Department of Ophthalmology, Technical University of Munich, Munich, Germany; David J. Apple Center for Vision Research, Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany.
Department of Ophthalmology, Technical University of Munich, Munich, Germany.
Am J Ophthalmol. 2019 Mar;199:159-166. doi: 10.1016/j.ajo.2018.09.001. Epub 2018 Sep 17.
To evaluate the effect of an artificial iris implant on the remnant iris.
Interventional case series.
Setting: Single center.
Forty-two consecutive patients.
Morphologic evaluation over 24 ± 14 months.
Remnant pupillary aperture, iris color, visual acuity, intraocular pressure, and endothelial cell count.
In 7 of 42 cases (16.7%), the residual iris aperture dilated from 36.6 ± 15.4 mm preoperatively to 61.1 ± 12.5 mm 1 year postoperatively (66.9% increase). In 5 of 7 affected eyes the artificial iris had been implanted into the ciliary sulcus; in 2 eyes it had been sutured to the sclera. Four of the 7 patients presented with remarkable complications: 2 eyes needed glaucoma shunt surgeries owing to pigment dispersion; 1 suffered from recurrent bleedings; and in 1 case artificial iris explantation was performed owing to chronic inflammation. Anterior chamber depth and angle, endothelial cell count, and visual acuity did not change in this cohort. Changes in color were not observed in the remnant iris.
The implantation of an artificial iris prosthesis can lead to a residual iris retraction syndrome. It is likely that residual iris is trapped in the fissure between the artificial iris and the anterior chamber angle, preventing further pupil constriction. Another possibility could be a constriction or atrophy of the residual iris. A scleral-sutured implant and an implantation in the capsular bag were both found to prevent the iris retraction. The study group number is inadequate to allow statistical comparison of these different implantation methods. As the use of artificial irises increases, we may expect more patients with iris retraction syndrome in the future.
评估人工虹膜植入物对残留虹膜的影响。
介入性病例系列。
设置：单中心。
42 例连续患者。
形态评估超过 24 ± 14 个月。
残余瞳孔孔径、虹膜颜色、视力、眼内压和内皮细胞计数。
在 42 例中有 7 例（16.7%），残留虹膜孔径从术前的 36.6 ± 15.4mm 扩大到术后 1 年的 61.1 ± 12.5mm（增加 66.9%）。在受影响的 7 只眼中，有 5 只人工虹膜植入睫状沟，2 只缝合到巩膜。在这 7 例患者中有 4 例出现明显并发症：2 只眼因色素播散需要行青光眼分流手术；1 只眼反复出血；1 例因慢性炎症行人工虹膜摘除术。该队列的前房深度和角度、内皮细胞计数和视力均未发生变化。在残留虹膜中未观察到颜色变化。
人工虹膜假体的植入可导致残留虹膜退缩综合征。残留虹膜可能被困在人工虹膜和前房角之间的裂隙中，阻止瞳孔进一步收缩。另一种可能性是残留虹膜的收缩或萎缩。巩膜缝合植入和囊袋内植入都被发现可以防止虹膜退缩。研究组数量不足，无法对这些不同的植入方法进行统计学比较。随着人工虹膜的使用增加，我们可能会在未来看到更多的虹膜退缩综合征患者。
