Artificial iris and intraocular lens implantation by modified Yamane technique after penetrating ocular trauma

Author: Amparo Toro (Spain)

Co-authors: Juan De Las Morenas, Sergio Matas, Antonio Uceda, Arturo Talego

Purpose

Traumatic aphakia and aniridia are one of the most challenging surgical cases to manage. We present the combined artificial iris and intraocular lens (IOL) implantation using the modified Yamane technique in a patient with aphakia and significant iridocorneal sequelae after penetrating trauma.

Setting/Venue

We present an aphakic patient with severe iris defects and corneal leukomas. The absence of enough capsular remnants associated with the iris damage led us to consider the implantation of a scleral-fixed IOL and an iris prosthesis. The Yamane technique associated with the artificial iris proved to be an effective optical and cosmetic correction alternative.

Methods

A 58-year-old patient suffered a penetrating ocular trauma in one of his eyes. After the primary globe rupture repair he had a second repairing surgery including new corneal suture, vitrectomy and extraction of crystalline debris. The patient results with significant iris atrophy, aphakia, corneal leukomas and a visual acuity of hand motion. Six months after the trauma, the Yamane technique associated with artificial iris implantation was proposed. The IOL was fixed to the artificial iris prior to surgery. We start the procedure removing the remnants of the atrophic iris. Due to the iridocorneal disruption the intraoperative visualisation of the IOL haptics was poor. Because of this difficulty we decided intraoperatively to fix one of the two IOL haptics to the sclera and left the other haptic in sulcus over some remnants of the lens capsule.

Results

One year after surgery, the IOL-iris complex remains stable, with a best corrected visual acuity of 20/32 and a spherical equivalent of - 1.5D in the injured eye. The absence of sutures allowed by the Yamane technique minimizes the risk of instability following suture resorption that could occur in the next years.

Conlusions

Combining haptics fixation of a 3-piece IOL onto an iris prosthesis provides an excellent cosmetic and functional results. Fixation the haptics to the sclera avoids the use of sutures and its long-term resorption. The artificial iris implant associated with an IOL using the Yamane technique is an excellent sutureless alternative in the management of penetrating ocular trauma with iris and lens involvement.

Financial Disclosure

None of the autors have any financial interests in the products shown in this video. Dr Antonio Uceda-Montañes is Medical Monitor in the EMEA region for Johnson and Johnson Vision.