Iris implant surgery: everything you need to know

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Iris implantation surgery is the procedure to place a prosthesis of the iris, the colored part of the eye. It can restore vision and change the color of the eyes . Originally developed to treat people with iris defects such as ocular albinism or aniridia .

Surgery is also sometimes used for cosmetic purposes around the world. However, the use of artificial iris implants for non-medical purposes is considered risky and is prohibited by the Food and Drug Administration (FDA). Iris implantation surgery is often performed in conjunction with a cataract procedure , lens implantation, or corneal transplant .

Get Medical Information / Jessica Olah

What is iris implantation surgery?

Iris implantation surgery is an outpatient procedure used to insert a prosthetic iris into the eye under local anesthesia.

This technique was first developed in 1956 to repair iris defects caused by birth problems, disease, or injury. Research shows that iris lens diaphragm implants help restore iris function, including reducing glare and improving visual acuity.

Prosthetic iris implants used to improve visual acuity come in several different types, including:

  • Lens iris diaphragm
  • Endocapsular tension ring with ribs
  • Custom artificial iris

Most iris implants are available in several standard colors, such as blue, green, brown, and black. Patients requiring surgery on one eye may want to choose a custom iris that best matches the color of their other eye.

Contraindications

Artificial iris implants are only recommended for people with iris defects who do not have a clear lens. Most healthcare professionals require the eye to have cataracts , no lens (aphakic), or an artificial lens (pseudophakic) to be a candidate for iris implantation surgery.

People who lack iris (aniridia) and clear lenses are not good candidates for iris implants because a functional lens should not be sacrificed to correct an iris defect.

In addition, artificial iris implants are contraindicated in people for whom any of the following conditions apply:

  • Active eye infection
  • Uncontrolled inflammation of the eyes
  • Eye conditions that cause the eye to have an abnormal size, shape, or function (such as microphthalmos or rubella cataracts )
  • Untreated retinal detachment
  • Untreated chronic glaucoma
  • Rubeosis of the iris
  • Proliferative diabetic retinopathy
  • Stargardt retinopathy
  • The pregnancy

Potential risks

Functional prosthetic iris implants are designed to be placed in a sulcus or within a capsule, whereas cosmetic implants are placed in the anterior chamber above the iris .

The complication rate is low for functional iris implants, but higher for cosmetic implants. The risks of iris implants include :

  • Decreased vision or blindness.
  • Increased pressure inside the eye, which can lead to glaucoma.
  • waterfalls
  • Trauma to the cornea leading to vision problems.
  • Blurred vision and watery eyes due to inflammation of the iris.

Purpose of iris implantation surgery

The iris is a colored ring of muscle fibers behind the clear cornea and in front of the lens of the eye. In addition to eye color, the iris contracts and expands, changing the size of the pupil. This controls the amount of light that enters to improve focus at different distances.

Therefore, an altered iris can affect vision. Iris implantation surgery is used to improve vision in patients with:

  • Traumatic defects of the iris, such as from trauma or previous surgical procedures.
  • Congenital aniridia is a condition in which one or both of the irises are missing at birth.
  • Iris coloboma , a hole or other defect in the iris
  • Herpetic atrophy of the iris, damage from a herpes outbreak in the eye.
  • Surgical loss of the iris
  • Ocular albinism is a genetic disorder that reduces the pigmentation of the iris.

Most iris prosthesis implant patients report a significant decrease in sensitivity to light and brightness and an overall improvement in vision.

To make sure you are eligible for iris implantation surgery, your ophthalmologist will perform a complete eye exam. This could include:

  • Visual acuity test (vision chart)
  • Refraction to measure the strength of a recipe.
  • Tonometry to check intraocular pressure
  • Gonioscopy to check the angle of the anterior chamber.
  • Ophthalmoscopy to examine the peripheral retina.
  • Mirror microscopy to determine the number of endothelial cells.

Additionally, your healthcare professional will measure the anterior chamber depth, axial length, and corneal diameter, and will take photographs to match the iris color for custom implants.

The doctor will also discuss your medical history, including whether you have diabetes , hepatitis B or C, Behcet's disease, collagen tissue disease, or a previous episode of uveitis, and will ask about current and past medications.

Unauthorized use for cosmetic purposes.

In some places, iris implants are also used to permanently change the color of the eyes for cosmetic purposes, such as changing brown eyes to blue. However, cosmetic iris implants are not approved in the US or Europe due to the risks of surgery .

The American Academy of Ophthalmology, the American Glaucoma Society, and the Association of Contact Lens Ophthalmologists strongly discourage people from undergoing cosmetic iris implant surgery because of the potential damage it can cause to healthy eyes .

Although not recommended, Americans who wish to undergo cosmetic eye discoloration surgery sometimes travel outside of the country (such as Mexico, Panama, or Costa Rica) to undergo this procedure, a practice known as medical tourism .

If you want to change your eye color for cosmetic reasons, you may want to consider other options. In addition to color contacts, the color of the eyes can be permanently changed with a laser that destroys the upper layer of melanin (pigment) in the eye, the amount of which determines the color / tint of the eyes. This will make your brown eyes turn blue forever.

