Objective: To evaluate the efficacy of a black diaphragm intraocular lens (IOL) implantation for congenital aniridia or traumatic iris deficiency and to explore the mechanism of postoperative complications.
Methods: The therapeutic effects and postoperative complications of twenty-five cases (27 eyes) of black diaphragm intraocular lens implantation were analyzed. Ultrasound biomicroscope (UBM) and gonioscopy were used to observe the position of the IOL haptics and anterior chamber angle structure in patient who developed secondary glaucoma postoperatively.
Results: After 3-18 months of follow-up, photophobia was reduced or disappear. The best corrected visual acuity (BCVA) Postoperation was improved 2 lines in 20 eyes, no change or within 1 line in 5 eyes, decreased 2 lines or more in 2 eyes. The complications included secondary glaucoma (10 eyes, 37.0%), astigmatism (17 eyes, 63.0%), corneal decompensation (2 eyes, 7.4%), hyphema (2 eyes, 7.4%), vitreous hemorrhage (3 eyes, 11.1%), and retinal detachment (1 eye, 3.7%). Of the 20 haptics in 10 patients, 9 were adequately located in the sulcus region, the others were located in chamber angle, ciliary processes or posterior to the ciliary processes. The changes of chamber angle included angle recession, anterior adhesion of iris and angle closure.
Conclusions: The black diaphragm intraocular lens implantation provides an effective method in the treatment of congenital aniridia or traumatic iris deficiency. Chamber angle impair is major cause of postoperative secondary glaucoma. Abnormality of lens haptics position, hemorrhage and persistent inflammation were also play a role in secondary glaucoma.