Iridodialysis Repair Research Articles

Iridodialysis repair using a modified sewing machine technique

A large iridodialysis can present with both visual and cosmetic disturbances, and therefore, surgical intervention is indicated. We describe a modified sewing machine technique in repairing large iridodialysis without the indication of an extensive scleral groove. Another modification made was a scleral flap. The scleral flap provides better control on the position of the knot and its whisker, allowing full coverage and eliminating the risk of whisker exposure and eventual conjunctival erosion. This technique for iridodialysis repair provides better cosmetic results, especially for extensive iridodialysis. It is also more economical and involves simple, safe, and efficient surgical maneuvers in repairing iridodialysis.

A simple suture technique to repair iatrogenic iridodialysis post cataract surgery: A case report

Disinsertion of iris from its attachment is called iridodialysis. Symptomatic and large iridodialysis often requires repair. Repair of iridodialysis is complex and often require special instruments and good surgical expertise. We describe a simple suture technique to repair an iatrogenic iridodialysis caused during small incision cataract surgery in a 62 year-old patient. This technique is simple and involves very minimal tissue handling. The primary aim of us doing this procedure is the functional and cosmetic result which can be obtained in the same sitting as the primary procedure with common available instruments.

Iris Reconstruction: A Surgeon's Guide.

Objectives: The aim of this review paper is to summarise surgical options available for repairing iris defects at the iris-lens plane, focusing on suturing techniques, iridodialysis repair, and prosthetic iris devices. Methods: A thorough literature search was conducted using multiple databases, including Medline, PubMed, Web of Science Core Collection, and the Cochrane Library, from inception to February 2024. Relevant studies were screened based on predefined criteria, and primary references cited in selected articles were also reviewed. Results: Various surgical techniques were identified for iris defect repair. Suturing methods such as interrupted full-thickness sutures and the McCannel technique offer solutions for smaller defects, while iridodialysis repair techniques address detachment of the iris from the ciliary body. Prosthetic iris devices, including iris-lens diaphragm devices, endocapsular capsular tension ring-based devices, and customizable artificial iris implants, provide options for larger defects, each with its own advantages and limitations. Conclusions: Successful iris reconstruction requires a personalised approach considering factors like defect size, ocular comorbidities, and patient preference. Surgeons must possess a thorough understanding of available techniques and prosthetic devices to achieve optimal outcomes in terms of both visual function and, nonetheless, cosmetic appearance.

One-Step Surgical Approach for Treating Lens-Induced Glaucoma with Iridodialysis Following Blunt Trauma

Introduction : Traumatic glaucoma is one of secondary glaucoma that can be challenging to treat. Blunt trauma to the eye may result in iritis, hyphema, lens subluxation, or dislocation leading to increased intraocular pressure (IOP). Every complication needs to be addressed promptly. Here we present about one-step surgical approach to treat lens indued glaucoma with iridodialysis following blunt trauma.
 Case Illustration : A 65-year-old man presented with a chief complaint of blurred vision and pain in his right eye for a month following blunt ocular trauma where he was hit with piece of wood while operating a chainsaw. Ophthalmologic examination revealed RE VA of 2/60 with IOP 32 mmHg. Anterior examination revealed a shallow anterior chamber, iridodialysis 90 degrees, cloudy lens with phacodonesis (Fig 1). Patient was diagnosed with lens-induced glaucoma, lens subluxation, iridodialysis and traumatic cataract. Patient was treated with antiglaucoma agents prior to surgery. One-step surgical approach: trabeculectomy, phacoemulsification with capsular tension ring, and iridodialysis repair become the treatment of choice (Fig 2). After one month of surgery, IOP decreased to 16 mmHg without anti-glaucoma medication, final VA RE achieved 0.2 (Fig 3).DiscussionManagement of traumatic glaucoma depends on the underlying cause of increased IOP. Trabeculectomy combined with lens extraction should be considered with degree of subluxation that may cause pupillary block. Repair iridodialysis can be done using various techniques.
 Conclusion : Management of traumatic glaucoma can be done with trabeculectomy, lens extraction and repair iridodialysis in one-step surgery. Surgical technique should be considered depending on the patient’s eye condition.

