We have another video from master surgeon Dr. Valentin I. Apostolov from Amsterdam. In this video he shows us his technique of repairing a congenital iris coloboma. The placement of the sutures results in an excellent functional and cosmetic outcome for the patient. The biggest learning in this case is the intra-ocular tension rod technique.
To suture this iris coloboma, the 10-0 Prolene with a CIF-4 needle is used to get sufficient bites of iris tissue. The question is then how do you tie this suture? There is the McCannel technique which involves making a paracentesis close to the sutured tissue. There is the Siepser technique which allows the know to be thrown outside the eye and then slid into the anterior chamber. The technique shown by Dr. Apostolov is different. The suture ends are brought out the main incision which is opposite from the coloboma. Then the knot is thrown outside the eye and then, in order to slide the knot inside the anterior chamber without damaging iris tissue, a spatula is placed as a tension rod to redirect the suture forces. It is a brilliant technique and it works very well.
Click below to learn how to use the tension rod technique in coloboma repair: