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Microscopic analysis of preinsertion cutting modalities on custom, flexible iris prostheses.

Michael E Snyder1, Adam R Leone, Liliana Werner

  • 1From the Cincinnati Eye Institute, Cincinnati, Ohio (Snyder); University of Cincinnati College of Medicine, Cincinnati, Ohio (Snyder, Leone); Intermountain Ocular Research Center, Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah (Werner, Bundogji, Hawn).

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Modifying custom iris implants can create sharp edges, increasing inflammation risk. Minimizing post-manufacture alterations and choosing smoother cutting methods like disposable blades is recommended for better patient outcomes.

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Area of Science:

  • Ophthalmology
  • Biomaterials Science
  • Surgical Device Engineering

Background:

  • Custom iris implants are used to correct iris defects.
  • Post-manufacture modifications are sometimes performed to fit implants.
  • The impact of these modifications on implant edges is not fully understood.

Purpose of the Study:

  • To evaluate the edge effects induced by various clinical modification techniques on custom iris implants.
  • To compare the smoothness of cut edges resulting from different cutting tools and methods.

Main Methods:

  • Custom iris prostheses were modified using described patterns, blades, and surgical instruments.
  • Edges were analyzed using slitlamp microscopy, light microscopy, and scanning electron microscopy.

Main Results:

  • Disposable blades produced smoother edges than scissors.
  • Trephine blade brand influenced silicone matrix cut surface smoothness.
  • Meshwork-embedded implants showed irregular sharp edges, particularly with scissors and certain trephine brands.
  • Pseudoiridectomies and scissor cuts generated sharp peripheral points and corners.

Conclusions:

  • Minimizing post-manufacture modifications of iris implants is advisable.
  • Fiber-free implants with fewer sharp edges may be better for sulcus placement.
  • In-the-bag placement can reduce the clinical effect of sharp edges.
  • These strategies may decrease post-implantation inflammation.