10 Iridodialysis Repair
Summary
The correction of iridodialysis is crucial to prevent glare and photophobia. Following iridodialysis repair, corectopia is often observed that leads to potential problems on the functional as well as cosmetic aspect. The chapter deals with methods and techniques to repair the iris disinsertion as well as achieve a satisfactory outcome from the patient’s perspective. The chapter also describes the twofold technique to deal with iridodialysis of varying severity.
10.1 Introduction
The term iridodialysis implies the disinsertion of iris root from the ciliary body that can be traumatic, iatrogenic, or rarely congenital in origin. Numerous techniques have been described in peer literature for the management of this clinical scenario. 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 It is extremely important to treat this entity as it leads to glare, photophobia, and monocular diplopia. Corectopia is often observed following an iridodialysis repair that often needs to be corrected with iris repair techniques to achieve the proper pupil shape and contour. For iridodialysis repair, one of the most commonly employed techniques is the nonappositional or hangback iris repair technique. 11
10.2 The Essentials and Basics of Iridodialysis Repair
The procedure is performed under peribulbar anesthesia. Conjunctival peritomy is done throughout the extent of the area of iridodialysis and the area is cauterized. A scleral groove is made about 1.5 mm away from the limbus along the entire extent.
10.3 Nonappositional Iridodialysis Repair
This technique comprises the application of the passage of a 10–0 double-arm polypropylene suture attached to the curved long-arm needle. One arm of the needle is passed through the torn peripheral iris tissue and the needle is then passed and pulled out through the scleral groove. The second arm of the needle is passed through the adjacent iris tissue that is to be apposed and the needle is similarly pulled out from the adjacent corresponding scleral portion of the groove. Both the sutures are pulled and this apposes the iris tissue to its base. Both the sutures are then tied and the knot is buried in the scleral groove. The procedure is repeated until the entire iris tissue is reapposed to its base.
10.4 Twofold Technique (TFT) for Iridodialysis Repair
This technique 12 comprises the combination of nonappositional repair and single-pass four-throw (SFT) pupilloplasty. 13 TFT is applicable in all cases of iridodialysis with varied degree of severity (▶Video 10.1). To describe the clinical line of management, iridodialysis has been clinically classified into:
Massive iridodialysis (>120°).
Moderate iridodialysis (45–120°).
Minimal iridodialysis (<45°).
10.4.1 Massive Iridodialysis
This type is encountered in cases with massive trauma and it is often associated with either an absence of iris tissue or sectoral avulsion of the iris to the extent that it is difficult to reattach it to the iris base on the sclera. Under such circumstances, TFT is applied and the amount of iris that can be reapposed to the sclera is done with nonappositional technique. Following this, SFT is performed to cover up the missing iris tissue. This helps to restore the continuity of the iris structure and also helps to achieve a functional pupil (▶Fig. 10.1, ▶Fig. 10.2, ▶Fig. 10.3, and ▶Fig. 10.4).
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