{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T18:28:53Z","timestamp":1790792933532,"version":"4.1.0"},"reference-count":59,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2024,5,4]],"date-time":"2024-05-04T00:00:00Z","timestamp":1714780800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Objectives: The aim of this review paper is to summarise surgical options available for repairing iris defects at the iris\u2013lens plane, focusing on suturing techniques, iridodialysis repair, and prosthetic iris devices. Methods: A thorough literature search was conducted using multiple databases, including Medline, PubMed, Web of Science Core Collection, and the Cochrane Library, from inception to February 2024. Relevant studies were screened based on predefined criteria, and primary references cited in selected articles were also reviewed. Results: Various surgical techniques were identified for iris defect repair. Suturing methods such as interrupted full-thickness sutures and the McCannel technique offer solutions for smaller defects, while iridodialysis repair techniques address detachment of the iris from the ciliary body. Prosthetic iris devices, including iris\u2013lens diaphragm devices, endocapsular capsular tension ring-based devices, and customizable artificial iris implants, provide options for larger defects, each with its own advantages and limitations. Conclusions: Successful iris reconstruction requires a personalised approach considering factors like defect size, ocular comorbidities, and patient preference. Surgeons must possess a thorough understanding of available techniques and prosthetic devices to achieve optimal outcomes in terms of both visual function and, nonetheless, cosmetic appearance.<\/jats:p>","DOI":"10.3390\/jcm13092706","type":"journal-article","created":{"date-parts":[[2024,5,6]],"date-time":"2024-05-06T14:26:11Z","timestamp":1715005571000},"page":"2706","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Iris Reconstruction: A Surgeon\u2019s Guide"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0715-6369","authenticated-orcid":false,"given":"Lorenzo","family":"Ferro Desideri","sequence":"first","affiliation":[{"name":"Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 15, CH-3010 Bern, Switzerland"},{"name":"Department for BioMedical Research, University of Bern, Murtenstrasse 24, CH-3008 Bern, Switzerland"},{"name":"Bern Photographic Reading Center, Inselspital, Bern University Hospital, University of Bern, CH-3010 Bern, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kirupakaran","family":"Arun","sequence":"additional","affiliation":[{"name":"Moorfields Eye Hospital, NHS Foundation Trust, London EC1V 2PD, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5161-3753","authenticated-orcid":false,"given":"Grace","family":"Doherty","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Queen\u2019s University Belfast School of Medicine, Belfast BT9 7BL, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Enrico","family":"Bernardi","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 15, CH-3010 Bern, Switzerland"},{"name":"Department for BioMedical Research, University of Bern, Murtenstrasse 24, CH-3008 Bern, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2382-1111","authenticated-orcid":false,"given":"Rodrigo","family":"Anguita","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 15, CH-3010 Bern, Switzerland"},{"name":"Department for BioMedical Research, University of Bern, Murtenstrasse 24, CH-3008 Bern, Switzerland"},{"name":"Moorfields Eye Hospital, NHS Foundation Trust, London EC1V 2PD, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,5,4]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1334","DOI":"10.1167\/iovs.05-1154","article-title":"Influence of pupil diameter on the relation between ocular higher-order aberration and contrast sensitivity after laser in situ keratomileusis","volume":"47","author":"Oshika","year":"2006","journal-title":"Investig. Ophthalmol. Vis. Sci."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1111\/j.1475-1313.2005.00297.x","article-title":"Aberrations and myopia","volume":"25","author":"Charman","year":"2005","journal-title":"Ophthalmic Physiol. Opt."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"771","DOI":"10.1001\/archophthalmol.2011.1778","article-title":"A new technique for treating posttraumatic aniridia with aphakia: First results of haptic fixation of a foldable intraocular lens on a foldable and custom-tailored iris prosthesis","volume":"130","author":"Spitzer","year":"2012","journal-title":"Arch. Ophthalmol."},{"key":"ref_4","first-page":"23","article-title":"Analiza powik\u0142a\u0144 fakoemulsyfikacji w trakcie opanowywania metody [Analysis of phacoemulsification complications during mastering of the method]","volume":"106","author":"Popiela","year":"2004","journal-title":"Klin. Oczna"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"505","DOI":"10.1097\/00006324-200407000-00011","article-title":"Minimal angle horizontal strabismus detectable by lay observers","volume":"81","author":"Weissberg","year":"2004","journal-title":"Optom. Vis. Sci."