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An '''artificial iris''' is an intraocular implant (implant inside the eye) that is used as both a cosmetic and to treat those with [[aniridia]] (missing or damaged [[Iris (anatomy)|irises]]) or other eye trauma.<ref>{{Cite web |last=Shahreef |first=Farah J. |date=April 2016 |title=Engineering a Light-Attenuating Artificial Iris |url=https://iovs.arvojournals.org/article.aspx?articleid=2518409 |access-date=2023-10-17 |website=iovs.arvojournals.org}}</ref> People with this condition experience [[photophobia]], which means their eyes absorb too much light.<ref name=":4">{{Cite journal |last=Mayer |first=Christian |last2=Tandogan |first2=Tamer |last3=Hoffmann |first3=Andrea E. |last4=Khoramnia |first4=Ramin |date=2017-06-01 |title=Artificial iris implantation in various iris defects and lens conditions |url=https://www.sciencedirect.com/science/article/pii/S0886335017303346 |journal=Journal of Cataract & Refractive Surgery |volume=43 |issue=6 |pages=724–731 |doi=10.1016/j.jcrs.2017.06.003 |issn=0886-3350}}</ref> The artificial iris, made from [[silicone]], acts as a replacement iris. The artificial iris is implanted in the eye using different surgery techniques depending on the patient's eye trauma. Most of the major artificial iris manufacturers are European and the treatment is used sparingly in the United States because of limited [[Food and Drug Administration|FDA]] approval. This is because of the possibility of vision loss and other risks.<ref>{{Cite journal |last=Charters |first=Lynda |date=2022-04-30 |title=Cosmetic iris implants pose high risk of vision loss |url=https://europe.ophthalmologytimes.com/view/cosmetic-iris-implants-pose-high-risk-of-vision-loss |series=Ophthalmology Times Europe May 2022 |language=en |volume=18}}</ref>
An '''artificial iris''' is a surgically implanted device to treat damage or absence of the [[iris (eye)|iris]] of the eye.<ref>{{cite web |title=Iris Implants Advance—but Face Continuing Challenges |url=https://www.aao.org/eyenet/article/iris-implants-advance-face-continuing-challenges |website=American Academy of Ophthalmology |date=1 February 2013}}</ref>


== Basic Function ==
In 2018, the United States [[Food and Drug Administration]] approved the first artificial iris, CustomFlex Artificial Iris developed and produced by [http://www.humanoptics.com/en/physicians/artificialiris/ HumanOptics Holding AG], made of medical grade [[silicone]].<ref name=fda>{{cite web |last1=Commissioner |first1=Office of the |title=Press Announcements - FDA approves first artificial iris |url=https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm609291.htm |website=www.fda.gov |date=24 March 2020 |language=en}}</ref>


