What procedure should be more widely taught to young ophthalmologists?
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Iris repair is a technique that I learned in fellowship, and I am often thankful I have this in my skill set.
As a cataract surgeon, the ability to concurrently address iris pathology is valuable, whether for a pupilloplasty or closure of a symptomatic peripheral iridotomy. When an unexpected iris trauma occurs during cataract surgery, it can be addressed immediately, avoiding an additional procedure for the patient.
Historically, iris suturing has been considered advanced anterior segment surgeon territory, but for me, the simplicity and ease of Dr. Amar Agarwal’s single-pass four-throw technique allowed me to comfortably venture into iris repair. Young surgeons should be able to start iris suturing with this technique and expand from there, learning different knots, needles and techniques along the way.
I have used the single-pass four-throw technique to repair traumatic mydriasis, iatrogenic defects and large iridotomies that are symptomatic and bothersome. The procedure is versatile and easy, although you do need to become comfortable using a long, larger needle and working within the anterior chamber. No procedure is risk free, and poor technique or handling of the iris tissue could cause bleeding, further iris trauma or iridodialysis.
Early in my career, a cannula plunger I was working with popped off while I was aspirating viscoelastic during a cataract surgery. The cannula sheered and cut the pupil margin, creating a keyhole defect that needed to be repaired. Fortunately, I knew how to fix it right then and there. The patient did great, and the iris has been stable for many years. Something relatively minor could have turned into a major hassle if I was uncomfortable with iris repair.
Iris repair is an achievable skill for the final year of residency for trainees who display skill in phacoemulsification and closures of other delicate tissues, such as the conjunctiva. I often work with new glaucoma fellows who are fresh out of residency, and I am always eager to introduce them to iris repair techniques, starting with the single-pass four-throw technique. Based on my experience, I think it is something that residents could learn and take with them. It does not require a fellowship.
- Reference:
- Narang P, et al. Eur J Ophthalmol. 2017;doi:10.5301/ejo.5000922.
Lorraine M. Provencher, MD, is an ophthalmologist specializing in cataract surgery and glaucoma at Cincinnati Eye Institute.
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