Bilateral Irreversible Severe Vision Loss From Cosmetic Iris Implants

PURPOSE: To report a case of bilateral neovascular glaucoma with central retinal vein occlusions secondary to cosmetic iris implantation. DESIGN: Interventional case report. METHODS: SETTING: Tertiary care center; ophthalmology clinic. PATIENT: A 25-year-old woman presented with persistent bilateral blurry vision after simultaneous bilateral cosmetic iris implantation. Examination showed best-corrected visual acuity of hand motion in the right and 20/400 in the left eye with intraocular pressures (IOP) of 48 mm Hg in the right and 40 mm Hg in the left eye on maximal medical therapy. She had bilateral neovascularization of the iris and angle with synechial angle closure, surgical aniridia, central retinal vein occlusion, and end-stage glaucomatous optic neuropathy. She was diagnosed with neovascular glaucoma in both eyes, associated with cosmetic iris implants. INTERVENTION PROCEDURES: Humphrey 24-2 visual field testing, optic nerve coherence tomography, and fundus imaging were performed. After bilateral intravitreal bevacizumab and panretinal photocoagulation, Ahmed glaucoma drainage devices were implanted in both eyes. MAIN OUTCOME MEASURES: IOp, anterior chamber inflammation, neovascularization. RESULTS: Despite aggressive treatment, severe permanent bilateral vision loss ensued. CONCLUSION: We strongly advise against the use of anterior chamber iris implants for cosmetic indications. Close monitoring of implanted individuals is necessary. Explantation should be considered at the earliest sign of adverse reaction. (Am J Ophthalmol 2011;151:872-875. (C) 2011 by Elsevier Inc. All rights reserved.)