=== Medical Function ===
The device improves vision by controlling the amount of light let into the eye. It also improves cosmetic appearance.<ref name=fda/> There are a number of surgical techniques for implanting the prosthetic.<ref>{{cite journal |last1=Mayer |first1=Christian |last2=Tandogan |first2=Tamer |last3=Hoffmann |first3=Andrea E. |last4=Khoramnia |first4=Ramin |title=Artificial iris implantation in various iris defects and lens conditions |journal=Journal of Cataract & Refractive Surgery |date=June 2017 |volume=43 |issue=6 |pages=724–731 |doi=10.1016/j.jcrs.2017.06.003|pmid=28732604 |doi-access=free }}</ref>
The artificial iris treats those who were born with aniridia or who have experienced eye trauma that lead to a damaged iris. This eye trauma can occur as a result of a complication from serious eye surgeries such as a ruptured [[Globe (human eye)|globe]] repair. The iris controls how much light enters the eye, so if a patient has a damaged iris or lacks an iris they can experience large amounts of glare from normal daylight.<ref>{{Cite web |last=Galehouse |first=Maggie |date=2019-06-03 |title=Building a durable, flexible iris |url=https://www.tmc.edu/news/2019/06/building-a-durable-flexible-iris/ |access-date=2023-10-24 |website=TMC News |language=en}}</ref> They may also have other visual disturbances such as seeing arcs or halos. Implanting an artificial iris gives the patient's eye something to regulate light again. After implantation, patients saw an improvement in overall [[visual acuity]], [[contrast sensitivity]], [[depth of focus]], and a decrease in perceived glare.<ref name=":5">{{Cite journal |last=Rickmann |first=Annekatrin |last2=Szurman |first2=Peter |last3=Januschowski |first3=Kai |last4=Waizel |first4=Maria |last5=Spitzer |first5=Martin S. |last6=Boden |first6=Karl T. |last7=Szurman |first7=Gesine B. |date=2016-07-01 |title=Long-term results after artificial iris implantation in patients with aniridia |url=https://doi.org/10.1007/s00417-016-3292-3 |journal=Graefe's Archive for Clinical and Experimental Ophthalmology |language=en |volume=254 |issue=7 |pages=1419–1424 |doi=10.1007/s00417-016-3292-3 |issn=1435-702X}}</ref> It is only recommended to get surgical implants if the patient has [[Aphakia|aphakic]] (absence of lens) or [[pseudophakic]] (artificial lens) eyes. The artificial iris is an alternative to eyepatches, sunglasses, or blackout contact lenses.<ref name=":0">{{Cite web |date=2022-05-01 |title=The Artificial Iris: Technically Challenging and Unusually Rewarding |url=https://www.aao.org/eyenet/article/the-artificial-iris-challenging-and-rewarding |access-date=2023-10-24 |website=American Academy of Ophthalmology |language=en}}</ref>

=== Cosmetic Function ===
Some artificial irises are implanted into people with healthy eyes to change their eye color. These cosmetic irises are marketed as an alternative to cosmetic [[Contact lens|contact lenses]]. Cosmetic implants are criticized by [[Ophthalmology|ophthalmologists]] as they can lead to vision loss in healthy eyes.<ref>{{Cite journal |last=Charters |first=Lynda |date=2022-04-30 |title=Cosmetic iris implants pose high risk of vision loss |url=https://europe.ophthalmologytimes.com/view/cosmetic-iris-implants-pose-high-risk-of-vision-loss |series=Ophthalmology Times Europe May 2022 |language=en |volume=18}}</ref>

== Design and Implantation ==
Each artificial iris is custom-made for the patient's eye, using an image of their undamaged iris, or any other iris as reference.<ref name=":3">{{Cite journal |last=Szurman |first=P. |last2=Jaissle |first2=G. |date=2011-08-01 |title=Künstliche Iris |url=https://doi.org/10.1007/s00347-011-2367-0 |journal=Der Ophthalmologe |language=de |volume=108 |issue=8 |pages=720–727 |doi=10.1007/s00347-011-2367-0 |issn=1433-0423}}</ref><ref name=":0" /> Artificial irises are made from silicone or other [[Polymer matrix composite|polymer matrix composites]] into a disk shape with a hole in the middle. Encased inside, is the color design. Before implantation, the iris' size is adjusted to fit the eye. The implants can be made with a tough fiber mesh so that they can be sewn onto a damaged iris. When there is no iris to attach to, the implants are made without the mesh to be more flexible to adapt to the eye's shape.<ref name=":0" /><ref name=":3" />