Iridodialysis Repair With Intrascleral Fixation of Flattened Flanged Polypropylene Suture.

To present the flattened flanged polypropylene suture technique developed to obtain round and stable pupils in patients with iridodialysis. After performing a fornix-based conjunctival peritomy, a flange was created at the tip of a 6.0 polypropylene suture by cautery. In the quadrant of iridodialysis, an ultrathin 30-gauge needle was inserted into the sclera at a distance of 2 mm from the limbus and advanced 1.5 mm intrasclerally, parallel to the limbus. The needle was directed radially into the eye and easily passed through the edge of the peripheral iris. The polypropylene suture was pushed into the lumen of the needle with the help of forceps. After the needle was externalized, the tip of the suture was flanged by cautery, and the flange was immediately flattened using a needle holder. Six eyes of six patients with iridodialysis were enrolled in this study. Postoperatively, the irises remained well positioned and the pupils became round in all eyes. None of the patients developed suture erosion, suture loosening or rupture, hyphema, hypotony, chronic iridocyclitis, and angle closure. The present technique provides a minimally invasive surgery and robust iris fixation without the need to create a scleral flap, groove, or pocket.

A novel transconjunctival, intrascleral, ab-externo, knotless, and double-flanged technique with 6-0 Prolene for iridodialysis repair

Small traumatic iridodialysis (ID) may be asymptomatic, but large ones usually cause polycoria and corectopia, leading to symptoms like diplopia, glare, and photophobia. The management of ID, including medical and surgical methods, depends upon the patient’s symptoms. Mild glare and diplopia can be treated either with atropine, antiglaucoma medications, tinted spectacles, colored contact lens, or corneal tattooing, but extensive IDs require surgical options. The surgical techniques are challenging due to the iris texture and the damage encountered during the primary surgery, the narrow anatomical workspace for repair, and the associated surgical complications. Numerous techniques have been described by several authors in the literature; each has its advantages and disadvantages. All the procedures described previously involve conjunctival peritomy, scleral incisions, and suture knots and are time consuming. Here, we report a novel transconjunctival, intrascleral, knotless, and ab-externo, double-flanged technique for repair of large ID with a 1-year follow-up.

Triple Procedures for Mechanical Ocular Trauma

Introduction: Mechanical ocular trauma is a major cause of ocular morbidity and can lead to severe visual loss. One of the most complicated mechanical ocular trauma is iridodialysis. In this case, we report three surgical procedures to treat the effect of mechanical ocular trauma. Case Presentation: A 32-year-old man was referred to Gatot Soebroto National Army Hospital, Jakarta, with major complaints of pain and blurred vision in the left eye after sustaining blunt trauma while playing tennis two days ago. He was diagnosed with postoperative corneal laceration repair, subtotal iridodialysis, traumatic cataract, and vitreous hemorrhage on his left eye. He underwent iridodialysis repair with the McCannel suture technique and continued with a pars plana lensectomy to remove the lens and a pars plana vitrectomy to treat the vitreous hemorrhage. Postoperative examination showed a significant improvement of best-corrected visual acuity (BCVA) from hand movement to 0.15 and no sign of acquired infection. Conclusions: The effect of mechanical ocular trauma might be unpredictable and may include various conditions. Accurate management will prevent further complication and improves the patient’s quality of life. A good approach and visual result will satisfy both patients and doctors.

Twofold technique for iridodialysis repair

Disinsertion of iris leads to debilitating sequelae like diplopia and glare. Hence, iridodialysis repair is essential to optimize the visual quality. Iris base repair often leads to corectopia that necessitates an additional procedure to optimize the pupil shape and size. Twofold technique helps to achieve both the aspects. To highlight the technique of twofold iridodialysis repair. The video highlights the method of twofold iridodialysis repair, wherein nonappositional repair is followed by single-pass four-throw (SFT) pupilloplasty that allows adequate closure of varied degrees of iridodialysis along with centration of eccentric pupil. The twofold technique is a combination of nonappositional iris repair and SFT procedure. It can be clinically applied in all cases of iridodialysis with varied degrees of severity. https://youtu.be/OncBdz2UIBY.

