Arslan Osman Sevki, Toker Mustafa Ilker, Yildirim Rengin, Ozdamar Akif, Sevim Okay, Gursoy Huseyin, Ozkok Ahmet Department of Ophthalmology Istanbul University Cerrahpasa Medical School Istanbul, TURKEY The iris prosthesis applications in aniridic or wide iris defective patients

Pupil and iris work separately or together and make functions as 1-Regulating light dosage 2-Preventing eyes from extreme amount of light 3-Contributing fluid circulation between the chambers 4-Contributing anterior chamber angle structure and its function 5-Allowing intraocular lens implantation Pupil and Iris

Absence/damage of subtotal or total iris tissue Pupil shape and function disorders Congenital and acquired (trauma, surgery) factors can be responsible.

Traumatic and non- traumatic factors Subtotal / total damage in pupil and iris tissues Loss or decrease of function Indication of surgical treatment

Congenital aniridia  It is generally found together with the other abnornalities and nystagmus.  In best cases, the visual acuity stays at 1- 2/10 level with Snellen chart.  In all iris defective cases, the most important symptom is light discomfort.

Congenital aniridia  When intraocular surgery indication is concluded for the other ocular pathologies (cataract, corneal opacity, etc.) together with iris-pupil pathology, the surgery for iris defect can be performed at the same session or iris – pupil reparation can be done in next session.

In this study, 54 patients who had iris defect with several reasons, and who were applied iris prosthesis during the other surgeries for other indications were included. Sex 31 male (57%) 23 female (43%) Age Min 2 years Max 79 years Mean age 36.4  12.7 years Cases

Follow-up time Min 6 months Max 7 years Mean (3.27  1.62 years) Etiopathologic causes of the surgeries Congenital aniridia →2 Traumatic iris-pupil defect (including operative cases) →36 Traumatic iris-pupil defect (including operative cases) → 36 Silicon keratopaty associated iris and/or pupil damage →10 Silicon keratopaty associated iris and/or pupil damage → 10 Fixed dilated pupil due to Urres-Zavalia syndrome → 5 Fixed dilated pupil due to glaucoma surgery →1 Fixed dilated pupil due to glaucoma surgery → 1 Total 54 Cases

Pupil and iris tissue reparations were performed in combination with other surgical procedures. Surgery

The aims of pupil and/or iris tissue reparations: 1-Prevention of light discomfort 2-Contributingvisual clarity 2-Contributing visual clarity 3-Blocking passage of silicon oil to anterior chamber 4-Cosmetic purpose Surgical procedure

Reparation techniques performed with several prosthetic implants designed for the management of damaged iris and pupil. Surgical Technique

Iris – pupil diaphragm Iris – pupil diaphragm + peripheric iridectomy peripheric iridectomy + Reconstruction with the implants having intraocular lens function Reconstruction with the implants having intraocular lens function

Pupil reconstruction with the colored-opaque implants during cataract surgery.

Iris colored big optic scleral fixation lens implantation during keratoplasty with indications such as - Optic - Restoration of iris function - Cosmetic

Prosthetic iris implantation in capsular bag - During cataract surgery - During keratoplasty

 Any toxic reactions associated with the used prosthetic iris implantation were not seen in the patients during follow-up. Any findings related to bio-discrepancy were not occurred. Postoperative Evaluation

The positive effects below were detected 1-Reducing light disaster 2-Increasing visual acuity 3-Preventing from silicon oil damages 4-Cosmetic improvement of the patients Postoperative Evaluation

In iris defective cases, the appropriate iris prostheses selected according to iris defect type and its size increase the visual success and postoperative patient comfort during surgeries performed for another pathology. The cosmetic benefit is an additional positive side of the prostheses. Conclusion