EyeWorld India March 2021 Issue

44 EWAP MAR C H 2021 CORNEA T here are several companies in the field of artificial irises. Kevin M. Miller, MD, and Sathish Srinivasan, MD, discussed the available products and important considerations when working with artificial irises. Currently, there is only one product FDA approved in the U.S., the CUSTOMFLEX (HumanOptics), which has models with and without fiber. Other companies working on such devices that are not yet commercially available in the U.S. are Morcher and Reper. Dr. Miller said Ophtec was working on artificial irises but as of January 2020 discontinued sale. Dr. Miller has experience with the Morcher artificial iris under an investigational device exemption, making him the only person in the U.S. allowed to implant it. Dr. Miller performs 1–3 artificial iris cases a month. In general, he said these cases are by Ellen Stodola Editorial Co-Director Contact information Miller: kmiller@ucla.edu Srinivasan: sathish.srinivasan@gmail.com This article originally appeared in the December 2020 issue of EyeWorld . It has been slightly modified and appears here with permission from the ASCRS Ophthalmic Services Corp. Current options in artificial irises a lot of work from start to finish. Dr. Srinivasan has a few more options with the CE mark available to him in the UK. He has experience with the Ophtec, Morcher, and HumanOptics devices and said he has done more than 100 cases. Most are patients with large iris defects, he said, noting that they’re not for cosmetic iris color changes. Best patients for artificial irises Dr. Srinivasan again stressed that artificial irises are for medical use, such as for patients who have had trauma or damage to the iris or pupil for which sutures cannot be used. A partial or total artificial iris to reconstruct the pupil, iris, or both may be necessary, he said. The treatment plan depends on the size of the defect. “Some of the defects could be corrected using a cosmetic contact lens with an artificial iris or pupil painted on it,” Dr. Srinivasan said. “If that doesn’t work, then we have to see how big the defect is.” A partial defect might accommodate surgical iris reconstruction, but if there is extensive iris or pupil loss, that’s where artificial devices come into play, he said. Morcher makes partial implants that can help with smaller defects and is the only company to do so. Larger defects merit a full artificial iris. The Morcher product, Dr. Srinivasan said, is not custom made, so this can be used if it fits the patient’s profile. The HumanOptics artificial iris is a custom implant based on a photograph of the fellow eye (assuming the fellow eye is normal). The Reper device is also off the shelf, so the sizing is not custom, but the color can be customized. Dr. Srinivasan highlighted the learning curve with these devices and said “it requires a Three months after implantation and scleral suture fixation of a HumanOptics artificial iris and intraocular lens. Cornea remained clear and the artificial iris was both functional and cosmetically acceptable. The two 10-0 nylon sutures were subsequently removed. Source (all): Kevin M. Miller, MD A hockey puck injury resulted in globe rupture and orbital floor fracture. After globe repair and several surgeries to repair retinal detachment, the patient was aphakic and had both a traumatic mydriasis and large inferior iridectomy. continued on page 35