Department of Ophthalmology, Santa Maria Delle Croci Hospital, Viale V Randi n. 5-48121, Ravenna, Italy.
Graefes Arch Clin Exp Ophthalmol. 2013 Mar;251(3):667-75. doi: 10.1007/s00417-012-2254-7. Epub 2013 Jan 17.
Combined post-traumatic aniridia and aphakia demand extensive and complex reconstructive surgery. We present our approach for simultaneous correction of this surgical situation with the use of the ArtificialIris (Dr. Schmidt Intraocularlinsen GmbH, Germany) with a foldable acrylic IOL Lentis L-313 (Oculentis, GmbH, Germany) sutured to its surface. The novelty (our first operation was on June 2010) of this surgical technique is based on the combined use of foldable (with closed haptics) IOL and Artificialiris to correct post-traumatic aniridia and aphakia.
Four consecutive cases of combined post-traumatic lesions of iris and lens, corrected with complex device ArtificialIris and foldable IOL. In two cases, the compound implant was sutured to the sclera in sulcus during the penetrating keratoplasty; in another case, it was positioned through a corneal incision of about 5.0 mm with transscleral fixation, and in one patient with preserved capsular support and possibility of IOL in-the-bag implantation the ArtificialIris was placed in sulcus sutureless through a clear corneal tunnel.
Maximal follow-up was 6 months. The complex device was placed firmly fixed within the sulcus, including in the eye implanted without sutures, and showed a stable and centered position without any tilt or torque.
Management of post-traumatic aniridia combined with aphakia by haptic fixation of a foldable acrylic IOL on a foldable iris prosthesis appears to be a promising approach which gives the surgeon the possibility to correct a complex lesion with one procedure, which is less traumatic and faster. Existence of foldable materials, both iris and IOL, permits relatively small corneal incisions (4.0-5.0 mm). Moreover, the custom-tailored iris prosthesis gives a perfect aesthetic result.
联合创伤性无虹膜和无晶状体需要广泛而复杂的重建手术。我们介绍了一种使用人工虹膜（德国施密特眼科晶状体有限公司）和表面缝合折叠式丙烯酸人工晶状体 Lentis L-313（欧科伦特斯有限公司）同时矫正这种手术情况的方法。这种手术技术的新颖之处（我们的第一次手术是在 2010 年 6 月）在于结合使用折叠式（带闭合襻的）人工晶状体和人工虹膜来矫正创伤性无虹膜和无晶状体。
连续 4 例联合创伤性虹膜和晶状体病变，采用复杂装置人工虹膜和折叠式人工晶状体矫正。在 2 例中，复合植入物在穿透性角膜移植术中缝合于巩膜沟；在另 1 例中，通过约 5.0mm 的角膜切口，经巩膜固定，在 1 例保留囊袋支持和囊袋内人工晶状体植入可能的患者中，通过透明角膜隧道无缝线将人工虹膜置于巩膜沟内。
最大随访时间为 6 个月。复杂装置牢固地固定在巩膜沟内，包括未缝线植入的眼内，位置稳定且居中，无倾斜或扭转。
通过将折叠式丙烯酸人工晶状体的襻固定在折叠式虹膜假体上，治疗创伤性无虹膜合并无晶状体，似乎是一种有前途的方法，它使外科医生有可能通过一次手术矫正复杂病变，手术创伤更小，速度更快。折叠式材料（虹膜和人工晶状体）的存在允许相对较小的角膜切口（4.0-5.0mm）。此外，定制的虹膜假体可获得完美的美学效果。
