Cobbler's Technique for Iridodialysis Repair.

We describe a novel "Cobbler's technique" for iridodialysis repair in the right eye of a patient aged 18 years, with a traumatic iridodialysis secondary to open globe injury with an iron rod. Our technique is simple with easy surgical maneuvers, that is, effective for repairing iridodialysis. The "Cobbler's technique" allows a maximally functional and cosmetic result for iridodialysis.

INTRODUCTION

Iridodialysis commonly occurs secondary to blunt ocular trauma,1 penetrating ocular trauma, and intraocular surgical procedures. In the cases of small iridodialysis, surgical intervention might not be required. However, large symptomatic iridodialysis often needs repair.

The upper eyelid covers iridodialysis superiorly and prevents symptoms. However, temporal iridodialysis is usually symptomatic. In addition to visual problems such as diplopia, glare, and photophobia, cosmetic problems such as polycoria and ectopic pupil might occur due to large iridodialysis. The presence of these symptoms requires surgical intervention. A number of surgical techniques have been described for the repair of iridodialysis.245678

We describe a novel “Cobbler's technique” for repairing iridodialysis in the right eye of an 18-year-old patient. Iridodialysis was secondary to globe rupture that was repaired 2 months previously. There was a large iridodialysis inferotemporally with the iris occluding the visual axis. The visual acuity was the perception of light with an accurate projection of light.

SURGICAL TECHNIQUE

Following peribulbar anesthesia, a fornix-based localized conjunctival peritomy (6–11 O’clock) was performed in the right eye of a patient with traumatic iridodialysis extending from 7 O’clock to 10 O’clock position in the inferotemporal quadrant [Figure 1]. Hemostasis of the scleral bed was achieved with wet field cautery. A partial thickness scleral tunnel was created 1.5 mm from the limbus along the extent of the iridodialysis. A limbal paracentesis was created with a stiletto knife at the 2 O’clock position, and intracameral pilocarpine was injected into the anterior chamber to place the iris tissue on the maximal stretch. Sodium hyaluronate 1.4% was then injected to deepen the anterior chamber. A 10-0 polypropylene suture was threaded through a 26-gauge needle. The 26-gauge needle was passed through the paracentesis and the 10 O’clock end of the scleral groove engaging the root of the iris. The free end of the prolene suture was pulled out at 10 O’clock. The needle was withdrawn into the anterior chamber and taken out at the 9.30 O’clock position engaging the root of the iris again. The prolene suture was pulled out forming a loop through which the free end of the suture was passed to lock the loop. This step was repeated multiple times until multiple loops laid over the scleral bed [Figure 2]. These loops were then tied [Figure 3] and the conjuctival peritomy was closed using 8-0 vicryl sutures. Subconjunctival gentamycin and dexamethasone were delivered. The postoperative photograph was as shown in Figures 4 and 5. The visual acuity at 3 weeks postoperatively was 6/18 with a pinhole.

Figure 1

Preoperative photograph showing a corneal scar inferiorly and a large iridodialysis from 7 O’clock to 10 O’clock position

Figure 2

Illustration of passage of the 10-0 polypropylene suture from iris to sclera with multiple suture loops lying over the scleral bed

Figure 3

Illustration of suture tied at 7 O’clock position

Figure 4

First postoperative day photograph of the same eye after iridodialysis repair

Figure 5

Postoperative photograph 3 weeks following surgery

DISCUSSION

Iridodialysis can present both functional and cosmetic problems to the patient. Functional symptoms, such as glare and monocular diplopia, result from the polycoria of a pseudo-pupil created by the iridodialysis. Typically, these complaints are most commonly seen when iridodialysis is located in the nasal, temporal, or inferior quadrants, as was seen in our patient. Cosmetic deformities associated with iridodialysis can affect self-esteem adversely and thus have a major psychosocial impact on the patient.910

Various methods for surgical repair of iridodialysis2345678 have been described in literature. Most of these procedures require more surgical maneuvers and anterior chamber is often not stable while repairing large iridodialysis.

The advantages of “Cobbler's technique” for repairing iridodialysis as described above include: (1) It is performed through a small paracentesis wound; (2) the anterior chamber remains stable throughout; (3) multiple sutures can be passed without withdrawing the needle from anterior chamber; (4) large dialysis can be repaired easily; (5) the shape of the iris can be controlled; (6) only one suture knot is required at the end of the incision which can be easily be buried within the sclera groove minimizing the likelihood of late suture erosion.

Our novel “Cobbler's technique” for iridodialysis repair allows a maximally functional and cosmetic result. This technique involves simple surgical maneuvers that are effective for repairing iridodialysis. We obtained a good repositioning with less needle passages and surgical maneuvers. This technique was named “Cobbler's technique” since it bears great similarity to the way a cobbler repairs shoes.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.