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Riveting with double-flanged polypropylene suture helps repair iridodialysis
A 30-gauge needle, 6-0 Prolene suture and low temperature cautery are essential to perform this technique.
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Iridodialysis is often an accompanied clinical sign seen in cases with trauma. Occasionally it can be iatrogenic in nature, too. Numerous techniques have been described for the repair of iridodialysis. Mami Kusaka and Masayuki Akimoto from Japan recently described iridodialysis repair by riveting with double-flanged polypropylene sutures. The technique derives its inspiration from the flanged fixation of an IOL described by Shin Yamane.
Technique
A 30-gauge needle, a 6-0 Prolene suture and a low temperature cautery are essential to perform this technique. For flange creation, the needle is cut off from the suture end, and the suture is eventually cut into pieces of around 7 cm to 9 cm, depending on the amount of iris disinsertion. One suture piece is needed to approximate the iris at any one given point.
Source: Priya Narang, MS, and Amar Agarwal, MS, FRCS, FRCOphth
One suture piece is taken, and a low temperature cautery is brought closer to the suture end so as to create a bulb. The bulb is pressed with forceps, and a flat flange is created (Figures 1a to 1c). Kusaka and Akimoto recommend making a bulb that involves heating the suture end up to 3 cm.
A scleral groove is made along the length of the iridodialysis, and a 30-gauge needle is passed from the scleral groove into the anterior chamber. The needle engages the peripheral base of disinserted iris, and the other end of the flanged suture is introduced from the corneal entry and is threaded into the 30-gauge needle. The needle is withdrawn, thereby pulling the suture along with it. The suture end is pulled, and the flange lies along the disinserted base (Figures 1a to 1f). The free end of suture on the scleral side is heated with a low temperature cautery, and a flange is created on the other side as well (Figure 2). Thus, the flanges on either side of the iris base hold the iris tissue to the sclera and prevent it from slipping (Figures 3 and 4).
Thus, suturing of the iris to the base is not needed and is averted, thereby overcoming the complexities associated with suture knots.
Precautions
The suture bulb that is created should be neither too small nor too big. If the bulb is made much bigger, there is a chance that the bulb will hang down by its own weight. Too small a bulb will create a small flange that might not hold the iris tissue, and it might slip through the iris tissue and cut through it.
The low temperature cautery should be held at an ideal distance from the suture end. If it is held too close, then it might burn the entire suture material, which will eventually shrink and be rendered dysfunctional.
- For more information:
- Amar Agarwal, MS, FRCS, FRCOphth, is director of Dr. Agarwal’s Eye Hospital and Eye Research Centre. Agarwal is the author of several books published by SLACK Incorporated, publisher of Ocular Surgery News, including Phaco Nightmares: Conquering Cataract Catastrophes, Bimanual Phaco: Mastering the Phakonit/MICS Technique, Dry Eye: A Practical Guide to Ocular Surface Disorders and Stem Cell Surgery and Presbyopia: A Surgical Textbook. He can be reached at 19 Cathedral Road, Chennai 600 086, India; email: aehl19c@gmail.com; website: www.dragarwal.com.
- Priya Narang, MS, can be reached at Narang Eye Care & Laser Centre, Ahmedabad, India; email: narangpriya19@gmail.com.
Disclosures: Agarwal and Narang report no relevant financial disclosures.