In cases of chronic traumatic mydriasis, we can use sutures to reconstruct a pupil of a reasonable diameter. We have shown the Agarwal four throw pupilloplasty technique which is easy to perform, even by resident ophthalmologists. There is also the cerclage technique which is a purse-string suture that encircles the iris margin and then once it is tied, a round pupil of the desired size is created.
Our guest surgeon is Dr. Valentin I. Apostolov from Amsterdam, The Netherlands, who does a beautiful surgery and gives this patient a great outcome. There are important pearls to learn from this video, including the placement of the paracenteses incisions, the technique of draping the iris edge over the needle, and the exit-and-reentry of the needle in the same incision.
Click below to learn the technique of pupillary cerclage: