Eyeworld

EW CATARACT August 2017 A detailed look at pupil reconstruction I rregular shape of the pupil or its eccentric placement can lead to visual disturbance and dissatisfaction that can arise due to photophobia, distortion of images, and spherical aberration. Under such circumstances, pupil reconstruction is essential to opti- mize the visual outcomes. Various techniques have been described for restructuring the pupil, and the single-pass four-throw technique (SFT) is a new entrant into the zone of pupilloplasty procedures. Technique A paracentesis incision is made in the peripheral cornea in line with the proposed tract of the suture needle and the iris defect. A 10-0 polypropylene suture attached to the long arm needle is passed through the paracentesis incision and enters the anterior chamber (AC) followed by engagement of the proximal iris defect with the tip of the needle (Figure 1A, B). An end-opening for- ceps holds the peripheral edge, and the needle can then be passed easily through it as the iris tissue becomes taut and is no longer crumpled in texture. A 26 g needle is introduced from the opposite side of the paracente- sis incision, and the end-opening forceps grasps the distal end of the iris tissue (Figure 1C, D). The tip of the 10-0 needle is docked into the barrel of the 26 g needle (Figure 1E) that is then pulled out from the AC, and this facilitates the exit of the needle from the AC (Figure 1F). A Sinskey hook or an end-opening forceps is passed from the paracente- sis incision, and a loop is created by pulling the suture end from the exit site (Figure 2A, B). The suture end is passed from the loop four times (Fig- ure 2C), taking care to always pass it in the same direction. Four throws are taken and intertwining of the Tips and tricks by Priya Narang, MS, and Amar Agarwal, MS, FRCS Single-pass four-throw (SFT) pupilloplasty technique Figure 1. A: The proximal iris edge of iris defect is grasped with an end-opening forceps, and a 10-0 polypropylene suture attached to the long arm needle is introduced into the anterior chamber. B: The needle is passed through the proximal iris defect. C: The distal edge of an iris defect is grasped with an end-opening forceps. D: A 26 g needle is passed through the distal iris leaflet that is to be apposed. E: The 10-0 needle is docked into the barrel of the 26 g needle. F: The 26 g needle is pulled, and this facilitates the exit of the 10-0 needle from the eye. Figure 2. A: The suture is seen passing from both edges of the iris leaflet. B: A loop is withdrawn from the AC by pulling the end of the suture with an end-opening forceps. C: The suture end is passed from the loop and four throws are taken. D: The suture ends are pulled and the loop slides into the AC, bridging both the iris leaflets together. E: The suture ends are cut with microscissors. F: Well-approximated edges of iris tissue are seen. Source: Amar Agarwal, MD 36

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