Conclusion Artificial iris implants can be safely inserted in eyes with pre-existing scleral-fixated IOLs, provided close monitoring is undertaken to ensure issues with raised IOP are managed promptly.
