Supplementary Material for: Neovascular proliferation over a cosmetic artificial iris implant. Management of multiple complication after cosmetic iris implant

Introduction
The NewColorIris and BrightOcular implants were initially developed to address congenital iris defects. However, they found application for cosmetic purposes. Unfortunately, these implants are frequently linked to severe complications, including glaucoma, endothelial dysfunction, cataract development, and iris abnormalities. In this context, we present an unusual complication that manifested long after the implantation of the BrightOcular artificial iris.
Case Presentation
A 28-year-old woman presented to our emergency room with blurred vision in both eyes. She had undergone bilateral cosmetic iris implantation (BrightOcular, Stellar Devices, New York, NY, USA) six years earlier in Tunisia. At the first examination, her BCVA was hand motion in the right eye and 20/100 in the left eye, and intraocular pressure (IOP) was 45 mmHg and 30 mmHg, respectively. Despite the maximum-tolerated glaucoma medical treatment, the elevated IOP persisted, leading to the decision to perform bilateral sequential Baerveldt glaucoma drainage device implantation. However, she subsequently developed CCRAVO (combined central retinal artery and vein occlusion) in the right eye and hypotensive maculopathy in the left eye; the latter resolving within one month. Two months post-surgery, extensive neovascularization above the implant of the right eye was observed, and this was successfully treated with three sequential injections of bevacizumab.
Conclusion
Cosmetic iris implantation is associated with severe, sight-threatening complications. Herein, we describe a previously unreported case of angle neovascularization with new vessels growing over the artificial iris implant. The condition regressed after intravitreal anti-vascular endothelial growth factor injections.