Purpose: To evaluate a customized silicone flexible artificial iris in cases of aniridia or iris deficiencies. Setting: Centre Hospitalier National d'Ophtalmologie, Hôpital des Quinze-Vingts, Paris, France. Design: Retrospective case series investigating cosmetic result, photophobia, endothelial cell density and intraocular pressure. Methods: Patients with iris deficiencies requiring cataract surgery or correction of aphakia, or pseudophakic patients, complaining of photophobia or cosmetic disturbances were implanted with the new flexible artificial iris. Results: Fifteen eyes of 14 patients were evaluated. Mean age was: 49.5 (±18.5). A total of 50% were aphakic, 22.4% pseudophakic and 28.6% phakic. Etiology was trauma (57.1%), previous surgical trauma (28.6%) and congenital aniridia (14.3%). Three months postoperatively, the mean subjective photophobia score improved by 5.2 points (P = .002) and the mean cosmesis score by 4.7 points (P = .001) on a 0 to 10 scale. Mean endothelial cell loss was 16% (P = .001). There was no further statistically significant endothelial cell loss between the 3-month follow-up and the 1-year follow-up visit (P = .320). Elevated intraocular pressure was the main complication (35.7%). Two patients with pre-existing glaucoma required cyclodestructive procedures. The artificial iris was removed in one eye because of chronic pain, elevated intraocular pressure and inflammation that resolved rapidly after removal. Conclusion: Implantation of the customized artificial iris is a very good option because of its outstanding cosmetic result. However, patients with pre-existing glaucoma are not good candidates. Patients should also be warned of possible chronic inflammation necessitating explantation.