This video features our talented guest surgeon performing two tough cases, both with a pupilloplasty and each doing a different technique. When addressing small-pupil cases or traumatic iris defects, the choice between a pupillary cerclage and the four-throw pupilloplasty depends on the desired functional outcome and the degree of iris loss.
The Cerclage Technique
The cerclage involves a continuous 10-0 polypropylene suture woven through the iris and pupillary margin in a 360° fashion. It acts like a drawstring bag (pursestring), allowing the surgeon to precisely cinch the pupil to a specific diameter. This is superior for cases with extensive iris atrophy or where a perfectly circular, centered pupil is the priority. However, it requires more intra-ocular manipulation and often multiple paracenteses to complete the running suture.
The Four-Throw Pupilloplasty
Developed by Dr Amar Agarwal, the four-throw pupilloplasty is a modified Siepser knot that is faster and more efficient. By passing the suture through the iris leaflets and wrapping it four times before locking, the surgeon creates a stable, self-locking knot without the need for multiple loops. It is excellent for focal defects or sector iridectomies. While it is technically easier to perform, it may result in a slightly less perfect circle compared to a well-tensioned cerclage.
Which do you prefer? please comment below.
