Repair of Iris Trauma and Iris Suturing Techniques

Repair of Iris Trauma and Iris Suturing Techniques


Iridodialyses and iris sphincter tear, causing glare, photo-phobia, or cosmetically unacceptable anisocoria


image Preserve as much iris tissue and maintain as normal ocular anatomy as possible.

image Reconstruct pupil to prevent glare and photophobia.

image Restore a firm iris structure to avoid synechia formation and glaucoma.

image Protect cornea (or corneal graft) from iridocorneal adhesions and glaucoma.

image Create a stable iris diaphragm for support of anterior or posterior intraocular lens.

Preoperative Procedure

The initial treatment of iris injury is conservative until initial trauma repair is complete and wound is stabilized.

1. Shield (metal or plastic) the affected eye at all times.

2. Reduce pain and nausea to prevent lid squeezing.

3. Confine patient to bed rest and keep fasting (NPO) until time of surgery.

4. Administer prophylactic intravenous broad-spectrum antibiotics if appropriate

a. Cefazolin (1 g IV every 8 hours) and ciprofloxacin (400 mg IV 2 times per day) are a typical combination.

b. Clindamycin is added when an intraocular foreign body is suspected (for Bacillus coverage).

5. Tetanus toxoid as needed.

Nonsurgical Management

image Sunglasses

image Tinted contact lenses

image Contact lenses with an artificial iris peripheral pigmentation

image Topical medications

image Miotic agents (e.g., pilocarpine 1%) may reduce size of a traumatically dilated pupil.

image Mydriatic agents (e.g., cyclopentolate 1%) may normalize a decentered pupil.

Laser Treatments

Note: This technique is most useful when dilating drops are ineffective, where adhesions and bands can be lysed, and a sphincterotomy can recenter an eccentric pupil.

1. Argon laser settings: 50 μ (micron) spot size, power 1000 mW (milliwatts) power, 0.1 second duration; low risk of lens capsule rupture (can use in phakic patients).

2. Neodymium:yttrium-aluminum-garnet (Nd:YAG) laser settings: 5 to 6 mJ and higher; higher rate of bleeding than argon laser.


image Lid speculum (e.g., Lieberman)

image Fine-toothed tissue forceps (e.g., 0.12 mm forceps)

image Westcott scissors

image 10–0 polypropylene sutures (with a long needle e.g., Ethicon CIF-4 for closed-chamber cases; Short needle e.g., Ethicon BV 100–4 for open sky cases)

image Sutures (4–0 silk, 10–0 nylon, 8–10 Vicryl)

image Needle holder

image Smooth forceps (e.g., Chandler or Bracken forceps)

image Viscoelastic material (e.g., Amvisc, Viscoat)

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Jun 4, 2016 | Posted by in OPHTHALMOLOGY | Comments Off on Repair of Iris Trauma and Iris Suturing Techniques

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