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1033","DOI":"10.1542\/peds.2007-3484","article-title":"Mental illness in young adults who had strabismus as children","volume":"122","author":"Mohney","year":"2008","journal-title":"Pediatrics"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"2493","DOI":"10.1007\/s00417-013-2402-8","article-title":"Simultaneous correction of post-traumatic aphakia and aniridia with the use of artificial iris and IOL implantation","volume":"251","author":"Forlini","year":"2013","journal-title":"Graefes Arch. Clin. Exp. Ophthalmol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1016\/j.clae.2012.10.079","article-title":"A new customized artificial iris diaphragm for treatment of traumatic aniridia","volume":"36","author":"Rana","year":"2013","journal-title":"Cont. Lens Anterior Eye"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"786","DOI":"10.1055\/s-0032-1328508","article-title":"Aniridie-IOL und k\u00fcnstlicher Irisersatz [Aniridia-IOL and artificial iris reconstruction]","volume":"230","author":"Thomas","year":"2013","journal-title":"Klin. Monbl. Augenheilkd."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1016\/j.ajo.2007.10.006","article-title":"Iris reconstruction in penetrating keratoplasty\u2014Surgical techniques and a case-control study to evaluate effect on graft survival","volume":"145","author":"Arundhati","year":"2008","journal-title":"Am. J. Ophthalmol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1079","DOI":"10.1055\/a-1217-1199","article-title":"Iris and Lens Trauma\u2014Iris Reconstruction","volume":"237","author":"Lenglinger","year":"2020","journal-title":"Klin. Monbl. Augenheilkd."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"522","DOI":"10.1097\/j.jcrs.0000000000000411","article-title":"Management of common iatrogenic iris defects induced by cataract surgery","volume":"47","author":"Foster","year":"2021","journal-title":"J. Cataract. Refract. Surg."},{"key":"ref_13","first-page":"98","article-title":"A retrievable suture idea for anterior uveal problems","volume":"7","author":"McCannel","year":"1976","journal-title":"Ophthalmic Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"460","DOI":"10.1001\/archopht.1982.01030030462017","article-title":"Repair of sector iris coloboma. Closed-chamber technique","volume":"100","author":"Shin","year":"1982","journal-title":"Arch. Ophthalmol."},{"key":"ref_15","first-page":"71","article-title":"The closed chamber slipping suture technique for iris repair","volume":"26","author":"Siepser","year":"1994","journal-title":"Ann. Ophthalmol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1097\/ICU.0000000000000628","article-title":"Iris reconstruction suturing techniques","volume":"31","author":"Lian","year":"2020","journal-title":"Curr. Opin. Ophthalmol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1170","DOI":"10.1016\/j.jcrs.2003.10.025","article-title":"Siepser slipknot for McCannel iris-suture fixation of subluxated intraocular lenses","volume":"30","author":"Chang","year":"2004","journal-title":"J. Cataract. Refract. Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"207","DOI":"10.3928\/1081597X-20190125-01","article-title":"Single-Pass Four-Throw Pupilloplasty Knot Mechanics","volume":"35","author":"Narang","year":"2019","journal-title":"J. Refract. Surg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"120","DOI":"10.4103\/ijo.IJO_559_17","article-title":"Single-pass four-throw pupilloplasty for angle-closure glaucoma","volume":"66","author":"Narang","year":"2018","journal-title":"Indian J. Ophthalmol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1001","DOI":"10.3928\/1542-8877-19981201-12","article-title":"The iris cerclage suture for permanent mydriasis: A running suture technique","volume":"29","author":"Ogawa","year":"1998","journal-title":"Ophthalmic Surg. Lasers"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"480","DOI":"10.1177\/1120672119839304","article-title":"Pupil cerclage technique for treatment of traumatic mydriasis","volume":"30","author":"Frisina","year":"2020","journal-title":"Eur. J. Ophthalmol."},{"key":"ref_22","first-page":"637","article-title":"Quelle attitude adopter devant une iridodialyse [Management of iridodialysis]","volume":"72","author":"Legrand","year":"1972","journal-title":"Bull. Soc. Ophtalmol. Fr."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1073","DOI":"10.4103\/ijo.IJO_428_22","article-title":"Iridodialysis repair\u2014A simplified approach","volume":"70","author":"Shekhar","year":"2022","journal-title":"Indian J. Ophthalmol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1016\/S0886-3350(99)00365-X","article-title":"Closed chamber iridodialysis repair using a needle with a distal hole","volume":"26","author":"Bardak","year":"2000","journal-title":"J. Cataract. Refract. Surg."