Reversed scleral tunnel technique for repair of iridodialysis after blunt force trauma: a retrospective clinical study

BackgroundTo investigate the efficacy and safety of reversed scleral tunnel technique for repairing iridodialysis after blunt force trauma.MethodsA total of 51 eyes of 51 patients with iridodialysis undergoing surgery were included in this study. Patients were divided into 2 groups: group A (the reversed scleral tunnel technique) and group B (the control group). Before the procedure and at 1, 3, and 6 months afterward, data on the patients’ age, gender, treatments, diagnosis, mechanism of injury, best-corrected visual acuity (BCVA), intraocular pressure (IOP), degree of iridodialysis, lens status, concomitant ocular damage, number of sutures, complications, and follow-up time were collected and compared between the 2 groups.ResultsIridodialysis was repaired and the pupil shape was restored to nearly round in all eyes. Standard phacoemulsification or lens removal was performed in all eyes. A final BCVA ≥20/60 was achieved in 13 eyes (48.1%) in Group A and 13 eyes (54.2%) in Group B. The IOP remained stable during the follow-up period in all eyes except 2 eyes (7.4%) in Group A and 3 eyes (12.5%) in Group B with angle recession. There were no statistically significant differences in BCVA and IOP between group A and group B. Intraoperatively, A significantly lower percentage of extensive subconjunctival hemorrhage occurred in Group A compared to Group B (1 eye versus 24 eyes, χ2 = 47.1, P = 0.00). Hyphema was observed in 2 eyes (7.4%) in Group A and 1 eye (4.2%) in Group B. Postoperatively, two eyes (7.4%) in Group A and 2 eyes (8.3%) in Group B developed retinal detachment. No other complications were noted during the follow-up period.ConclusionsThe reversed scleral tunnel technique is a safe and effective approach for repairing iridodialysis after blunt force trauma with few complications, favorable cosmetic and visual outcomes.

Iridodialysis repair - A simplified approach.

Background:Iris root is the thinnest and weakest portion of the iris stroma. It can detach easily due to blunt trauma or accidental engagement of the iris during intraocular surgery resulting in glare, photophobia and monocular diplopia. Multiple techniques described for iridodialysis repair such as hang back technique, stroke and dock technique and sewing machine technique are technically challenging.Purpose:To describe an simplified approach of iridodialysis repair using 9-0 prolene suture.Synopsis:We demonstrate the technique of iridodialysis repair using animation for better understanding. Scleral flap is made adjacent to the iridodialysis area and a paracentesis is made oppsite to the iridodialysis. One arm of the double armed straight needle with 9-0 prolene suture is passed through the paracentesis into the iris root and docked in the 26G needle which is passed underneath the scleral flap 1.5mm posterior to the limbus. Then the needle is pulled out underneath the scleral flap and the manoeuvre is repeated for the second arm as well. The sutures are secured with 5-6 knots under the scleral flap. Intra-operative surgical videos of two patients with traumatic cataract and iridodialysis following blunt trauma are shown. After stabilizing the detached iris using iris hooks, phacoemlsification is done with implantation of foldable acrylic IOL, followed by iridodialysis repair as described above. Both the patients were relieved of their pre-operative symtoms and had good visual recovery.Highlights:We describe a simplified approach of iridodialysis repair that can significantly reduce the patient’s troublesome symptoms such as glare and monocular double vision.Online Video Link: https://youtu.be/-axYnSfWSb0

In-N-Out technique: double-flanged suture ab interno iridodialysis repair.

In this study, a procedure for iridodialysis repair using an elegant, cost-effective, and quick technique using 6-0 polypropylene sutures, low-temperature electrocautery, and a 27-gauge needle is presented. Previously, all methods required performing a conjunctival peritomy to expose bare sclera and then typically intricate movements and knot tying. The method described in this study combined the sewing machine technique and a modified Yamane scleral-fixation technique to treat iridodialysis that required no knots, peritomies, or specialized equipment.

