IRIDODIALYSIS- EVALUATION AND MANAGEMENT

1. EVALUATION & MANAGEMENT OF
IRIDODIALYSIS
PRESENTER:
DR.SUKLENMUNG BURAGOHAIN
DR.ANKIT AHIR
MODERATOR:
DR.NILUTPARNA DEURI

2.  Also known as Coreodialysis
 Dehiscence/separation of iris
from ciliary body at its root
 D shaped pupil
 Asymptomatic, Monoocular
diplopia, Glare, Photophobia
 Trauma – m/c
 Iatrogenic – cataract sx

3. Courtsey:
DR.NILUTPARNA DEURI
MAM

4.  The clinical signs of dialysis are of interest and importance when studied
with the slit-lamp, with the gonioscope, and especially transilluminator.
 The character of the tear, its basal defect, the iris structure, radial tears,
atrophic changes, herniation of the vitreous, and the condition of the
ciliary processes should b studied.
 These observations are of importance in determining the advisability of
operation.

5.  Spontaneous replacement of the iris may be secured by giving prompt
treatment with atropine instillation and complete rest.
 This is attributed to three factors:
(1) Mydriasis from atropine
(2) blood absorption and organization
(3) fibrinous exudates incident to the haemorrhage and the
reaction to the trauma.

6.  The upper eyelid covers iridodialysis superiorly and prevents
symptoms.
 However, temporal iridodialysis is usually symptomatic.

7.  Sunglasses
 Miotics
 Contact lens with artificial pupil
 Aqueous suppressants
 Surgery :
-Small iridodialysis with minimal symptoms require no surgical treatment.
-Large iridodialysis with double pupil effect, monocular diplopia, glare, poor
cosmesis and photophobia require surgical intervention.

8. Principles of IRIS REPAIR
 Instillation of miotic agent  stretches and increases the surface area.
 Soft & friable consistency if iris demands  Atraumatic technique.
 When present, Synechiolysis should be the first step in repair.
 If sphincter is involved ,pupillary margin should be reapposed  establishes a
central pupil and creates more taught iris diaphragm.
 Exposed optic margin of implanted lens  patients develop glare symptoms,the
repaired iris leaflets should cover all IOL edges.

9. Hang-back technique
 Dr. Michael Snyder - “hang-back”
technique  works best for smaller
repairs of 3 o’clock hours or less.
 Instead of repositioning the iris tightly to
the sclera, he suspends the detached
peripheral iris by a 10-0 polypropylene
suture inside the normal iris insertion. A
horizontal mattress suture is placed ab
interno and tightened to bring the iris
periphery to inside and under the limbus.

10. Cobbler’s technique

11. Sewing machine technique

12. Modified sewing machine technique

13. ??RIVETING

14. Riveting technique

15. ??COMPLICATIONS DURING NUCLEUS
MANAGEMENT
 More common when the lens loop is being used to deliver Nucleus in
the presence of a small pupil
 The 6’o clock pupillary edge can get caught between Nucleus and the
loops and be pulled out creating a large ‘IRIDODIALYSIS’.
 Superior iris can also be caught with the Nucleus in the wound and be
pulled out.

16. Management is always a second option,
Prevention comes FIRST

17. (1) CREATE A “LONGER” WOUND

18. AVOID OVERFILLING WITH VISCO ELASTIC

19. RESIST THE URGE TO REPOSIT PROLAPSED
IRIS

20. CAREFUL AND EASY NUCLEUS DELIVERY

21. DON’T MAKE BAD SITUATION WORSE

22.  ALWAYS SUTURE THE WOUND WHERE THE IRIS
HAS PROLAPSED FROM IF NECESSARY.
 “ BETWEEN THE SURGEON’S EGO AND THE KNOT
, LET THE KNOT ALWAYS WIN…!!!”

24. THANK YOU