Letter to Editor

Black Diaphragm Intraocular Lens in Patients with
Aniridia

Arjun Srirampur, MS, FRCS; Pasyanthi Balijepalli, MS

Anand Eye Institute, Habsiguda, Hyderabad, India

J Ophthalmic Vis Res 2020; 15 (4): 584–584

Dear Sir,

We read with great interest the article by Al-
Rashidi SH on black diaphragm intraocular lens
(IOL) in patients with Aniridia.[1] We would like to
congratulate the author for the interesting and
well-written paper, but we have some concerns
regarding the article.

First, the author should have mentioned the
site and size of the corneal incision made for the
implantation of the IOL. As these IOLs are quite
bulky, it would require at least a 9 mm incision to
insert them into the anterior chamber. Such a large
incision has the potential to damage the limbal
stem cell population which may subsequently
accelerate epithelial healing problems in patients
with aniridia.

Furthermore, these patients are prone to
develop intraocular pressure elevation in the long
term which may need a glaucoma filtering surgery,
therefore it would be prudent to spare the superior
limbus for possible future glaucoma procedures.

Second, most previous reports on the long-term
results of aniridia IOLs mention a high risk of
postoperative cystoid macular edema (CME) and
IOP elevation due to direct contact of the IOL
haptics with the trabecular meshwork.[2, 3] It would
have been nice if this paper could have provided

Correspondence to:

Arjun Srirampur, MS, FRCS. Consultant – Cornea,
Cataract and Refractive surgery, Anand Eye Institute,
Habsiguda, Hyderabad 500007, India.
E-mail: sarjuneye@gmail.com
Received: 11-02-2019 Accepted: 29-04-2019

Access this article online

Website: https://knepublishing.com/index.php/JOVR

DOI: 10.18502/jovr.v15i4.7801

details of the postoperative status stating whether
any patient developed CME.

Third, as mentioned earlier, glaucoma is the
most commonly reported complication of black
diaphragm IOL implantation. Most previous reports
state risks as high as 40%.[4] But it is surprising
to note that none of the patients in this study
developed postoperative glaucoma in the follow-
up period. On the contrary, all patients who were on
anti-glaucoma medications preoperatively and did
not require any medications in the postoperative
period.

Financial Support and Sponsorship

Nil.

Conflicts of Interest

There are no conflicts of interest.

REFERENCES
1. Al-Rashidi. Black diaphragm intraocular lens implantation

in patients with aniridia. J Ophthalmic Vis Res 2019;14:27–
31.

2. Aslam SA, Wong SC, Ficker LA, MacLaren RE. Implantation
of the black diaphragm intraocular lens in congenital and
traumatic aniridia. Ophthalmology 2008;115:1705–1712.

3. Dong X, Xu H, Yu B, Ying L, Xie L. Long-term outcome of
black diaphragm intraocular lens implantation in traumatic
aniridia. Br J Ophthalmol 2010;94:456–459.

4. Reinhard T, Engelhardt S, Sundmacher R.Black diaphragm
aniridia intraocular lens for congenital aniridia: long-term
follow-up. J Cataract Refract Surg 2000;26:375–381.

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How to cite this article: Srirampur A, Balijepalli P. Black Diaphragm
Intraocular Lens in Patients with Aniridia. J Ophthalmic Vis Res
2020;15:584–584.

584 © 2020 JOURNAL OF OPHTHALMIC AND VISION RESEARCH | PUBLISHED BY PUBLISHED BY KNOWLEDGE E

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