Artificial iris insertion for acquired aniridia

Evidence-based recommendations on artificial iris insertion for acquired aniridia. This involves inserting an artificial iris into the eye.

# Recommendations
Evidence on the safety and efficacy of artificial iris implant insertion for acquired aniridia is limited in quantity and quality. Therefore, this procedure should only be used with special arrangements for clinical governance, consent, and audit or research. Find out what special arrangements mean on the NICE website.
Clinicians wishing to do artificial iris implant insertion for acquired aniridia should:
Inform the clinical governance leads in their NHS trusts.
Give patients clear information to support shared decision making, including NICE's information for the public.
Ensure that patients understand the procedure's safety and efficacy, as well as any uncertainties about these.
Audit and review clinical outcomes of all patients having the procedure. NICE has identified relevant audit criteria and developed an audit tool (which is for use at local discretion).
The procedure should only be done by ophthalmic surgeons with appropriate experience and training.
Research could include the use of observational data from cohort studies or high-quality case series. Studies should report details of patient selection and the type of implant used. Outcomes should include quality of life and other patient-reported outcomes.
NICE may update the guidance on publication of further evidence.# The condition, current treatments and procedure

# The condition
Acquired aniridia means the iris is either missing or incomplete as a result of trauma, surgery or laser treatment.
People with aniridia may be very light sensitive (photophobic) and report symptoms of glare. They may develop other eye problems such as glaucoma, cataract and corneal opacification. The degree of vision loss varies.

# Current treatments
Treatment includes contact lenses with iris prints and tinted spectacle lenses.
Surgical implantation of an artificial iris device may be an option for some people with complete or partial acquired aniridia.

# The procedure
There are different devices available, including a solid acrylic ring or segment and a flexible silicone disc, which can be custom-made for each patient. The implant has a defined pupil size, which offers a compromise between day and night vision.
The artificial iris implant is inserted using local or general anaesthesia. The exact details of the procedure vary according to the type of implant being used.
Flexible implants are rolled up and inserted through a cut about 3 mm long at the edge of the cornea, into the posterior chamber of the eye. They are then unfolded and fixed in the eye. If sutures are needed to hold the implant in place, a larger cut may be necessary. The implant insertion can be done on its own or at the time of cataract or lens fixation surgery.
Solid ring implants are typically inserted during cataract surgery along with an intraocular lens. In some patients, an iris reconstruction lens containing both an artificial iris and a lens is implanted. Depending on the condition of the eye, the lens and iris device may need to be sutured to the sclera.
The aim of artificial iris implant insertion is to improve visual acuity, reduce photophobia and glare, and improve the eye's appearance.