While it can give you the look you want, the American Academy of Ophthalmology cautions that the procedure carries risks of glaucoma, uveitis, and can lead to blindness .

How to prepare

For many years, iris implants were only approved individually in the United States under the FDA's compassionate devices exemption, which meant the agency had to approve your particular surgery.

That changed in 2018 when the CustomFlex (from HumanOptics) artificial diaphragm received FDA clearance for medical use. Made of thin, collapsible medical grade silicone, the iris prosthesis is custom-made for each individual patient, and can be used by healthcare professionals without additional FDA review of the patient's case if they meet the criteria for surgery .

However, for patients requiring iris implantation for medical reasons, the road to surgery can be long and bureaucratic. Few medical professionals are certified to perform surgery in the United States, so you can take the time to find someone who is qualified and available to you.

If you are in medical tourism, it is very important to research and verify the qualifications of the surgeon. Traveling abroad for any cosmetic surgery can be risky in itself, and improperly performed eye surgery can lead to permanent blindness.

Also, there is no billing code for the procedure, which means that the surgeon cannot bill any insurance plan for it. Insurance may cover the cost of a pre-authorized iris prosthesis, but you will most likely have to pay out of pocket.

Orders and planning

Before prescribing iris implantation surgery, the ophthalmologist will need to take accurate measurements and photographs of your eyes in order to request a prosthesis. Since each iris implant is custom-made, the wait can be several months. After submitting the order, the surgeon's office will contact you to schedule the operation.

You will not be allowed to drive after surgery, so be sure to arrange your trip home as soon as your surgery date is set.

What to Expect the Day of Surgery

When you arrive at the outpatient center, you will most likely be asked to fill out various forms and verify your personal information.

Before the procedure

You will then be taken back to the treatment room for a brief examination by the doctor. The surgeon will cover your eyes with drops to relieve pain. Your head will be tied in a headgear to keep your head still, and a small device will be placed to keep your eyelid open and prevent blinking.

During the procedure

Once the pain relievers have worked, the surgeon will begin the procedure. If you have work ahead of you other than iris surgery, such as cataract surgery, your doctor will start with that and complete the iris implantation.

To implant the iris, the surgeon makes a small incision in the cornea where it meets the sclera (the white part of the eye). The silicone iris is folded and inserted through the incision. The prosthesis is then unfolded and sutured to the natural iris.

After the procedure

After the surgery is complete, your healthcare professional will give you instructions for caring for your eyes, which may include wearing dark glasses to protect you from light. They will also prescribe eye drops to prevent infection and complications. Then they will send you home.

Recovery

Healing after iris implantation surgery is highly dependent on the condition of the eye before surgery. Most patients make a full recovery within a few weeks without complications. Your healthcare professional will tell you when you can return to your normal activities.

Follow all instructions from your healthcare provider and call if you have any questions or concerns. Your healthcare provider will most likely ask you to return for several follow-up visits to monitor your recovery.

Recovery

In the first 24 to 48 hours after surgery, grit or scratches may appear in the eye. Your vision may be blurry and your eye may water. Don't touch or lose your eyes. Your surgeon may recommend that you sleep with a protective eye patch at night to prevent this.

Sensitivity to light is common after iris implantation surgery and should decrease within a few days. Your eye may also become slightly swollen after surgery, which can lead to slightly blurred vision that persists for the first week or so.

Your healthcare provider will likely prescribe antibacterial drops or other medications to help prevent infection. They may also recommend the use of lubricating drops , a cold saline-soaked cloth as a compress, or over-the-counter pain relievers such as Tylenol (acetaminophen) to relieve postoperative pain.

Get the word of drug information

Iris implantation surgery should only be performed by a qualified and experienced ophthalmologist. It is currently only medically approved in the United States. If you are looking to undergo cosmetic eye color change surgery abroad, be sure to research this institution and the surgeon. If not done correctly, iris implantation surgery can lead to complications, including blindness.

Frequently asked questions

  • Cosmetic iris surgery outside of the US is estimated to cost up to $ 10,000, not including travel costs. Eye discoloration surgery for any reason other than medical treatment is not approved by the FDA.

  • There is nothing you can do to naturally change the color of the iris. However, there are diseases in which a change in eye color can occur spontaneously, including:

    • Fuchs' heterochromic iridocyclitis (inflammation of certain structures of the eye, including the iris)
    • Pigment dispersion syndrome ( loss of pigments)
    • Uveitis (inflammation of the middle layer of the eyeball)
    • Horner syndrome
    • Eye wound

    If you notice that the color of one or both eyes has started to change, see an ophthalmologist immediately.

  • The American Academy of Ophthalmology cautions that this procedure, which aims to turn brown eyes into blue with a laser to remove melanin (the pigment responsible for skin, hair, and eye color) from the iris, has a number of possible security risks. including glaucoma and uveitis. Laser eye color change surgery is not available in the United States.

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