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VIDEO BLOG: Single-pass four-throw pupilloplasty technique
Several techniques have been described for pupilloplasty, with single-pass four-throw, or SFT, being new a variant. SFT is a variation of the modified Siepser slip knot technique, but with SFT two passes are not needed; the surgeon passes the 10-0 long arm needle only once through the anterior chamber, and once the loop is made, four throws are made to pass through the loop.
The video showcases the SFT technique wherein a 10-0 long arm needle is passed through the proximal leaflet of the iris tissue that is to be apposed. In order to facilitate the passage of the needle, the iris leaflet can be grasped with end-opening forceps introduced through the side-port incision followed by the passage of a 10-0 needle. A 26-gauge needle is introduced through the opposite side and is passed through the distal iris leaflet that is to be apposed. The 10-0 needle is then docked into the barrel of the 26-gauge needle that is then withdrawn from the eye. A Sinskey hook is passed into the anterior chamber, and the suture is pulled, creating a loop that is pulled with the end-opening forceps and is withdrawn from the eye. The other end of the suture is passed through the loop four times, and the ends of the suture from both the sides is pulled, leading to the slippage of the loop inside the eye. This leads to approximation of the iris tissue that needs to be repaired, and the helical structure created due to intertwining of sutures due to the creation of four loops secures the approximation of the iris tissue. The suture ends are cut with scissors in a way that 1 mm of suture end is left in the anterior chamber. In the second clip, a big iridodialysis is seen wherein the iris tissue is disinserted from the base. Initially SFT is performed to bridge down the big iris defect at the base followed by repositioning the iris tissue to the scleral wall at its original insertion.
In my recent paper with Dr. Amar Agarwal in the European Journal of Ophthalmology, we report performing SFT in 27 cases with no incidence of loop opening or loosening.