Samuel Masket MD Advanced Vision Care Clinical Professor - UCLA Los Angeles

Transcription

1 Surgery for defects of the IRIS Samuel Masket MD Advanced Vision Care Clinical Professor - UCLA Los Angeles

2 Iris Defects Loss of Iris Tissue or function can have devastating effects on quality of vision, glare, cosmesis, and general quality of life Some cases are amenable for nonsurgical means, some can be sutured, while others require an artificial iris

3 Question # 1 Non Surgical Options For Iris Defects Include: 1 Dark Spectacles 2 Custom Contact Lenses 3 Corneal Tattoo 4 All of the Above

4 Question # 2 How many clock hours of iris defect can reliably be closed by sutures?

5 Iris suturing

6 Iris Suturing May Provide Only Limited Benefits

7 Iris Suturing Indications Repair peripheral and pupil margin iris defects Fixate IOLs Cerclage for atonic pupil Repair iridodialysis Basic Methods McCannel Technique via common paracentesis Siepser Sliding knot method 10-0 polypropylene suture material

8 Iris Cerclage

9 Seipser Sliding Knot

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12 SSIN DAN

13 - STASSIN DAN

14 Question # 3 How many clock hours of iris defect can reliably be closed by sutures?

15 Morcher Coloboma/CTR for limited iris defects

16 Original and Modified Aniridic Ring

17 Modified Ring Segments Outcome

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19 Post-Traumatic Subluxated Mature Cataract with Atonic Pupil

20 Morcher Iris Diaphragm IOL

21 Ophtec Aniridia devices

22 Question 4 Limitations of the Morcher and Ophtec Devices for Aniridia Include: 1 Less than ideal cosmesis 2 Large incision size 3 Poor color match 4 Inadequate sizing 5 All of the above

23 Humanoptics silicone custom artificial iris

24 Harnessing the Humanoptics Iris Bag Fixation Sulcus Fixation Sewn to IOL Sewn to Sclera Sewn to Native Iris Remnant

25 Harnessing the Humanoptics Iris Bag Fixation Sulcus Fixation Sewn to IOL Sewn to Sclera Sewn to Native Iris Remnant

26 SP Acute NAG/filter

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31 PERFORATING INJURY 49 y/o woman sustained perforating corneal injury to LE in 1980 RE normal all aspects LE CF VA

32 OUTCOME Le

33 Post-Op Uninvolved RE Implanted LE

34 Harnessing the Humanoptics Iris Bag Fixation Sulcus Fixation Sewn to IOL Sewn to Sclera Sewn to Native Iris Remnant

35 IFIS Non Tamsulosin

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37 Ice SP: kpe/pkp/shunt

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39 Harnessing the Humanoptics Iris Bag Fixation Sulcus Fixation Sewn to IOL Sewn to Sclera Sewn to Native Iris Remnant

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43 Perforating injury

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46 Harnessing the Humanoptics Iris Bag Fixation Sulcus Fixation Sewn to IOL Sewn to Sclera Sewn to Native Iris Remnant

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49 Harnessing the Humanoptics Iris Bag Fixation Sulcus Fixation Sewn to IOL Sewn to Sclera Sewn to Native Iris Remnant

50 Fish Hook injury age 5

51 Fish Hook Injury Age 5

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53 Fish Hook Injury age 5

54 Congenital Aniridia Mutation PAX6 Gene neuro-ectodermal abnormalities Wilm s Tumor 1:70 Aniridia (rudimentary stump) Photosensitivity, nystagmus Corneal stem cell deficiency with neovascularization, haze ulceration, and scarring Cortical, PSC, polar cataracts, THIN FRIABLE CAPSULE Zonulopathy Glaucoma- Aniridic Fibrosis Syndrome Foveal Hypoplasia or Aplasia reduced visual acuity

55 Congenital Aniridia

56 29 Y/O male Congenital Aniridia - Humanoptics Artificial Iris LE

57 Question 5 Advantages of the Humanoptics Artificial Iris Include: 1 Variable size implant 2 Outstanding Cosmesis 3 Able to be implanted through small incision 4 May be attached to eye tissue in many locations 5 All of the above

58 Humanoptics silicone custom artificial iris

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