Over 10-year follow-up outcomes and failure analysis of black diaphragm intraocular lens implantation in traumatic Aniridia

Purpose To determine the over 10-year follow-up outcomes and analyse the reason for failure in patients who underwent black diaphragm intraocular lens (IOL) implantation for the management of traumatic aniridia. Methods Fifty-three patients underwent black diaphragm IOL implantation for the treatment of traumatic aniridia from September 1998 to August 2007. 33 eyes of 33 patients were enrolled in our study, and the mean follow-up period was 185.6 +/- 36.2 months (range: 126-247 months). The primary methods employed for assessment of the safety of the IOL and the causes of failure were the ultrasound biomicroscopy (UBM) and observation during reoperation. Results In the current study, 13 patients (39.4%) who underwent IOL implantation by means of trans-scleral fixation were observed to maintain a transparent cornea and normal intraocular pressure. 20 patients (60.6%) developed corneal endothelial decompensation, and 14 patients (42.4%) developed secondary glaucoma. 27 patients were examined by means of UBM or reoperation and the position of black diaphragm IOL in 18 patients was observed to be abnormal; the IOL had shifted forward and directly contacted with the anterior chamber and even the corneal endothelium. Conclusion The forward displacement of black diaphragm IOL is a direct cause of treatment failure. Although the implantation of black diaphragm IOL is an effective method of management of traumatic aniridia, the treatment should be guarded and performed in an appropriate manner. Patients should be informed regarding the need for life-long follow-up, so that the complications can be identified in a timely manner.