A novel transconjunctival, intrascleral, ab-externo, knotless, and double-flanged technique with 6-0 Prolene for iridodialysis repair

Small traumatic iridodialysis (ID) may be asymptomatic, but large ones usually cause polycoria and corectopia, leading to symptoms like diplopia, glare, and photophobia. The management of ID, including medical and surgical methods, depends upon the patient’s symptoms. Mild glare and diplopia can be treated either with atropine, antiglaucoma medications, tinted spectacles, colored contact lens, or corneal tattooing, but extensive IDs require surgical options. The surgical techniques are challenging due to the iris texture and the damage encountered during the primary surgery, the narrow anatomical workspace for repair, and the associated surgical complications. Numerous techniques have been described by several authors in the literature; each has its advantages and disadvantages. All the procedures described previously involve conjunctival peritomy, scleral incisions, and suture knots and are time consuming. Here, we report a novel transconjunctival, intrascleral, knotless, and ab-externo, double-flanged technique for repair of large ID with a 1-year follow-up

Twofold technique for iridodialysis repair

Background: Disinsertion of iris leads to debilitating sequelae like diplopia and glare. Hence, iridodialysis repair is essential to optimize the visual quality. Iris base repair often leads to corectopia that necessitates an additional procedure to optimize the pupil shape and size. Twofold technique helps to achieve both the aspects. Purpose: To highlight the technique of twofold iridodialysis repair. Synopsis: The video highlights the method of twofold iridodialysis repair, wherein nonappositional repair is followed by single?pass four?throw (SFT) pupilloplasty thatallows adequate closure of varied degrees of iridodialysis along with centration of eccentric pupil. Highlights: The twofold technique is a combination of nonappositional iris repair and SFT procedure. It can be clinically applied in all cases of iridodialysis with varied degrees of severity

Iridodialysis repair – A simplified approach

Background: Iris root is the thinnest and weakest portion of the iris stroma. It can detach easily due to blunt trauma or accidental engagement of the iris during intraocular surgery resulting in glare, photophobia and monocular diplopia. Multiple techniques described for iridodialysis repair such as hang back technique, stroke and dock technique and sewing machine technique are technically challenging. Purpose: To describe an simplified approach of iridodialysis repair using 9?0 prolene suture. Synopsis: We demonstrate the technique of iridodialysis repair using animation for better understanding. Scleral flap is made adjacent to the iridodialysis area and a paracentesis is made oppsite to the iridodialysis. One arm of the double armed straight needle with 9?0 prolene suture is passed through the paracentesis into the iris root and docked in the 26G needle which is passed underneath the scleral flap 1.5mm posterior to the limbus. Then the needle is pulled out underneath the scleral flap and the manoeuvre is repeated for the second arm as well. The sutures are secured with 5?6 knots under the scleral flap. Intra? operative surgical videos of two patients with traumatic cataract and iridodialysis following blunt trauma are shown. After stabilizing the detached iris using iris hooks, phacoemlsification is done with implantation of foldable acrylic IOL, followed by iridodialysis repair as described above. Both the patients were relieved of their pre?operative symtoms and had good visual recovery. Highlights: We describe a simplified approach of iridodialysis repair that can significantly reduce the patient’s troublesome symptoms such as glare and monocular double vision.

Iridodiálisis y catarata como resultado de un trauma ocular / Iridodialysis and cataract as a result of eye trauma

RESUMEN Los traumas oculares son motivo de consulta de alta incidencia en los Servicios de Urgencias. Estos pueden producir daños devastadores para la anatomía y la fisiología del globo ocular. Muchas lesiones pueden ser provocadas por ellos, entre las que se encuentran las iridodiálisis. Muchas veces estas no requieren tratamiento por ser de pequeña magnitud, pero cuando su tamaño es mediano o grande sí requieren de una cirugía bastante compleja para solucionarla. A veces se deben combinar varias técnicas quirúrgicas para lograr el objetivo final de restablecer nuevamente y de la mejor manera la anatomía del globo ocular. El caso que se presenta es un paciente joven de 20 años de edad, quien recibió un trauma ocular a globo cerrado en el ojo derecho, el cual le provocó dos iridodiálisis grandes y una catarata traumática. Para solucionarlo se repararon primero las iridodiálisis utilizando una técnica de McCannell en ambos casos; después se realizó la facoemulsificación de la catarata traumática con implante de lente intraocular, y por último se realizó una pupiloplastia mediante la técnica del nudo deslizante de Siepser. De esta manera, y mediante la combinación de ambas técnicas, se logra solucionar el caso y que el paciente recupere la agudeza visual y su total incorporación a su vida cotidiana(AU)

ABSTRACT Eye trauma is a very common reason for attendance to emergency services. Eye trauma may cause devastating damage to the anatomy and physiology of the eyeball. Iridodialysis is one of the many injuries that may be caused by eye trauma. On many occasions iridodialysis does not require any treatment due to its small size, but when it is medium-sized or large it does require quite complex surgery. At times several surgical techniques should be combined to achieve the final goal of restoring eyeball anatomy in the best way. A case is presented of a male 20-year-old patient who underwent closed-globe trauma of his right eye resulting in two large iridodialyses and a traumatic cataract. The iridodialyses were repaired first using the McCannell technique in both cases. Then phacoemulsification of the traumatic cataract was performed with intraocular lens implantation. Finally pupilloplasty was conducted by the Siepser sliding knot technique. In this manner, and by combining the two techniques, the case was solved; the patient recovered visual acuity and was totally reintegrated into his daily activities(AU)

