Devastating complication of cosmetic iris implants.

A 29-year-old patient presented to our clinic in the year 2016, with complaints of poor vision in both eyes. The visual acuity was 20/500 in the right eye and 20/200 in the left eye. He had a history of multiple ocular surgeries performed in both eyes elsewhere in the past. In 2013, he had undergone cosmetic iris implants (BrightOcular) in India for a change in the natural color of his iris. Few months after the surgery, he suffered recurrent episodes of redness in both eyes for which topical prednisolone acetate 1% and antiglaucoma medications were advised. Subsequent follow-up visits also revealed raised intraocular pressures in both eyes. The intraocular pressure was brought under control with medications in the left eye, but the right eye had medically uncontrolled glaucoma. Trabeculectomy was performed in the right eye and cosmetic iris implants were removed from both the eyes 3 months later. Antiglaucoma medications were continued in both eyes. The intraocular pressures were under control, but he developed progressively increasing corneal edema.

On examination at this visit, he had corneal edema in both eyes, the anterior chamber was shallow due to extensive peripheral anterior synechiae, the iris pattern was distorted, and pupil was eccentric in both eyes [Fig. 1a and b]. The right eye had a large superior iridectomy, a cataractous lens, and a filtering bleb in the superior bulbar conjunctiva. The optic nerve showed advanced disc cupping in the right eye with cup-to-disc ratio of 0.7 in the left eye. In view of corneal edema with poor vision, endothelial keratoplasty was performed in the left eye followed by cataract surgery (phacoemulsification with posterior chamber intraocular lens) and endothelial keratoplasty in the right eye.

Figure 1

(a) Slit-lamp photograph of the right eye showing diffuse corneal edema, extensive peripheral anterior synechiae, cataract, and superior iridectomy. (b) Slit-lamp photograph of the left eye showing corneal edema, shallow anterior chamber, and peripheral anterior synechiae

Iris implant surgery is an option in patients with aniridia and traumatic iris defects for better cosmesis.[1] Although the iris implant devices are not Food and Drug Administration approved, the number of these surgeries in normal eyes for reasons of changing the iris color is on the rise in some countries including India. The use of iris implants for cosmetic reasons in normal eyes is a debatable concept. Several cases of complications with this procedure in normal eyes have been reported from countries other than India.[2345] It is possible that these complications lack a proper reporting in India. The various complications that can occur are chronic uveitis, raised intraocular pressures, glaucoma, cataract, and corneal decompensation. In the case described here, raised intraocular pressures and anterior chamber inflammation warranted implant removal at an earlier stage to prevent irreversible ocular damage. This report highlights the devastating consequences of this surgery in normal eyes and calls for an urgent attention to condemn and ban this surgery.

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