|Year : 2022 | Volume
| Issue : 1 | Page : 118-119
Commentary: Cosmetic iris implants - A clinical and ethical dilemma in ophthalmology
Samendra Karkhur, Priti Singh, Darshana Koshti, Bhavana Sharma
Department of Ophthalmology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
|Date of Web Publication||07-Jan-2022|
Prof. Bhavana Sharma
Department of Ophthalmology, All India Institute of Medical Sciences, Bhopal - 462 020, Madhya Pradesh
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Karkhur S, Singh P, Koshti D, Sharma B. Commentary: Cosmetic iris implants - A clinical and ethical dilemma in ophthalmology. Indian J Ophthalmol Case Rep 2022;2:118-9
|How to cite this URL:|
Karkhur S, Singh P, Koshti D, Sharma B. Commentary: Cosmetic iris implants - A clinical and ethical dilemma in ophthalmology. Indian J Ophthalmol Case Rep [serial online] 2022 [cited 2022 Aug 17];2:118-9. Available from: https://www.ijoreports.in/text.asp?2022/2/1/118/334936
In the last few decades, medical science has witnessed tremendous innovations in healthcare. The majority of these have saved uncountable human lives while also improving the quality of life of many others. A very important aspect in the form of medical implants has found prominence and has become inseparable from the practice of modern medicine. Medical implants are widely used in the medical field, and the practice of ophthalmology has nearly become synonymous with their use in the form of intraocular lens implantation (IOL) for cataract surgery, glaucoma drainage devices, drug release implants, and cosmetic prosthesis. There has been an escalated interest toward the use of implants in cosmetic procedures, where the yardstick for clinical decision-making may often appear blurred, frequently posing clinical and ethical dilemmas.
By definition, a medical implant is a device that replaces or augments the structure or function, wholly or partially, of a body part, organ, or organ system altered by a disease process, injury, or infection in order to ensure normal functioning of the human body. Modern lifestyle has expanded the indication of these medical devices to alter the outward perception of the human body for enhanced social validation and to suit an individual personality type or professional requirements.
Anterior chamber cosmetic iris prostheses were introduced by Kahn to treat oculo-cutaneous albinism and to improve the iris appearance in patients with congenital or traumatic iris defects such as coloboma or aniridia. The cosmetic use of implants has also been extremely useful for anophthalmic sockets as a result of evisceration/enucleation, trauma-related disfigurement, unsightly corneal scars, and ensuring facial symmetry during childhood. Currently, these implants are being marketed as an alternative to cosmetic contact lens for cosmetic use in people willing to change their eye color; however, their use for purely cosmetic purposes has been fraught with several complications, which often become difficult to manage and could result in profound and irreversible visual damage.
Bright OcularTM prosthetic iris device (Stellar Devices) are currently available and widely marketed to change the color of the iris. These cosmetic iris implants receive promotion through several Internet portals, including social media. Neither this device nor its predecessor, the New Color IrisTM (Kahn Medical Devices), has been licensed for use in the United States or the European Union. Patients from these countries typically travel abroad to countries with nonexistent or lax regulations concerning the use of such implants in order to undergo the surgical procedure. Neither is the safety data available for the human use of these implants, nor there is an accurate estimate of the number of devices implanted. These devices could pose a major public health concern considering widespread publicity: they have also been widely reported in the medical literature as causing significant morbidity, including uveitis, glaucoma, cataract, and corneal decompensation—an observation very well corroborated by the authors in their report.
Significant complications arising from anterior chamber iris implants have been widely reported. There is a consensus that these devices should not be implanted and that they can cause long-term problems even years after implantation. The Bright Ocular artificial iris can cause corneal decompensation, cataract, recurrent uveitis, anterior chamber hyphema, glaucoma, iris atrophy, and ectropion uvea. Many of these complications can occur simultaneously and necessitate the implant's removal. Reported secondary surgeries required after explantation include Descemet stripping automated endothelial keratoplasty, cataract extraction with IOL placement, trabeculectomy, implantation of a glaucoma drainage device, and penetrating keratoplasty.
The complications following cosmetic iris implants possibly arise from the devices' placement in close apposition with the iris, within the anterior chamber. Micro-trauma brought about by pupillary movements can lead to repeated Iris chafing, resulting in uveitis-glaucoma-hyphema syndrome, which in turn leads to iris atrophy and ectropion uvea. The formation of peripheral anterior synechia and damage to the angle and trabecular meshwork leads to glaucoma and recurrent inflammation, with repeated use of corticosteroids leading to cataract formation. Similar to other anterior chamber implants, gradual attrition of endothelial cells invariably results.
The quest for enhanced appearance, social validity, niche professional needs, and peer pressure has led people to seek extreme surgical interventions and is no longer limited to only tattooing or body piercing. To achieve the desired look, efforts have moved in the direction of vision-threatening surgical procedures with dangerous complications. This approach is further endorsed by the media, industry, and prominent public figures. While as health professionals, ophthalmologists should respect the wishes of those who seek consultation, we must also be aggressive in our approach toward counseling and informing patients regarding the high rate of potential complications and the possibility of total vision loss. The regulatory authorities should actively collect individual case-based data of complications and ensure stricter guidelines for patient selection and mandatory counseling regarding complications. It becomes our duty to ensure that patients who choose to undergo such procedures have thoroughly understood the grave consequences following such implants that could ultimately jeopardize the very outcome which these implants intended to address in the first place.
| References|| |
Thiagalingam S, Tarongoy P, Hamrah P, Lobo AM, Nagao K, Barsam C, et al
. Complications of cosmetic iris implants. J Cataract Refract Surg 2008;34:1222-4.
Dayal A, Annadurai P, Khurana M, Vijaya L Cosmetic iris prosthesis and severe visual loss. Indian J Ophthalmol Case Rep 2022;70:116-8.
Mansour AM, Ahmed II, Eadie B, Chelala E, Saade JS, Slade SG, et al
. Iritis, glaucoma and corneal decompensation associated with Bright Ocular cosmetic iris implant. Br J Ophthalmol 2016;100:1098-101.
Arthur SN, Wright MM, Kramarevsky N, Kaufman SC, Grajewski AL. Uveitis-glaucoma-hyphema syndrome and corneal decompensation in association with cosmetic iris implants. Am J Ophthalmol 2009;148:790-3.
Kelly A, Kaufman SC. Corneal endothelial cell loss and iritis associated with a new cosmetic iris implant. JAMA Ophthalmol 2015;133:723-4.
Hoguet A, Ritterband D, Koplin R, Wu E, Raviv T, Aljian J, et al
. Serious ocular complications of cosmetic iris implants in 14 eyes. J Cataract Refract Surg 2012;38:387-93.