I was really amazed by the technique in this video because the surgeon achieved a fantastic result by first trimming the iris margin, which I’ve not seen before. Surgically repairing a congenital iris coloboma to restore a round, functional pupil requires meticulous intra-ocular suturing, often performed alongside cataract surgery. Because the iris tissue in a coloboma is tethered to the periphery, a simple apposition would result in an eccentric, “keyhole” pupil. To achieve a centered result, surgeons often use intra-ocular scissors to create relaxing incisions in the iris sphincter. This releases the tissue, allowing the central leaflets to be pulled together. A 10-0 polypropylene (Prolene) suture is then passed through the iris margins using a modified sliding knot or a Single-Pass Four-Throw technique. These techniques allow knots to be tied outside the eye and slid into the anterior chamber, minimizing tissue trauma. However in this case, our guest surgeon actually does conventional sutures by using micro instruments in the anterior chamber – very impressive! By carefully approximating the central and peripheral iris segments, the surgeon reconstructs a circular pupillary aperture, significantly reducing glare and improving the patient’s cosmetic appearance.