Review of surgical repair of traumatic iridodialysis

Iridodialysis is a dehiscence of the iris from the ciliary body at its root. Surgical intervention in iridodialysis is indicated when the tear is large and causing symptoms. In this study11 eyes of 11 patients with traumatic iridodialysis were included to repair the iris defect using open chamber technique .

Results of a novel surgical technique for iridodialysis repair using an iris retractor segment.

To describe a novel surgical technique for iridodialysis repair using an iris retractor segment and report its clinical results. Fifty-three eyes of 53 patients who underwent iridodialysis repair using an iris retractor segment were enrolled in this retrospective study. Data recorded from patient files consisted of age, sex, degree of iridodialysis, surgical techniques, number of segments used, preoperative and postoperative corrected distance visual acuity (CDVA), intraocular pressure (IOP), complications, and follow-up time. Mean follow-up time was 34.4months. The subjects included 29 men (54.7%) and 26 women (45.3%), and the mean age was 56.6 ± 14.0years. According to the degree of iridodialysis, the patients were divided into Group 1 (60°-89°, n = 19) and Group 2 (90°-270°, n = 34). During the iridodialysis repair for Group 1, a single segment was sufficient; however, in Group 2, one segment was used in 18 eyes (52.9%), two segments in 15 eyes (44.1%), and three segments in one eye (2.9%). The pre- and postoperative last control CDVA value in Group 2 was significantly lower than in Group 1. The pre- and postoperative IOPs for Group 2 were significantly higher than Group 1. Iridodialysis repair using an iris retractor segment is a minimally invasive technique and found to be safe and effective. It will be a good option for patients with large iridodialysis, as it avoids excessive surgical manipulations and prolonged surgical time.

Modified sewing machine technique in combination with lens aspiration and anterior vitrectomy for large iridodialysis repair

We describe the management of a large iridodialysis repair using the modified sewing machine technique and lens aspiration in a single setting in an eye with blunt ocular injury. We performed the lens aspiration first followed by iridodialysis repair. The technique was easy and fast, with good postoperative anatomical outcome.

Trocar assisted nonappositional repair of iridodialysis.

To describe trocar-assisted method of Nonappositional repair of iridodialysis. The technique described involves placement of a 25 G trocar at the limbus wherein the lumen of the cannula works as a guide to introduce a double arm polypropylene suture attached to the long arm needle thereby preventing any accidental entrapment of corneal fibers into the needle. The technique was performed in 7 cases and no entrapment of corneal tissue was observed while maneuvering the suture needle through paracentesis incision during an iridodialysis repair procedure. Anterior segment optical coherence tomography demonstrated closure of the limbal trocar wound at 1-week follow-up. No incidence of wound leak or Descemets membrane detachment was observed. The technique allows performing iridodialysis repair in technically challenging situations by directing the needle appropriately and preventing any undulating movement inside the anterior chamber. The trocar-assisted method serves as an effective method to perform non-appositional iridodialysis repair.

Intrascleral Fixation of Flanged Polypropylene Suture(s) for Iridodialysis Repair.

We will describe a minimally invasive technique for the repair of iridodialysis, without conjunctival dissections, using intrasceral fixation of a 6-0 polypropylene suture with a flanged tip. A flange was created at the end of the suture with thermoplasticity. An ab interno passing of the needle attached to the suture was performed through the peripheral part of the iris and was further passed out from the eye 1.5 mm to 2 mm behind the limbus. Intrascleral fixation of the exterior suture was performed with the aid of the attached needle. After adjusting the tension of the iris relocation, the externalized end of the suture was cut flush to the sclera with scissors. For a wide dialysis, the same manipulations were repeated until the repair was completed. The technique was used in three eyes of three patients. No visual impairments of monocular diplopia and glare were observed after surgery. Postoperatively, the irises remained well positioned, with no suture erosion, suture loosening, hypotony, scleral atrophy, or chronic inflammation being observed within the follow-up period. Mild postoperative hyphema was observed in one eye of blunt trauma. The present technique provides minimal surgical invasion for the repair of iridodialysis without creations of scleral flap/groove/pocket and conjunctival dissection.