},{"key":"ref_25","first-page":"38","article-title":"Management of iridodialysis","volume":"4","author":"Paton","year":"1973","journal-title":"Ophthalmic Surg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"380","DOI":"10.1016\/S1091-8531(98)90041-6","article-title":"A technique for repair of iridodialysis in children","volume":"2","author":"Brown","year":"1998","journal-title":"J. AAPOS"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1016\/S0002-9394(14)71971-3","article-title":"Double-armed McCannell suture for repair of traumatic iridodialysis","volume":"122","author":"Wachler","year":"1996","journal-title":"Am. J. Ophthalmol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"625","DOI":"10.1016\/j.jcrs.2011.02.001","article-title":"Nonappositional repair of iridodialysis","volume":"37","author":"Snyder","year":"2011","journal-title":"J. Cataract. Refract. Surg."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"142","DOI":"10.4103\/0974-9233.171770","article-title":"Cobbler\u2019s Technique for Iridodialysis Repair","volume":"23","author":"Pandav","year":"2016","journal-title":"Middle East Afr. J. Ophthalmol."},{"key":"ref_30","first-page":"476","article-title":"A closed chamber technique for repair of iridodialysis","volume":"24","author":"Zeiter","year":"1993","journal-title":"Ophthalmic Surg."},{"key":"ref_31","first-page":"180","article-title":"Black-diaphragm intraocular lens for correction of aniridia","volume":"25","author":"Sundmacher","year":"1994","journal-title":"Ophthalmic Surg."},{"key":"ref_32","first-page":"197","article-title":"Black diaphragm intraocular lens in congenital aniridia","volume":"3","author":"Sundmacher","year":"1994","journal-title":"Ger. J. Ophthalmol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1177\/112067210301300109","article-title":"Implantation of a black diaphragm intraocular lens in ten cases of post-traumatic aniridia","volume":"13","author":"Beltrame","year":"2003","journal-title":"Eur. J. Ophthalmol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"2168","DOI":"10.1016\/S0886-3350(03)00668-0","article-title":"Black diaphragm intraocular lens implantation in aphakic eyes with traumatic aniridia and previous pars plana vitrectomy","volume":"29","author":"Dong","year":"2003","journal-title":"J. Cataract. Refract. Surg."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"27","DOI":"10.4103\/jovr.jovr_244_17","article-title":"Black Diaphragm Intraocular Lens Implantation in Patients with Aniridia","volume":"14","year":"2019","journal-title":"J. Ophthalmic Vis. Res."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1016\/j.jcjo.2013.10.001","article-title":"Prosthetic iris devices","volume":"49","author":"Srinivasan","year":"2014","journal-title":"Can. J. Ophthalmol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"754","DOI":"10.5301\/EJO.2011.6484","article-title":"Results and complications after implantation of a black iris-lens diaphragm in patients with traumatically induced aphakia and aniridia","volume":"21","author":"Petousis","year":"2011","journal-title":"Eur. J. Ophthalmol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"660","DOI":"10.1177\/112067210701700428","article-title":"Visual function after implantation of aniridia intraocular lens for traumatic aniridia in vitrectomized eye","volume":"17","author":"Moghimi","year":"2007","journal-title":"Eur. J. Ophthalmol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"686","DOI":"10.1016\/j.jcrs.2018.03.033","article-title":"Safety and efficacy of black iris diaphragm intraocular lens implantation in eyes with large iris defects: Report 4","volume":"44","author":"Miller","year":"2018","journal-title":"J. Cataract. Refract. Surg."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"108","DOI":"10.1097\/ICL.0b013e318199b00b","article-title":"Morcher iris reconstruction lens and rigid contact lens for traumatic aniridia","volume":"35","author":"Chung","year":"2009","journal-title":"Eye Contact Lens"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"2062","DOI":"10.1177\/11206721231160989","article-title":"Cosmetic iris implants\u2014Double edge sword","volume":"33","author":"Chauhan","year":"2023","journal-title":"Eur. J. Ophthalmol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1674","DOI":"10.1016\/j.jcrs.2008.05.048","article-title":"Interim results of a compassionate-use clinical trial of Morcher iris diaphragm implantation: Report 1","volume":"34","author":"Olson","year":"2008","journal-title":"J. Cataract. Refract. Surg."