Iridodialysis Repair with a Double-Flanged Prolene Suture
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Title: Iridodialysis Repair with a Double-Flanged Prolene Suture
Author: Austin S. Nakatsuka, MD; Craig Chaya, MD
Date: 03/13/2021
Keywords/Main subjects: cataract, iris, intraocular lens, anterior segment, iris repair, iridodialysis, eye trauma
Brief Description:
We present a technique of repairing a small traumatic iridodialysis with a flanged 6-0 prolene suture. The flange is created by melting the suture with high temperature cautery and clamping the heated suture material with a hemostat. This forms a flattened “button” that effectively fastens the iris to the adjacent sclera both externally and internally, avoiding the need to make multiple needle passes through the iris. Credit goes to Kusaka and authors for describing this technique.
Description of Procedure:
A patient presents with a traumatic iridodialysis and cataract. A limited peritomy is made adjacent to the iridodialysis cleft in preparation for the repair. The cataract is carefully removed utilizing a capsule hook in the area of focal zonular weakness. A capsular tension ring is placed, followed by a single piece lens in the capsular bag. A piece of 6-0 polypropylene suture is obtained and cut to size. The flange is created on one side by melting the suture with high temperature cautery placed near (but not touching) the suture until a heated “bulb” is formed. This bulb is then immediately clamped to form a flattened “button” that will serve as the flange internally. The iris is mobilized in the area of the iridodialysis with the MST forceps. A 30 gauge thin-walled TSK needle is bent and used to pierce the sclera just posterior to the limbus. The needle is passed through the adjacent iris in the area of the iridodialysis cleft with the help of MST forceps. The suture is then introduced into the eye and passed through the needle with the flanged side trailing. This suture is then externalized and pulled tight so that the iris defect is effectively closed and is cosmetically pleasing. The internal flange acts as a fastener to hold the iris against the scleral wall. The suture is then trimmed until about a 2-3 millimeters remain. The high temperature cautery is then used to create an external flange in the same fashion as the previous flange, although this is stopped once the flange reaches the sclera. The peritomy is then closed with vicryl suture.
Key Instruments:
-6-0 polypropylene suture
-High temperature hand held cautery unit
-MST set with micrograsper forceps
-30 gauge thin-walled needle
Reference:
Kusaka M, Miyamoto N, Akimoto M. Repairing iridodialysis by riveting with a double-flanged polypropylene suture. J Cataract Refract Surg. 2019 Nov;45(11):1531-1534.
Faculty approval by: Craig Chaya, MD
Disclosure (Financial or other): None