Alternate iris bypass technique of iridodialysis repair.

We describe a novel technique “alternate iris bypass technique” of iridodialysis repair in four patients experiencing traumatic iridodialysis along with cataract. In these cases, we have combined iridodialysis repair with phacoemulsification and intraocular lens implantation. The main advantage of this technique is that edges of the iridodialysis can be visible till the end of the repair by bypassing the iris tissue in alternate bites which helps in minimizing the corectopia of the pupil and localized iris clumping.

A novel technique for closed-chamber iridodialysis repair.

PURPOSE:We introduce a novel technique for closed chamber iridodialysis repair.MATERIALS AND METHODS:We use a 2.8-mm paracentesis knife to penetrate into the anterior chamber and create interrupted incisions in the sclera. The wounds are 1.5 mm distant from the limbus, at consistent 2.8-mm intervals along the dialysis area. After injecting viscocohesive ophthalmic viscosurgical device through a side port to relieve the synechia and to push the iris toward the incisions, the iris is then grasped by Kelman forceps through the sclera, dragged carefully, and incarcerated. After adjusting the tension of the iris according to the pupil shape, the sclera and the incarcerated iris tissue were sutured together with 10-0 nylon.RESULTS:The technique was effective in six patients with traumatic iridodialysis.CONCLUSION:Our surgical technique repairs the iris, restores the shape of pupil, as well as avoids creating a large incision in the limbus in patients suffering from iridodialysis.

Comparing safety and efficiency of two closed-chamber techniques for iridodialysis repair - a retrospective clinical study

BackgroundThis study aims to compare the safety and effectiveness of two closed-chamber techniques for repairing iridodialysis.MethodsSeventy five patients with iridodialysis undergoing surgery from February 2008 to October 2017 were included in this study. Patients were divided into two Groups, Group A (32 eyes) and Group B (35 eyes), with Group A using a 26-gauge hypodermic needle guided 10–0 nylon suture, and Group B using a double-armed polypropylene suture. Before operation and 1, 3, and 6 months after the operation, pupil shape, best corrected visual acuity (BCVA), intraocular pressure (IOP), the rate of endothelial cell loss, and intra- and postoperative complications were compared between two Groups during the follow-up period.ResultsIridodialysis was repaired with pupil shape restored in all cases. IOP was normalized in all eyes except 2 eyes (6.3%) in Group A and 3 eyes (8.6%) in Group B. Postoperative rate of endothelial cell loss was not significantly different between two Groups (P > 0.05). The percentage of complicated cataract was not significantly different in Group A (2 eyes, 6.3%) compared to Group B (2 eyes, 5.7%) (χ2 = 0.009, P = 0.658).ConclusionsBoth techniques for repairing iridodialysis not only were safe but also effective in improving visual function and cosmetic recovery. However, double-armed polypropylene suture might be less invasive than 26-gauge hypodermic needle guided suture.

Single-point pivot for combined repair of concurrent iridodialysis and cyclodialysis

Iridodialysis and cyclodialysis can occur simultaneously in patients with blunt trauma to the eye, and both might necessitate surgical correction when symptoms emerge. Numerous techniques are used to repair each dialysis individually; thus, the patient will have to return to the operating room for each additional surgery. To our knowledge, the literature lacks techniques to manage both conditions simultaneously. We developed a new approach in which both dialyses can be repaired using a single suture, pivoting both at the same point. The suture that passes through the eyelet of the capsular tension ring placed in the sulcus (for internal cyclopexy) is further passed through the detached iris root and retracted via the ciliary cleft to be tied over the scleral bed, facilitating closure of both dialyses at the same time. This is an effective approach for the repair of concurrent iridodialysis and cyclodialysis.