Surgical Technique for Explantation of Cosmetic Anterior Chamber Iris Implants
Narrative Responses:
Purpose
To describe a technique for removing a cosmetic silicone implant, a device used for alteration of iris colour with significant ocular complications of glaucoma, corneal edema and decreased vision, which may also reduce intraoperative complications associated with explantation of the device.
Methods
A 34 year old woman presented with bilateral cosmetic iris implants with decreased vision and corneal edema in her left eye. Corrected Distance Visual Acuity (CDVA) was 20/30 OD, 20/60 OS, and an endothelial cell count (ECC) of 904 OD and 864 OS. Intra-Ocular Pressure (IOP) was 14 mmHg OD and 16 mmHg OS. The iris implant was explanted with small incisions in 3 sections via a “slicing the pie” bimanual technique using iris microforceps, microscissors and microtyers.
Results
There were no intra-operative complications. Post-operative ECC was 928 OD and immeasurable OS. At her last visit 9 weeks post-op, BCVA was 20/30 OD and 20/200 OS. The cornea was clear in the right eye, though there was persistent moderate corneal edema in the left eye. There was no evidence of cataract, or cystoid macular edema in either eye. Her IOP was 9 mmHg OD and 15 mmHg OS, well-controlled on brimonidine/ timolol.
Conclusion
Our patient required removal five years after implantation, which is the longest reported interval in the literature. This suggests that as long as these devices are present, ocular structures remain at risk and explantation is recommended for all patients. The removal technique we describe may also minimize intra-operative complications.