are passed near the sphincter margin in a “spiral or baseball” stitch fashion in which the majority of the bites are placed through the iris tissue from the underside, then the needle tip is wrapped around the pupil margin and the next bite is taken. Both approaches result in an excellent cosmetic and functional result. If there is any difficulty controlling the passage of the needle through the iris tissue, microforceps, such as those used for bi-axial microincision surgery, introduced through a paracentesis may be helpful by grabbing iris tissue during the needle pass.

After completing the 360° passage of the suture, the knot is carefully tied through the principal limbal incision. Alternatively, the needle can be passed out through a paracentesis, and the suture tied through the main incision using the Siepser sliding knot technique. The pupil is drawn down to a size of 3–4mm, which is a good compromise between cosmetic and functional result and fundus visualization. During knot tying, pulling on the suture ends often results in a smaller than desired pupil size, and it is often helpful to deliberately start with a pupil size that is larger than required, and then draw it down to size. The postoperative appearance of the pupil is usually circular or only slightly irregular.

If a major retinal problem occurs subsequently, such as retinal detachment, the iris cerclage suture can be released with either laser spots or intraoperatively by cutting the suture.

7.3.5Adjunctive Pupil Repair Techniques

Adjunctive pupil repair techniques are useful in situations where the pupil is distorted or eccentric. Pupil

distortion and ovalization may occur resulting from trauma itself, or sometimes after repair of an iris dialysis. This may be remedied by the strategic placement of an interrupted suture to the pupil margin, with or without pupil sculpting techniques to round it off. Pupil reshaping may be achieved with a vitrector on the lowest available cut rate and moderate vacuum, or by using intraocular scissors. If the pupil is markedly eccentric, the pupil may be translocated by opening up a new pupil in the center with a vitrector, and closing the peripheral one with one or more interrupted sutures.

Acknowledgement The figures and portions of the text were previously published by, and are taken from, Steinert [6], Chap. 29, with permission.

References

1.Britten MJA (1965) Follow-up of 54 cases of ocular contusion with hyphaema, with special reference to the appearance and function of the filtration angle. Br J Ophthalmol 49:120–127

2.Weidenthal DT (1964) Experimental ocular contusion. Arch Ophthalmol 71:77–81

3.Wolff SM, Zimmerman LE (1962) Chronic secondary glaucoma associated with retrodisplacement of iris root and deepening of the anterior chamber angle secondary to contusion. Am J Ophthalmol 54:547–563

4.Paton D, Craig J (1973) Management of iridodialysis. Ophthalmic Surg 4:38–39

5.Osher RH, Snyder ME, Cionni RJ (2005) Modification of the Siepser slip-knot technique. J Cataract Refract Surg 31: 1098–1100

6.Steinert RF (ed) (2004) Cataract surgery, 2nd edn. Elsevier, London