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1847","DOI":"10.1016\/j.ophtha.2004.04.023","article-title":"Ophtec iris reconstruction lens United States clinical trial phase I","volume":"111","author":"Price","year":"2004","journal-title":"Ophthalmology"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1705","DOI":"10.1016\/j.ophtha.2008.03.025","article-title":"Implantation of the black diaphragm intraocular lens in congenital and traumatic aniridia","volume":"115","author":"Aslam","year":"2008","journal-title":"Ophthalmology"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"375","DOI":"10.1016\/S0886-3350(99)00432-0","article-title":"Black diaphragm aniridia intraocular lens for congenital aniridia: Long-term follow-up","volume":"26","author":"Reinhard","year":"2000","journal-title":"J. Cataract. Refract. Surg."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1038\/sj.eye.6701448","article-title":"Surgical management of iris defects with prosthetic iris devices","volume":"19","author":"Mavrikakis","year":"2005","journal-title":"Eye"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"451","DOI":"10.1177\/112067210501500405","article-title":"Implantation of iris devices in congenital and traumatic aniridias: Surgery solutions and complications","volume":"15","author":"Menezo","year":"2005","journal-title":"Eur. J. Ophthalmol."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"2051","DOI":"10.1016\/j.jcrs.2005.04.030","article-title":"Iris reconstruction with a multipiece endocapsular prosthesis in iridocorneal endothelial syndrome","volume":"31","author":"Khng","year":"2005","journal-title":"J. Cataract. Refract. Surg."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"318","DOI":"10.1016\/j.jcrs.2008.10.040","article-title":"Effect of trypan blue staining on the elastic modulus of anterior lens capsules of diabetic and nondiabetic patients","volume":"35","author":"Jardeleza","year":"2009","journal-title":"J. Cataract. Refract. Surg."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"1109","DOI":"10.1038\/sj.eye.6702472","article-title":"Endocapsular iris reconstruction implants for acquired iris defects: A clinical study","volume":"21","author":"Srinivasan","year":"2007","journal-title":"Eye"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"244","DOI":"10.1097\/ICU.0000000000000253","article-title":"Management of aniridia and iris defects: An update on iris prosthesis options","volume":"27","author":"Weissbart","year":"2016","journal-title":"Curr. Opin. Ophthalmol."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"1097","DOI":"10.1016\/j.jcrs.2012.03.021","article-title":"Safety of an artificial iris in a phakic eye","volume":"38","author":"Magnus","year":"2012","journal-title":"J. Cataract. Refract. Surg."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"376","DOI":"10.1016\/j.jcrs.2013.08.051","article-title":"Artificial iris devices: Benefits, limitations, and management of complications","volume":"40","author":"Koch","year":"2014","journal-title":"J. Cataract. Refract. Surg."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"101502","DOI":"10.1016\/j.ajoc.2022.101502","article-title":"Novel surgical technique of sutureless artificial iris and intraocular lens scleral fixation using Yamane technique","volume":"26","author":"Muth","year":"2022","journal-title":"Am. J. Ophthalmol. Case Rep."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"724","DOI":"10.1016\/j.jcrs.2017.06.003","article-title":"Artificial iris implantation in various iris defects and lens conditions","volume":"43","author":"Mayer","year":"2017","journal-title":"J. Cataract. Refract. Surg."},{"key":"ref_56","doi-asserted-by":"crossref","unstructured":"Yildirim, T.M., Khoramnia, R., Masyk, M., Son, H.S., Auffarth, G.U., and Mayer, C.S. (2020). Aesthetics of iris reconstruction with a custom-made artificial iris prosthesis. PLoS ONE, 15.","DOI":"10.1371\/journal.pone.0237616"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"893","DOI":"10.1097\/j.jcrs.0000000000000172","article-title":"Safety and efficacy of custom foldable silicone artificial iris implantation: Prospective compassionate-use case series","volume":"46","author":"Bonnet","year":"2020","journal-title":"J. Cataract. Refract. Surg."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"1419","DOI":"10.1007\/s00417-016-3292-3","article-title":"Long-term results after artificial iris implantation in patients with aniridia","volume":"254","author":"Rickmann","year":"2016","journal-title":"Graefes Arch. Clin. Exp. Ophthalmol."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"663","DOI":"10.3928\/1081597X-20130919-01","article-title":"Clinical and ultrasound biomicroscopic findings in a patient with anterior vaulting of a customized, flexible artificial iris","volume":"29","author":"Rosenthal","year":"2013","journal-title":"J. Refract. Surg."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/9\/2706\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T14:39:41Z","timestamp":1760107181000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/9\/2706"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,5,4]]},"references-count":59,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2024,5]]}},"alternative-id":["jcm13092706"],"URL":"https:\/\/doi.org\/10.3390\/jcm13092706","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,5,4]]}}}