Dr. Saurin Patel, O.D. and Dr. Sonal Patel, O.D.
James J. Howard VA Eye Clinic
Abstract:
Despite rare indications for prosthetic iris implantations, there are complications that
need prompt recognition and treatment. This case depicts complications of the procedure,
devastating course of disease, and importance of patient education on proper management
and treatment.
I.
Case History
A. 32 YO white female presents for first time at VA eye clinic in Chicago
1. Chief complaint is dissatisfaction of color of cosmetic iris
implants, dryness, and glare at night.
B. Past ocular history:
1. Bilateral PRK in 2005
2. Bilateral dry eyes
3. Bilateral iris implants
C. Past medical history/social history:
1. Anxiety
2. Hyperlipidemia
3. Liposuction in face
4. Breast implants
5. Rhinoplasty
6. Eyebrow lift
7. Lip surgery
D. Medications:
1.
Simvastatin
2.
Clonazepam
E. Other Salient Information
1. Allergy to codeine with reaction of emesis
II.
Pertinent Findings
A.
Clinical
1. Visual Acuities (without correction)
a. OD: 20/20
b. OS: 20/20
2. Direct pupillary response OD, however, pupil reaction OS could
not be determined due to blockage of pupillary frill from implant.
Consensual pupillary response and presence or absence of
afferent pupillary defect could not be assessed.
3. EOMs: NL, CVF: Full to Finger Count OD/ OS
4. Cornea: tr SPK OU, 3+ dispersed endothelial pigment and
epithelial scars OU. Anterior chamber: occasional pigment cell
OU. The patient’s true iris was minimally visible behind the
green intraocular implant of artificial iris OD, but not visible at
all OS
5. IOP: OD 28mmHg, OS 28mmHg at 9:05am by applanation
6. Lens: clear to extent seen OU
7. Dilated Fundus Exam:
a. OD: CD: 0.3
b. OS: CD: 0.3
8. Pachymetry: OD: 472um, OS: 485um.
9. Gonioscopy: Ciliary body in all quadrants with significant
pigment in the trabecular meshwork with areas of implant
obstructing views OU
10. HVF: OD: full, OS: full
11. Baseline corneal topography and anterior segment photos taken.
B.
C.
Physical
1.
BP: 120/78 right arm sitting.
2.
Pulse 69 bpm; strong, regular
Lab work including CBC, thyroid, and lipids: NL on medication
III.
Differential Diagnosis
A. Primary/Leading – Ocular hypertension OU secondary to cosmetic eye
surgery
IV.
Diagnosis and Discussion
A. Dry eyes OU s/p PRK OU
B. Ocular Hypertension s/p intraocular implant of artificial iris OU. Thin CCT,
but NL VF OU.
C. Anterior nongranulamatous iritis OU s/p intraocular implant of artifical iris
D. The reason for adverse effects in implants anterior to the iris is likely directly
related to chronic inflammation, pigment dispersion, and compression of the
trabecular meshwork by the implant and indirectly to chronic steroid use.
E. Indications for iris implants, despite there being no FDA approval, include
trauma, post-excision of iris melanoma, iris coloboma, congenital aniridia,
iridocorneal-endothelial syndrome and other inflammatory causes of iris
damage
F. Risks included intraoperative development of hyphema, suprachoroidal
hemorrhage and retinal detachment, and post-operative cataract development,
IOP increase, corneal edema/decompensation, uveitis, or endophthalmitis.
G. Explantation should be performed at the most earliest sign of any
complication
V.
Treatment Management
A.
AT QID OU
B.
C.
D.
E.
Begin Travatan qbedtime OU
Begin Brimonidine bid OU
Pt educated to have cosmetic iris implants explantation
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VI.
Conclusion
A. Although iris prosthetic devices do provide benefits, they can and do have
destructive results. Close and regular follow up is important to avoid such
complications. As with any medical procedure, risks and benefits should be
properly assessed. Depending on the reason for treatment, iris implant risks may
outweigh benefits, especially in cases for cosmetic purposes given the serious
complications of the implant and removal of implant. However, in contrast, a
patient with severe symptoms secondary to congenital or acquired defects the
benefits may outweigh the risks. This case portrays a young patient who had
healthy eyes that rapidly changed to diseased eyes as result of opting for cosmetic
iris implants. Patient education continues to be essential on proper treatment and
management.