The artificial iris is implanted in the area of the eye behind the iris and in front of the ciliary body (what focuses your eye) in an area called the ciliary sulcus. Multiple techniques can be used to implant artificial irises that involve the use of [[forceps]], injector systems, and [[suturing]].<ref name=":1">{{Cite journal |last=Mayer |first=Christian |last2=Tandogan |first2=Tamer |last3=Hoffmann |first3=Andrea E. |last4=Khoramnia |first4=Ramin |date=2017-06-01 |title=Artificial iris implantation in various iris defects and lens conditions |url=https://www.sciencedirect.com/science/article/pii/S0886335017303346 |journal=Journal of Cataract & Refractive Surgery |volume=43 |issue=6 |pages=724–731 |doi=10.1016/j.jcrs.2017.06.003 |issn=0886-3350}}</ref> The artificial iris is folded and placed in a cartridge on the side of the injector that is then injected into the ciliary sulcus like a [[syringe]].<ref>{{Cite journal |last=Sugiura |first=Takeshi |last2=Kaji |first2=Yuichi |last3=Tanaka |first3=Yoshikazu |date=2019-06-01 |title=Ciliary sulcus suture fixation of intraocular lens using an auxiliary device |url=https://www.sciencedirect.com/science/article/pii/S0886335019300458 |journal=Journal of Cataract & Refractive Surgery |volume=45 |issue=6 |pages=711–718 |doi=10.1016/j.jcrs.2019.01.021 |issn=0886-3350}}</ref>All operations are performed with the patient under [[General anaesthesia|general anesthesia]].<ref name=":4" />

=== Segment-Shaped Artificial Iris Implantation ===
When only part of the iris is damaged, surgeons cut the artificial iris into a segment that covers the damaged area. The segment is folded and inserted into a clear corneal incision using an injector or forceps. That segment is then unfolded and sutured to the damaged iris.<ref name=":1" /><ref name=":2">{{Citation |last=Pfeifer |first=Vladimir |title=Artificial Iris Implantation: Overview of Surgical Techniques |date=2022 |url=https://doi.org/10.1007/978-3-030-94530-5_29 |work=Cataract Surgery : Advanced Techniques for Complex and Complicated Cases |pages=321–338 |editor-last=Alió |editor-first=Jorge L. |access-date=2023-10-24 |series=Essentials in Ophthalmology |place=Cham |publisher=Springer International Publishing |language=en |doi=10.1007/978-3-030-94530-5_29 |isbn=978-3-030-94530-5 |last2=Marzidovšek |first2=Miha |last3=Lužnik |first3=Zala |editor2-last=Dick |editor2-first=H. Burkhard |editor3-last=Osher |editor3-first=Robert H.}}</ref>

=== Complete Artificial Iris Implantation ===
When the patient has complete aniridia, the artificial iris can be folded and inserted through a corneal or scleral incision via an injector system or forceps. After the iris is unfolded, it does not need to be sutured. This version of the artificial iris is more flexible and will adapt to the shape of the eye.<ref name=":2" />

== Post-Operative Complications ==

* In some cases, patients with partial aniridia saw their original '''iris tissue darkened''' and no longer matched the color of the artificial iris.<ref name=":3" />

* Patients who received the segmented implants made of mesh had a higher chance of developing [[Glaucoma|'''glaucoma''']], '''keratopathy''' (corneal disease), and '''iris hemorrhages'''. These are likely caused by the sharp mesh fibers that can cut or irritate the surrounding tissues.<ref name=":5" />
* The most common complication is an '''increase in eye pressure'''. The patient is given a topical treatment.<ref name=":5" />
* Following the surgery, the artificial iris '''may become misaligned or partially dislocated'''. This happens when the sutures become loose or if the patient had previous eye trauma around the implantation site that makes the implant fit loosely. The implant is realigned and given a new suture.<ref>{{Cite journal |last=Mayer |first=Christian S. |last2=Laubichler |first2=Andrea E. |last3=Khoramnia |first3=Ramin |last4=Tandogan |first4=Tamer |last5=Prahs |first5=Philipp |last6=Zapp |first6=Daniel |last7=Reznicek |first7=Lukas |date=2018-09-23 |title=Challenges and Complication Management in Novel Artificial Iris Implantation |url=https://www.hindawi.com/journals/joph/2018/3262068/ |journal=Journal of Ophthalmology |language=en |volume=2018 |pages=e3262068 |doi=10.1155/2018/3262068 |issn=2090-004X}}</ref>

