Surgical Technique for Removal of Cosmetic Iris Implants

Monday, April 20, 2015: 3:01 PM
Room 5A (San Diego Convention Center)
Andrew A. Kao, MD
Kenneth J. Rosenthal, MD

To describe a surgical technique for removal of silicone cosmetic iris implants in a patient with increased intraocular pressure, anterior segment inflammation, and corneal endothelial decompensation OU.

A 27 year old woman presented with bilateral cosmetic iris implants reporting photophobia, redness, pain, and increased intraocular pressure (IOP) for the previous three months. Best corrected visual acuity (BCVA) was 20/25 in both eyes. Endothelial cell count (ECC) was 1104 OD and 1294 OS. IOP was 14 mmHg OD and 48 mmHg OS. The patient was started on IOP-lowering eyedrops. Surgery was performed OS first, then OD, one month apart. The iris implants were explanted in one piece via a 2.75 mm incision using microforceps and intraocular lens-cutting scissors and performing an implant sphincterotomy.

There were no intraoperative complications. Post-operative findings included BCVA of 20/30 OU, IOP 22 and 24, multiple areas of iris atrophy with transillumination defects, peripheral anterior synechiae, trabecular meshwork pigment deposition, and vacuolar lenticular changes.

Cosmetic iris implants are not FDA-approved devices that may result in glaucoma, uveitis, corneal decompensation, cataract, and iris atrophy. Removal of the implants may not result in resolution of these complications, due to permanent damage to the endothelium, trabecular meshwork, and lens. Further surgery may be necessary to treat these complications.