By Lisa B. Arbisser, MD
The authors describe their experience performing in one patient the new surgical technique of femtosecond-assisted keratopigmentation (KTP) for severe visual dysfunction secondary to unilateral essential iris atrophy. The patient presented with photophobia and monocular diplopia in one eye and was subsequently diagnosed with iridocorneal endothelial syndrome (ICE). After undergoing KTP at the authors’ clinic in Alicante, Spain, she reported complete elimination of photophobia and diplopia and the authors report an excellent cosmetic result. Given that we have so much difficulty gaining access to iris implants for our patients, this is an eye-opening technique.
Published in the October issue of the Journal of Refractive & Cataract Surgery, the authors believe this to be the first report of severe visual function disability caused by essential iris atrophy that was corrected with KTP. The patient, a 23-year-old woman, had been referred to the authors’ clinic with complaints of severe light sensitivity and progressive cosmetic deformation of the iris in her left eye.
Initial examination found that she had ICE and a CDVA of 20/25 in this eye. External examination showed an oval pupil pattern. Slitlamp examination revealed advanced iris atrophy with large iris holes and an oval pupil. The endothelium showed guttata-like changes. Corneal specular microscopy showed an abnormal endothelial configuration with a low cell count of 1225 cell/mm2. The right eye was normal, with CDVA of 20/20. The patient was advised to use sunglasses, and a conventional cosmetic contact lens was prescribed and adapted to relieve her visual disturbances.
However, three months later, she complained of photophobia and blurred vision while reading and reported poor tolerance and fluctuating vision even while wearing the cosmetic contact lens. Examination revealed that the iris defect had progressed significantly, with more nasal extension and large pupil irregularity and corectopia and polycoria, resulting in monocular diplopia. She was then offered the option of KTP surgery.
At the immediate follow-up exam after KTP, the patient reported minimal conjunctival injection and ocular discomfort, which disappeared during the third postoperative day. After three months, CDVA was 20/20, and photophobia and diplopia were completely eliminated. The authors report no adverse events during 12 months of follow-up.
This case of essential iris atrophy is an example of the applicability of KTP to the restoration of functional problems created by iris defects. The authors say that the use of new micronized mineral pigment is an essential step in the modern development of KTP, and their experience using it has demonstrated its safety during two years of follow-up. They recommend future studies of the stability of this pigment in order to determine its half life in the corneal stroma.