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  • Grand Rounds

    Cosmetic iris implants have gained significant popularity in the media in the past 20 years. Despite their appeal to thousands of individuals across the globe, these implants have vision-threatening consequences. This case describes a patient with a history of bilateral cosmetic iris implant surgery performed 6 years ago in Colombia. The patient suddenly began to experience bilateral blurry vision and presented to the Bascom Palmer Emergency Department. Her presenting visual acuity was light perception OD and 20/150 OS, and her intraocular pressures were 17 OD and 11 OS. On slit lamp examination, she was found to have bilateral, diffuse Descemet membrane folds as well as prominent bullae and microcystic edema in the right eye. B scan ultrasound was significant for bean pot cupping of the right optic nerve as well as mild vitreous opacities in the right eye. B scan ultrasound was otherwise normal in the left eye. The patient returned less than a week later and had decreased vision to NLP in the right eye and “E” at face in the left eye. Intraocular pressures were now elevated to 42 in the right eye and 13 in the left eye. The patient was ultimately diagnosed with secondary angle closure due to cosmetic iris implants. Ultrasound biomicroscopy demonstrated diffuse iris atrophy in the right eye and areas concerning for angle closure in both eyes. The patient ultimately underwent bilateral explantation of the cosmetic iris implants. She additionally underwent goniosynechiolysis, DSAEK, and goniotomy in the left eye. The right eye had very extensive iris atrophy to the point where there was no longer a clear angle that remained. To date, the patient remains NLP in the right eye, but is now 20/40 in the left eye. The patient remains on prednisolone drops four times a day in both eyes, polymyxin drops four times a day in both eyes, and dorzolamide/timolol and brimonidine drops two times a day in the right eye for comfort.

    Presentation Date: 12/12/2024
    Issue Date: 02/14/2025