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Impressum
Experience with the artificial iris diaphragm in hypotonic eyes
Keller G. K. I., Dahlke C., Kuckelkorn R., Schrage N. F.
Universitätsaugenklinik der RWTH Aachen
Background: As a result of a partial or complete loss of the natural
iris diaphragm, longstanding silicone-oil tamponade frequently causes
keratopathy. Artificial iris diaphragm can avoid such complications. In
hypotony, with insufficient circulation of aqueous flow, the "close"
artificial iris diaphragm is used.
Methods: In this retrospective study 41 patients (41 eyes) were
observed, who recieved a close iris-diaphragm after silicone-oil surgery.
All 41 eyes were aphakic. The different diagnosis included trauma (22
eyes, 53,7 %), retinal detachment due to proliferative vitreoretinopathy
(12 eyes, 29,3 %), severe uveitis (4 eyes, 9,8 %) and proliferative diabetic
retinopathy (3 eyes, 7,3 %).
Results: In 25 eyes (60,9 %) silicone oil was retained behind the
iris diaphragm. In 14 eyes (32,4 %), silicone oil prolapsed in the anterior
chamber and resulted in a flatten anterior segment. In 2 eyes (4,9 %)
the silicone oil could not been described due to a very opaque cornea.
8 eyes (19,5 %) became a opaque cornea due to a flatten anterior chamber
with silicone oil endothelial contact. A deteriorated corneal situation
after the implantation of the diaphragm was observed in 11 eyes (26,9
%). As a longstanding complication permanent hypotony (£ 5 mm Hg)
in 29 eyes (70,8 %), fibrous reaction in 13 eyes (31,7 %) within fibrotic
membranes (9 eyes, 21,9 %) developed. The visual acuity remained stable
in 35 eyes (85,5 %), ameliorated in none eye and deteriorated in 5 eyes
(12,2 %). (One data missing)
Conclusion: Despite all complications, the artificial iris-diaphragm
is an important progress in the salvage of severely traumatized eyes though
there remains a persistent hypotony in 29 eyes (70,9 %). A silicone-oilendothelial-
contact is avoided in 25 eyes (60,9 %). Improvement of anterior-posterior
separation is necessary.