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Background  To assess the functional outcomes after combined iris and intraocular lens (IOL) repair in aniridia patients.    Methods  Retrospective observational study in 59 aniridic and aphakic eyes for ArtificialIris (AI) and IOL reconstruction. The iris prostheses were placed together with the IOL in the capsular bag using an injection system or were fixed by transscleral suturing of the IOL and AI. The primary outcomes measured were visual acuity, contrast and glare sensitivity (Pelli-Robson chart for photopic and dark adaptometer for mesopic conditions), intraocular pressure, endothelial cell density (ECD) and patient impairment.    Results  Blunt trauma (37 eyes) and penetrating injuries (16 eyes) were observed more frequently than congenital aniridia (1 eye), iatrogenic causes (1 eye), aniridic state after severe iritis (2 eyes) or iris tumor (2 eyes). Monocular CDVA improved significantly ( p  < 0.0001) from median 0.7 logMAR (0.0–1.98) to 0.3 logMAR (− 0.08–2.0). Median pupillary area could significantly ( p  < 0.0001) be reduced by 79.3% from 51.27 mm 2  (17.91 to 98.23) to 8.81 mm 2  (4.16 to 8.84). Median ECD decreased from 2646.0 mm 2  to 2497.5 mm 2  ( p  = 0.007). Contrast and glare sensitivity improved significantly ( p  = 0.008) in photopic light conditions from 0.9 (0.0–1.95) to 1.35 (0.0–1.8). Patients reported to be highly satisfied with the functional improvement.    Conclusion  The flexible ArtificialIris seems to be a safe and effective iris prosthesis in combination with an IOL having functionally and cosmetically exceptional reconstruction options.

Functional outcomes after combined iris and intraocular lens implantation in various iris and lens defects