A New Technique for Treating Posttraumatic Aniridia With Aphakia:  First Results of Haptic Fixation of a Foldable Intraocular Lens on a Foldable and Custom-Tailored Iris Prosthesis

Figure 1. First stage of implantation with iris prosthesis and intraocular lens (IOL). A, Two small stab incisions using a 0.9-mm microsurgical blade are created about 1 mm apart, passing through the back of the customized iris prosthesis (2 incisions at the 0° position and 2 at the 180° position). B, The haptics of a 3-piece IOL are docked inside the tip of a 28-gauge hollow needle and pulled through the small previously created tunnel in the iris prosthesis. C, Because of the high elasticity and stability of the iris prosthesis, the haptics are tightly attached to the back of the artificial iris. D, The haptics are slightly bent by using a needle holder to decrease the maximum diameter of the combined implant. Intraoperative video frames of this technique are found in the eFigure.

Figure 2. Suturing technique for placement of the iris prosthesis. A, Two scleral needles with a double-armed 10-0 polypropylene suture are passed obliquely through the sclera approximately 1.2 mm posterior to the limbus from the outside inward in an ab externo technique. B and C, The sutures are docked inside the tip of a 28-gauge hollow needle, which has been passed through the ciliary sulcus on the opposite side. D, Using a push-pull hook, the 2 sutures are pulled out through the superior tunnel.

Figure 3. Securing the ends of the sutures. A, The sutures are cut. B, The resulting 4 free ends are attached to the corresponding quadrant of the iris prosthesis. C and D, The free suture ends are pulled through the iris prosthesis along a loop that has been created with an additional polypropylene suture. E, Thereafter, the sutures can be firmly tied to the combined iris prosthesis–intraocular lens implant. F, The implant is partially folded and introduced through the tunnel incision.

Figure 4. Fixation of the combined implant. The implant is sutured to the sclera at 4 points with a polypropylene suture using a Z-suture technique in a zigzag-shaped pattern with 5 suture passes. The sutures are then cut at the level of the sclera and left without any knot.

Figure 5. Clinical photographs of patient 1. A, Before iris prosthesis–fixated intraocular lens (IOL) implantation, near-complete iris loss and aphakia is observed. Visual acuity at this time was 20/63 (with +11 diopters [D]), and the patient complained of debilitating glare and photophobia. B, Appearance at the last follow-up visit. The patient's visual acuity was 20/25 (with −0.5 D sphere), and glare and photophobia were absent. The IOL haptics are barely visible on the anterior surface of the iris prosthesis.