Modified sewing machine technique for iridodialysis repair, intraocular lens relocation, iris coloboma repair, Cionni ring fixation, and scleral-fixated intraocular lens

The purpose of this study is to report the modification of sewing machine technique for iris dialysis repair (MSMT) and its usefulness in managing other conditions such as intraocular lens (IOL) subluxation, iris coloboma, Cionni ring for zonular dialysis, and for scleral-fixated IOL. MSMT was based on sewing machine principle using a prethreaded 26G/30G needle with prolene suture for minimally invasive iris dialysis repair in a closed chamber manner. So far, eight patients (trauma � 3, surgical complication � 5) underwent this procedure. This technique is further modified to extend its use for IOL relocation � 2, iris coloboma repair � 3, and Cionni ring fixation for zonular dialysis � 2, SFIOL � 5 patients. All 20 patients had good visual recovery and cosmetic outcome with minimal morbidity. To conclude, MSMT offers cost -effective, minimally invasive, easy to learn procedure with a potential to tackle several problems related with cataract surgery and iris defects, which even an average cataract surgeon can learn to perform when required. Further comparative studies with conventional techniques with large sample size are required to standardize this procedure.

Iris reconstruction combined with iris-claw intraocular lens implantation for the management of iris-lens injured patients.

Aim: To study the efficiency and safety of iris reconstruction combined with iris‑claw intraocular lens (IOL) implantation in the patients with iris‑lens injuries. Settings and Design: Retrospective, noncomparable consecutive case series study. Materials and Methods: Eleven patients (11 eyes) following iris‑lens injuries underwent iris reconstructions combined with iris‑claw IOL implantations. Clinical data, such as cause and time of injury, visual acuity (VA), iris and lens injuries, surgical intervention, follow‑up period, corneal endothelial cell count, and optical coherence tomography, were collected. Results: Uncorrected VA (UCVA) in all injured eyes before combined surgery was equal to or <20/1000. Within a 1.1–4.2‑year follow‑up period, a significant increase, equal to or better than 20/66, in UCVA was observed in six (55%) cases, and in best‑corrected VA (BCVA) was observed in nine (82%) cases. Postoperative BCVA was 20/40 or better in seven cases (64%). After combined surgery, the iris returned to its natural round shape or smaller pupil, and the iris‑claw IOLs in the 11 eyes were well‑positioned on the anterior surface of reconstructed iris. No complications occurred in those patients. Conclusions: Iris reconstruction combined with iris‑claw IOL implantation is a safe and efficient procedure for an eye with iris‑lens injury in the absence of capsular support.

Isolated traumatic aniridia after trabeculectomy in a pseudophakic eye.

This is a single case report of an elderly patient who had blunt trauma in an eye that had phacoemulsification and two trabeculectomies. She had good vision with a well-functioning bleb before the trauma. She presented during her routine followup visit for glaucoma with isolated aniridia and an intact globe. The capsular bag, zonules, and the intraocular lens were intact. The cupping was 0.8, and the rest of the fundus and macula were normal. Pigments were seen over the sclera extending posteriorly upto the fornix. Gonioscopy revealed only faint pigments at the fistula. Following the trauma, the intraocular pressure had increased to 26 mm Hg. The mechanism and the management of the glaucoma are discussed.

Microscopic repair of iridodialysis by contusions / 中国基层医药

ObjectiveTo investigate the causes, operation time, and microscopic repairing procedures of contusive iridodialysis. Methods23cases(23 eyes) who had partial iridodialysis due to contusions of the eyeballs underwent the microscopic repair during 7 to 18 days after injury. Viscoelastic agent and other auxiliary devices were used in the operation. ResultsAll eyes were fully corrected with approximate round-shaped pupils and their visual function improved. 1 eye with raised intraocular pressure was performed with trabeculectomy. ConclusionTimely repair of partial iridodialysis performed under microscope was safe and effective.

Clinical Analysis of Ocular Injuries induced by Power Lawn Mowers

The authors analysed 22 patients who were admitted to Gyeongsang National University Hospital because of ocular injuries induced by Power lawn mowers from March 1, 1991 to December 31, 1994. All of the patients were males. The average age of the patients was 43.3(range 15-69). Most injuries occured between June and September. Perforating injuries were developed in 8(36.4%) of 22 eyes and non-perforating injuries in 14(63.6%) eyes. The type of injuries were lens damage(10/22), vitreous hemorrhage(8/22), iridodialysis(4/22), intraocular foreign body(3/22), endophthalmitis(2/22), retinal detachment(1/22), and choroidal rupture(1/22). The prognosis was poor when the eyeball was perforated. Therefore safety goggles are absolutely needed for prevention of ocular injuries induced by Power lawn mowers.