Glaucoma secondary to cosmetic iris implants in congenital iris coloboma

Abstract

Introduction: To report a case of angle closure and corneal decompensation requiring surgical intervention secondary to BrightOcular cosmetic iris implantation in a patient with a history of congenital bilateral iris coloboma. Patient and Clinical Findings: A 40-year-old male patient with a history of bilateral congenital coloboma presented to the emergency department with reduced visual acuity to count fingers and moderate pain in the left eye 4 months after bilateral BrightOcular iris implant surgery in Mexico. Intraocular pressure (IOP) was 70 mm Hg with little response to maximal medical therapy. Gonioscopy revealed dense pigment obstructing angle inferiorly. Diagnosis, Interventions, and Outcomes: The patient was diagnosed with angle closure, pigment dispersion syndrome, and corneal decompensation secondary to bilateral cosmetic iris implants. IOP stabilized after emergency Ahmed valve and Baerveldt shunt placement. Corneal decompensation addressed first with endothelial keratoplasty, however ultimately failed leading to penetrating keratoplasty in the left eye. Fellow eye required glaucoma shunt placement 4 years after initial presentation due to persistent glaucoma not controlled with laser and medical therapy. Conclusions: The use of iris implants for cosmetic reasons can have serious ocular morbidity in patients with iris coloboma. Close monitoring and explantation should be strongly recommended at the earliest sign of complication.