An atrophic iris due to the possibility of an iridodialysis and increased iris damage.Phakic eye with a clear lens due to the possibility of lens touch and cataract formation.Contraindications Relative contraindications include: To provide more cosmetically acceptable pupilĪlthough pupilloplasty is rarely performed solely for cosmesis, it can be considered, especially in large colobomas in a colored iris and it can provide functional and cosmetic repair. Single pass four through pupilllplasty can be used to break PAS and angle apposition angle closure glaucoma whether primary, post trauma, plateau iris syndrome, Urrets-Zavalia syndrome, and in cases associated with long standing silicone oil in the anterior chamber. To relieve appostional angle closure or PAS (peripheral anterior synechiae) In some cases of floppy iris that is expected to adhere to the peripheral edge of a corneal graft causing peripheral anterior synechiae, pupilloplasty is performed to tighten the iris preventing it from causing synechial adhesions that would increase the risk of angle closure and graft failure. To prevent post-operative complications as in PKP ( penetrating keratoplasty) Pupilloplasty can be performed to provide the necessary support required for iris claw lens (Artisan) implantation as an option if there was no adequate capsular support to implant in-bag or sulcus IOL. To provide structural support for lens implantation: Decentered pupil can be re-centered with laser pupilloplasty, this is usually used in cases of decentered pupil with implanted multifocal intraocular lens. Complicated intraocular surgery (can cause atonic dilated pupil or iris tissue loss and injury)ī.Traumatic (traumatic mydriasis or direct injury resulting in pupil irregularity or tissue loss).Symptomatic iris defects can be a consequence of either: Symptomatic iris defects can be considered for surgical intervention, symptoms can range from glare, shadow images and diplopia. Indications for surgery can be divided into these five main categories:Ī. Osher described a modification of the Siepser slip-knot that allowed the knot to become locked, decreasing the chance of suture failure in 2005. Siepser sliding knot technique was introduced in 1994. In 1985, Alpar modified the McCannel technique by using Healon ( 1% sodium hyaluronate) in cat eyes with improved corneal protection, less change in pachymetry, and less decrease in endothelial cell counts. The first published pupilloplasty technique was made by McCannel in 1976 who tried to repair an iris defect after ICCE to manage a subluxated, iris- sutured IOL inside the anterior chamber with full air bubble by using sutures retrieved through three small incisions. Many old, new and emerging novel techniques for iris repair are utilized.īecause of the better understanding of the importance of pupil size and regularity of pupillary aperture, pupilloplasty is increasingly used by ophthalmic surgeons to optimize patient visual outcomes.
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