Pupil reconstruction techniques reviewed
Boris Malyugin MD
Patients with iris defects can suffer functional consequences and cosmetic concerns. Boris Malyugin MD, PhD, Moscow, Russia, discussed methods for pupil reconstruction and presented intraoperative videos to illustrate the techniques at the XXXV Congress of the ESCRS.
The chosen approach will depend on the extent of the defect. Dr Malyugin said that iris defects of up to three clock hours can be repaired with suturing, whereas an iris prosthesis should be considered for larger lesions.
When it comes to suturing, a single suture technique performed with a Siepser sliding knot is very useful, relatively easy to perform and usually results in a polygonal pupil, which Dr Malyugin said is “absolutely cosmetically acceptable”.
On the other hand, iris cerclage using a purse-string suture will result in a round pupil. However, this procedure involves multiple manipulations inside the anterior chamber. Noting the potential for cheese-wiring with iris cerclage, Dr Malyugin said that additional sutures should be used to close any gaps.
For the repair of larger iris defects, artificial iris diaphragms are available from several manufacturers. These prosthetic devices are expensive, and their placement involves complex surgery. However, the cosmetic results can be excellent thanks to the opportunity to obtain good matching of iris color with the fellow eye
Dr Malyugin also reminded attendees to recognise that iris injury is likely a sign of serious trauma to the globe.
“When you see these patients, don’t think only about the iris, but consider that other ocular structures may also be affected,” he said.