== Artificial Iris as a Silicone Oil Diaphragm ==
To prevent [[hemorrhaging]] of the eye, ophthalmologists use silicone oil as a [[tamponade]] (block bleeding). The oil surrounds the eye and it is [[Viscosity|viscous]] enough to prevent bleeding.<ref>{{Cite web |last=Ophthalmologists & Retina Specialists of Vitreous Retina Macula Consultants of New York |title=Silicone Oil |url=https://www.vrmny.com/procedures/silicone-oil/ |access-date=2023-11-07 |website=Vitreous Retina Macula Consultants of New York |language=en-US}}</ref> Some patients who have eye trauma require a long-term silicone oil tamponade. To prevent the silicone oil from touching the cornea and causing corneal dystrophy, a diaphragm made of [[Poly(methyl acrylate)|polymethylacrylate]] (PMMA) is installed to seal the area around the cornea.<ref>{{Cite journal |last=Heimann |first=K |last2=Konen |first2=W |date=1992-01-01 |title=Artificial iris diaphragm and silicone oil surgery |url=https://doi.org/10.1097/00006982-199212031-00019 |journal=Retina (Philadelphia, Pa.) |volume=12 |issue=3 Suppl |pages=S90–4 |doi=10.1097/00006982-199212031-00019 |issn=1539-2864 |pmid=1455092}}</ref> For patients needing a long-term silicone oil tamponade, it is possible to implant an artificial iris that will act as this diaphragm while also appearing as a natural iris.<ref name=":3" /> However, if the patient's eyes are hypotonic (have low pressure), there is still a chance of silicone oil breaching the diaphragm.<ref name=":5" />

== History ==

* In the 1960s, the first prosthetic iris was developed by Peter Choyce. It was made of PMMA and tended to cause glaucoma and corneal failure.<ref name=":6">{{Citation |last=Pfeifer |first=Vladimir |title=Artificial Iris Implantation: Overview of Surgical Techniques |date=2022 |url=https://doi.org/10.1007/978-3-030-94530-5_29 |work=Cataract Surgery : Advanced Techniques for Complex and Complicated Cases |pages=321–338 |editor-last=Alió |editor-first=Jorge L. |access-date=2023-11-09 |series=Essentials in Ophthalmology |place=Cham |publisher=Springer International Publishing |language=en |doi=10.1007/978-3-030-94530-5_29 |isbn=978-3-030-94530-5 |last2=Marzidovšek |first2=Miha |last3=Lužnik |first3=Zala |editor2-last=Dick |editor2-first=H. Burkhard |editor3-last=Osher |editor3-first=Robert H.}}</ref>
* In 1991, Sudenmacher et al and [https://www.morcher.com/en.html Morcher GMBH] created a larger prosthetic iris made of PMMA with a black outer diaphragm that required a large incision.<ref name=":7">{{Cite book |url=https://www.thieme-connect.de/products/ebooks/lookinside/10.1055/b-0039-172073?update=true&ERSESSIONTOKEN=MZKx2FqeRWP6KGO6cXuouj3nxxeMSx2Fj3xxx2FJ-18x2dPg7PPO5x2BkXOJRRz45h82sgx3Dx3DTsFfoKVraDvwUoth7N4o5gx3Dx3D-d4x2FrgR0Sqp5KUK8uh7Xqkwx3Dx3D-6gOkCCiAjjGoRkJFX2VU8gx3Dx3D# |title=13 Iris Prosthesis Implantation |date=2019 |publisher=Thieme Verlag |isbn=978-1-68420-097-9 |edition=2019 |language=en |doi=10.1055/b-0039-172073?update=true&ersessiontoken=mzkx2fqerwp6kgo6cxuouj3nxxemsx2fj3xxx2fj-18x2dpg7ppo5x2bkxojrrz45h82sgx3dx3dtsffokvradvwuoth7n4o5gx3dx3d-d4x2frgr0sqp5kuk8uh7xqkwx3dx3d-6gokcciajjgorkjfx2vu8gx3dx3d#}}</ref>
* In 1996, Volker Rasch and Morcher's injectable prosthetic iris was implanted.<ref name=":6" /> It utilized a capsular tension ring to lock the iris into place.<ref name=":7" />
* [https://www.ophtec.com/ Ophtec] created a prosthetic iris that required smaller incisions to be implanted and was available in colors other than black.<ref name=":7" />
* In the early 2000s, [https://www.humanoptics.com/en/ HumanOptics] and Hans Reinhard Koch started to design a foldable and customizable iris made out of silicone.<ref name=":7" />
* In 2018, the HumanOptics CustomFlex Artificial Iris received regulatory approval from the FDA, becoming the first and only artificial iris to be cleared in the United States.<ref>{{Cite web |date=2018-06-04 |title=FDA clears first artificial iris by HumanOptics |url=https://www.aao.org/education/headline/fda-clears-first-artificial-iris-by-humanoptics |access-date=2023-11-09 |website=American Academy of Ophthalmology |language=en}}</ref>


== References ==
== References ==

Revision as of 20:21, 9 November 2023

An artificial iris is an intraocular implant (implant inside the eye) that is used as both a cosmetic and to treat those with aniridia (missing or damaged irises) or other eye trauma.[1] People with this condition experience photophobia, which means their eyes absorb too much light.[2] The artificial iris, made from silicone, acts as a replacement iris. The artificial iris is implanted in the eye using different surgery techniques depending on the patient's eye trauma. Most of the major artificial iris manufacturers are European and the treatment is used sparingly in the United States because of limited FDA approval. This is because of the possibility of vision loss and other risks.[3]

Basic Function

Medical Function

The artificial iris treats those who were born with aniridia or who have experienced eye trauma that lead to a damaged iris. This eye trauma can occur as a result of a complication from serious eye surgeries such as a ruptured globe repair. The iris controls how much light enters the eye, so if a patient has a damaged iris or lacks an iris they can experience large amounts of glare from normal daylight.[4] They may also have other visual disturbances such as seeing arcs or halos. Implanting an artificial iris gives the patient's eye something to regulate light again. After implantation, patients saw an improvement in overall visual acuity, contrast sensitivity, depth of focus, and a decrease in perceived glare.[5] It is only recommended to get surgical implants if the patient has aphakic (absence of lens) or pseudophakic (artificial lens) eyes. The artificial iris is an alternative to eyepatches, sunglasses, or blackout contact lenses.[6]

Cosmetic Function

Some artificial irises are implanted into people with healthy eyes to change their eye color. These cosmetic irises are marketed as an alternative to cosmetic contact lenses. Cosmetic implants are criticized by ophthalmologists as they can lead to vision loss in healthy eyes.[7]

Design and Implantation

Each artificial iris is custom-made for the patient's eye, using an image of their undamaged iris, or any other iris as reference.[8][6] Artificial irises are made from silicone or other polymer matrix composites into a disk shape with a hole in the middle. Encased inside, is the color design. Before implantation, the iris' size is adjusted to fit the eye. The implants can be made with a tough fiber mesh so that they can be sewn onto a damaged iris. When there is no iris to attach to, the implants are made without the mesh to be more flexible to adapt to the eye's shape.[6][8]

The artificial iris is implanted in the area of the eye behind the iris and in front of the ciliary body (what focuses your eye) in an area called the ciliary sulcus. Multiple techniques can be used to implant artificial irises that involve the use of forceps, injector systems, and suturing.[9] The artificial iris is folded and placed in a cartridge on the side of the injector that is then injected into the ciliary sulcus like a syringe.[10]All operations are performed with the patient under general anesthesia.[2]

Segment-Shaped Artificial Iris Implantation

When only part of the iris is damaged, surgeons cut the artificial iris into a segment that covers the damaged area. The segment is folded and inserted into a clear corneal incision using an injector or forceps. That segment is then unfolded and sutured to the damaged iris.[9][11]

Complete Artificial Iris Implantation

When the patient has complete aniridia, the artificial iris can be folded and inserted through a corneal or scleral incision via an injector system or forceps. After the iris is unfolded, it does not need to be sutured. This version of the artificial iris is more flexible and will adapt to the shape of the eye.[11]

