This document discusses various techniques for repairing iridodialysis, which is the separation of the iris from its attachment to the ciliary body. It describes McCannel's suture technique, the double armed suture/hang back technique, and several other methods such as the sewing machine technique, modified sewing machine technique using a 30-gauge needle, single suture custom loop technique, cobbler's technique, knotless technique, and the riveting technique. It provides details on how each technique is performed surgically to reattach the iris and repair the iridodialysis.

1. Presenter: Dr Harshitha K M
Moderator: Dr Usha B R

2.  Iridodialysis is a separation of the iris from its
attachment to the ciliary body
 Also known as coreodialysis.
 The iris root is one of the weakest parts of iris
that could be easily impaired.
 Most common cause-Trauma- either blunt or
penetrating trauma
 Iatrogenic (during cataract surgery)

3.  Asymptomatic if there is a small superior
iridodialysis- covered by the upper lid
 Temporal and inferio temporal, inferior
iridodialysis are symptomatic.
 Symptoms- Glare, photophobia, monocular
diplopia.
 Signs- ‘D shaped pupil’

4.  Iris incarceration- Paton
 Mc Cannel- Mc cannel’s
suture.
 Double armed suture/ re
attachment of iris to sclera.
 Sewing machine technique
 Modified SMT
 Single suture customised loop
technique
 Cobbler’s technique
 Knotless technique
 Riveting Technique

5.  The McCannel technique is usually done for
repairing iris lacerations.
 A limbal paracentesis is made over the iris
discontinuity.
 Then a long Drews needle with 10-0
polypropylene is passed through the peripheral
cornea, the edges of the iris, and the peripheral
cornea opposite, and the suture is cut.

6.  A Sinskey hook, introduced through the
paracentesis and around the suture peripherally, is
drawn back out through the paracentesis.
 The suture is securely tied.
 After the suture is secure, it is cut, and the iris is
allowed to retract.
 This technique is used for iridodialysis repair also

8.  Also known as Hang back technique.
 It is the principal of repairing peripheral iris defect
using horizontal mattress suture.
 A double-armed suture is employed.
 The first bite is taken at 1/3rd and 2/3rd junction of the
iris defect. Second bite- 1½ clock hours apart.
 The mattress suture brings the iris back to its origin, if
possible ,or closes a peripheral defect using available
adjacent iris tissue.

9.  The knot is tied with just enough tension so the iris is
replaced in its anatomical position and does extend further
beyond..
 The knot is tied externally but then rotated below the
surface so that only a smooth loop of external suture
remains.
 By using this technique of suture rotation and burying the
knot, identical to the concept used in transscleral suturing
of secondary posterior chamber (PC) IOLs ,only a smooth
loop of suture material remains.

11.  A scleral flap does not need to be dissected, and
conjunctiva alone provides adequate coverage of the
suture material.
 Alternatively, if it is desired that both suture material
and knot lie below the scleral surface, then creating a
scleral groove with a beaver blade before placement of
the sutures can be helpful.

12.  This allows the suture material to lie in a trench beneath
the scleral surface when the knot is tied.
 The knot can similarly be rotated into the sclera.
 A large iridodialysis will require several adjacent
horizontal mattress sutures.
 The size of each suture “bite” of iris should be about 1½
clock hours.
 This technique provides an excellent functional and
cosmetic result while minimizing occlusion of the
trabecular meshwork.

13.  Dr K V Ravi Kumar in 2013
 Retrograde threading of 10/0 prolene suture into
26G needle.
 Creation of partial thickness scleral tunnel
parallel to and all along the iris dialysis (1.5 to 2
mm away from the limbus).
 Pupil constriction by 0.5% pilocarpine injection
through a side port made with 20G MVR blade
180° degree opposite to iris dialysis.

14.  Create suture loops all along the dialysis by passing
prethreaded 26G needle with the suture through the root of iris
dialysis and scleral tunnel from inside out through a
paracentesis on the opposite side.
 Cut the loops of prolene and tying the adjacent free ends to
each other so that the knots get buried into scleral tunnel.
 Finally, closure of conjunctiva using 10/o nylon or vicryl or
using bipolar cautery .

16.  The SMT was further modified using 30G 25-mm long dental
needle instead of 26G needle.
 The dental needle with scalpel tip design has better
penetration with minimal trauma to tissue and suture can be
threaded from both sides of the hub.

17.  After creating suture loops as described earlier, first
free end of the suture is passed through the loops and
tied with the second free end of suture so that only
one knot is sufficient for entire iris dialysis repair.

18.  Modified SMT a 26-gauge needle.


19.  Under topical anaesthesia, a limbal conjunctival peritomy is
performed at the site of the iridodialysis.
 A paracentesis is created on the opposite side of the cornea.
 One end of a double-armed 10-0 prolene suture on a straight
needle is introduced into the anterior chamber via the
paracentesis.
 The needle is then driven through the iris base.
 Penetration through the iris tissue and externalization of the
needle are facilitated by introducing a bent 27-gauge needle
through the sclera 1.5 mm posterior to the limbus.

21.  Then the second arm of the prolene suture is introduced into the
anterior chamber via the same paracentesis and passed through a
second point of the iris base again using the 27-gauge needle.
 The second arm of the prolene suture is introduced into the
anterior chamber through the sclera and the iris base and then
retrieved through the paracentesis.
 The above 2 steps are repeated as necessary to achieve complete
apposition of the iris base.
 At the end, the prolene suture is secured in the sclera using a
zigzag-shaped intrascleral suture (Z-suture).
 Five passes are needed, and each pass starts directly adjacent to
the exiting site, then the suture is cut without any knot.

22.  Creation of partial thickness triangular scleral flap centered over the dialysis area
using a crescent knife
 Introduction of the first straight needle of a double-armed polypropylene suture
through the cornea and then through one end of the dialysis, and then using a 27-
gauge needle introduced below the scleral flap 1.0 mm posterior to the limbus as a
guide track
 Introduction of the second polypropylene suture straight needle through the cornea
facing the other end of the huge dialysis
 Withdrawing the two threads from the AC through the main phaco wound using a
Sinskey hook, forming two loops arising from the main wound

24.  Two loops are cut and the cut ends are tied together;
 The two ends of the polypropylene loop are pulled from
beneath the scleral flap to reposit the iris back to its root;
 One of the two suture ends is pulled to extrude the knot from
the ac;
 Pull on the other suture in the opposite direction to correct
any wrinkles in the iris periphery that might have been
caused by the first pull;
 Tie the free ends of the sutures below the scleral flap; and
 Suture the scleral flap with single nylon 10-0 suture at the
apex.

25.  Iridodialysis repair is performed using double-
flanged polypropylene suture.
 This method was first described by Drs. Mami
Kuasaka and Masayuki Akimoto from Japan.
 A scleral grove is created along the length of the
iridodialysis.
 A flange is created on one side of a 6-0 prolene
suture.

26.  The bulbs are flattenned and a 30-gauge
needle is used to pull the suture through the
anterior chamber and iridodialysis.
 Additional flanges are made on the remaining
end of the suture to prevent slippage.

27. Thank you! 