The iris is unlike any other tissue in the body. It is beautiful and delicate, but it is also tough enough to move tens of thousands of times per day in response to light and accommodative effort. On occasion we find ourselves in a position where placing sutures in the iris can be helpful in repairing trauma, securing an IOL, or restoring an appropriate aperture size. (scroll down for full video)
(1) Maximize the view with retro-illumination
Retro-illumination is important to fully understand the details of the situation prior to taking the patient to the operating room. Take your time at the pre-operative consultation to glean as much information as possible.
(2) Place haptic fixation sutures in the peripheral iris
When placing iris sutures to secure an IOL haptic, place these sutures in the iris periphery and away from the pupillary margin.
(3) Minimize Pupil Ovalization
Also a sufficient bite of iris tissue is needed otherwise the 10-0 polypropylene can cheese-wire through the tissue. Also, by pulling the iris tissue centrally before cinching the knot we can ensure that the pupil stays round instead of becoming ovoid.
(4) First suture the iris root to the angle, then repair other iris defects
Iris damage from trauma can also be repaired as we saw in yesterday’s video. First use mattress sutures to secure the iris root to the angle. Then iris defects can be sutured and a pupil reconstructed. Make sure that the new pupil is not too constricted since we still need to be able to examine the retina in the future.
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