Post-Operative Complications

  • In some cases, patients with partial aniridia saw their original iris tissue darkened and no longer matched the color of the artificial iris.[8]
  • Patients who received the segmented implants made of mesh had a higher chance of developing glaucoma, keratopathy (corneal disease), and iris hemorrhages. These are likely caused by the sharp mesh fibers that can cut or irritate the surrounding tissues.[5]
  • The most common complication is an increase in eye pressure. The patient is given a topical treatment.[5]
  • Following the surgery, the artificial iris may become misaligned or partially dislocated. This happens when the sutures become loose or if the patient had previous eye trauma around the implantation site that makes the implant fit loosely. The implant is realigned and given a new suture.[12]

Artificial Iris as a Silicone Oil Diaphragm

To prevent hemorrhaging of the eye, ophthalmologists use silicone oil as a tamponade (block bleeding). The oil surrounds the eye and it is viscous enough to prevent bleeding.[13] Some patients who have eye trauma require a long-term silicone oil tamponade. To prevent the silicone oil from touching the cornea and causing corneal dystrophy, a diaphragm made of polymethylacrylate (PMMA) is installed to seal the area around the cornea.[14] For patients needing a long-term silicone oil tamponade, it is possible to implant an artificial iris that will act as this diaphragm while also appearing as a natural iris.[8] However, if the patient's eyes are hypotonic (have low pressure), there is still a chance of silicone oil breaching the diaphragm.[5]

History

  • In the 1960s, the first prosthetic iris was developed by Peter Choyce. It was made of PMMA and tended to cause glaucoma and corneal failure.[15]
  • In 1991, Sudenmacher et al and Morcher GMBH created a larger prosthetic iris made of PMMA with a black outer diaphragm that required a large incision.[16]
  • In 1996, Volker Rasch and Morcher's injectable prosthetic iris was implanted.[15] It utilized a capsular tension ring to lock the iris into place.[16]
  • Ophtec created a prosthetic iris that required smaller incisions to be implanted and was available in colors other than black.[16]
  • In the early 2000s, HumanOptics and Hans Reinhard Koch started to design a foldable and customizable iris made out of silicone.[16]
  • In 2018, the HumanOptics CustomFlex Artificial Iris received regulatory approval from the FDA, becoming the first and only artificial iris to be cleared in the United States.[17]

