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Blurred Vision in a Young Woman With Cosmetic Iris Implants

Educational Objective
Based on this clinical scenario and the accompanying image, understand how to arrive at a correct diagnosis.
1 Credit CME

A 34-year-old woman presented with photophobia in both eyes. Six months earlier while abroad, the patient had bilateral cosmetic iris implants (BrightOcular) placed. The patient had a mild change in refractive error postoperatively and was offered laser in situ keratomileusis surgery for correction. She did not report any other immediate postoperative complications. For 4 weeks before presentation, she had blurred vision of the right eye.

Her visual acuity was 20/50 OD and 20/25 OS. Intraocular pressure (IOP) was 31 mm Hg in the right eye and 17 mm Hg in the left. The pupillary reflex could not be visualized secondary to the iris implants. Slitlamp examination revealed trace anterior chamber cell bilaterally with pigmented keratic precipitates. The implants were overlying the iris structures (Figure 1A). Results of an ultrasonographic biomicroscopy are shown in Figure 1B. Posterior examination was limited by the iris implants, but the optic nerve did not reveal edema or hemorrhages. The peripheral retina could not be visualized in either eye.

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Uveitis-glaucoma-hyphema syndrome secondary to cosmetic iris implants

D. Remove the cosmetic iris implants surgically

Herpetic keratouveitis can present with elevated pressure, anterior chamber cells, and keratic precipitates, as in this patient’s case. However, these findings are most commonly unilateral in herpetic disease.1 Thus, initiating oral acyclovir (choice C) would not be the most appropriate option.

Instead, on the basis of the initial presentation of anterior chamber cells, elevated IOP, and pigmented keratic precipitates, a diagnosis of uveitis-glaucoma-hyphema (UGH) syndrome secondary to the patient’s cosmetic iris implants was made. Initially conceived for use in patients with congenital or traumatic aniridia, iris implants were first used in 1994.2 A decade later, anterior chamber iris implants were marketed for cosmetic purposes. These cosmetic implants have been associated with multiple complications aside from UGH syndrome, including corneal decompensation, synechiae formation, iris and retinal neovascularization, and cataracts.35

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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.

Article Information

Corresponding Author: Guillermo Amescua, MD, Bascom Palmer Eye Institute, 900 NW 17th St, Miami, FL 33130 (gamescua@med.miami.edu).

Published Online: June 17, 2021. doi:10.1001/jamaophthalmol.2020.6549

Conflict of Interest Disclosures: None reported.

Additional Contributions: We thank the patient for granting permission to publish this information.

References
1.
Cunningham  ET  Jr .  Diagnosing and treating herpetic anterior uveitis.   Ophthalmology. 2000;107(12):2129-2130. doi:10.1016/S0161-6420(00)00287-6 PubMedGoogle ScholarCrossref
2.
Sundmacher  R , Reinhard  T , Althaus  C .  Black-diaphragm intraocular lens for correction of aniridia.   Ophthalmic Surg. 1994;25(3):180-185.PubMedGoogle Scholar
3.
Hoguet  A , Ritterband  D , Koplin  R ,  et al.  Serious ocular complications of cosmetic iris implants in 14 eyes.   J Cataract Refract Surg. 2012;38(3):387-393. doi:10.1016/j.jcrs.2011.09.037 PubMedGoogle ScholarCrossref
4.
Sikder  S , Davis  SW , Holz  H , Moshirfar  M .  Complications of NewColorIris implantation in phakic eyes: a review.   Clin Ophthalmol. 2011;5:435-438.PubMedGoogle Scholar
5.
Arthur  SN , Wright  MM , Kramarevsky  N , Kaufman  SC , Grajewski  AL .  Uveitis-glaucoma-hyphema syndrome and corneal decompensation in association with cosmetic iris implants.   Am J Ophthalmol. 2009;148(5):790-793. doi:10.1016/j.ajo.2009.06.008 PubMedGoogle ScholarCrossref
6.
Ellingson  FT .  The uveitis-glaucoma-hyphema syndrome associated with the Mark VIII anterior chamber lens implant.   J Am Intraocul Implant Soc. 1978;4(2):50-53. doi:10.1016/S0146-2776(78)80054-8 PubMedGoogle ScholarCrossref
7.
Arjmand  P , Gooi  P , Ahmed  IIK .  Surgical technique for explantation of cosmetic anterior chamber iris implants.   J Cataract Refract Surg. 2015;41(1):18-22. doi:10.1016/j.jcrs.2013.12.027 PubMedGoogle ScholarCrossref
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