References

  1. ^ Shahreef, Farah J. (April 2016). "Engineering a Light-Attenuating Artificial Iris". iovs.arvojournals.org. Retrieved 2023-10-17.
  2. ^ a b Mayer, Christian; Tandogan, Tamer; Hoffmann, Andrea E.; Khoramnia, Ramin (2017-06-01). "Artificial iris implantation in various iris defects and lens conditions". Journal of Cataract & Refractive Surgery. 43 (6): 724–731. doi:10.1016/j.jcrs.2017.06.003. ISSN 0886-3350.
  3. ^ Charters, Lynda (2022-04-30). "Cosmetic iris implants pose high risk of vision loss". Ophthalmology Times Europe May 2022. 18. {{cite journal}}: Cite journal requires |journal= (help)
  4. ^ Galehouse, Maggie (2019-06-03). "Building a durable, flexible iris". TMC News. Retrieved 2023-10-24.
  5. ^ a b c d Rickmann, Annekatrin; Szurman, Peter; Januschowski, Kai; Waizel, Maria; Spitzer, Martin S.; Boden, Karl T.; Szurman, Gesine B. (2016-07-01). "Long-term results after artificial iris implantation in patients with aniridia". Graefe's Archive for Clinical and Experimental Ophthalmology. 254 (7): 1419–1424. doi:10.1007/s00417-016-3292-3. ISSN 1435-702X.
  6. ^ a b c "The Artificial Iris: Technically Challenging and Unusually Rewarding". American Academy of Ophthalmology. 2022-05-01. Retrieved 2023-10-24.
  7. ^ Charters, Lynda (2022-04-30). "Cosmetic iris implants pose high risk of vision loss". Ophthalmology Times Europe May 2022. 18. {{cite journal}}: Cite journal requires |journal= (help)
  8. ^ a b c d Szurman, P.; Jaissle, G. (2011-08-01). "Künstliche Iris". Der Ophthalmologe (in German). 108 (8): 720–727. doi:10.1007/s00347-011-2367-0. ISSN 1433-0423.
  9. ^ a b Mayer, Christian; Tandogan, Tamer; Hoffmann, Andrea E.; Khoramnia, Ramin (2017-06-01). "Artificial iris implantation in various iris defects and lens conditions". Journal of Cataract & Refractive Surgery. 43 (6): 724–731. doi:10.1016/j.jcrs.2017.06.003. ISSN 0886-3350.
  10. ^ Sugiura, Takeshi; Kaji, Yuichi; Tanaka, Yoshikazu (2019-06-01). "Ciliary sulcus suture fixation of intraocular lens using an auxiliary device". Journal of Cataract & Refractive Surgery. 45 (6): 711–718. doi:10.1016/j.jcrs.2019.01.021. ISSN 0886-3350.
  11. ^ a b Pfeifer, Vladimir; Marzidovšek, Miha; Lužnik, Zala (2022), Alió, Jorge L.; Dick, H. Burkhard; Osher, Robert H. (eds.), "Artificial Iris Implantation: Overview of Surgical Techniques", Cataract Surgery : Advanced Techniques for Complex and Complicated Cases, Essentials in Ophthalmology, Cham: Springer International Publishing, pp. 321–338, doi:10.1007/978-3-030-94530-5_29, ISBN 978-3-030-94530-5, retrieved 2023-10-24
  12. ^ Mayer, Christian S.; Laubichler, Andrea E.; Khoramnia, Ramin; Tandogan, Tamer; Prahs, Philipp; Zapp, Daniel; Reznicek, Lukas (2018-09-23). "Challenges and Complication Management in Novel Artificial Iris Implantation". Journal of Ophthalmology. 2018: e3262068. doi:10.1155/2018/3262068. ISSN 2090-004X.{{cite journal}}: CS1 maint: unflagged free DOI (link)
  13. ^ Ophthalmologists & Retina Specialists of Vitreous Retina Macula Consultants of New York. "Silicone Oil". Vitreous Retina Macula Consultants of New York. Retrieved 2023-11-07.
  14. ^ Heimann, K; Konen, W (1992-01-01). "Artificial iris diaphragm and silicone oil surgery". Retina (Philadelphia, Pa.). 12 (3 Suppl): S90–4. doi:10.1097/00006982-199212031-00019. ISSN 1539-2864. PMID 1455092.
  15. ^ a b Pfeifer, Vladimir; Marzidovšek, Miha; Lužnik, Zala (2022), Alió, Jorge L.; Dick, H. Burkhard; Osher, Robert H. (eds.), "Artificial Iris Implantation: Overview of Surgical Techniques", Cataract Surgery : Advanced Techniques for Complex and Complicated Cases, Essentials in Ophthalmology, Cham: Springer International Publishing, pp. 321–338, doi:10.1007/978-3-030-94530-5_29, ISBN 978-3-030-94530-5, retrieved 2023-11-09
  16. ^ a b c d 13 Iris Prosthesis Implantation (2019 ed.). Thieme Verlag. 2019. doi:10.1055/b-0039-172073?update=true&ersessiontoken=mzkx2fqerwp6kgo6cxuouj3nxxemsx2fj3xxx2fj-18x2dpg7ppo5x2bkxojrrz45h82sgx3dx3dtsffokvradvwuoth7n4o5gx3dx3d-d4x2frgr0sqp5kuk8uh7xqkwx3dx3d-6gokcciajjgorkjfx2vu8gx3dx3d#. ISBN 978-1-68420-097-9.
  17. ^ "FDA clears first artificial iris by HumanOptics". American Academy of Ophthalmology. 2018-06-04. Retrieved 2023-11-09.


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