Iridoplasty with subsequent laser pupil centering following penetrating ocular injury

Iris injuries may cause diplopia, glare, photophobia, cosmetic concerns, and a significant decrease in visual acuity. The choice of surgical treatment depends on the extent of the iris defect. If the damaged area is less than 30 %, closed iridoplasty is usually performed. Various iris reconstruction techniques have been proposed, each with its own advantages and limitations. However, in some cases, the pupil formed after iridoplasty may be irregular in shape and displaced from the main optical axis of the eye. In such situations, an additional laser optical-reconstructive procedure may be performed as a second stage. Purpose: to evaluate the functional and cosmetic outcomes of iridoplasty followed by laser pupil centration in patients with traumatic iris injury. Material and methods. We analyzed the surgical treatment of 10 patients with traumatic iris injury. All patients underwent closed iridoplasty as the first stage, followed by laser pupil centration using a 532-nm diode laser as the second stage. The article presents a clinical case of two-stage treatment of an iris defect after penetrating ocular injury. A 46-year-old woman presented with complaints of decreased vision in the right eye, glare, photic phenomena, and cosmetic discomfort. In addition to standard clinical and functional examinations, including visual acuity testing, biomicroscopy, and pneumotonometry, ultrasound biomicroscopy was performed. Laser pupil centration was carried out three weeks after iridoplasty. Results. Iridoplasty resolved the patient’s complaints of undesirable visual effects. After laser pupil centration, the pupil was aligned with the main optical axis, round, and 2.5 mm in diameter. Conclusion. Two-stage treatment of small iris defects, consisting of iridoplasty followed by laser pupil centration, provides favorable functional and cosmetic outcomes.

1. Sobolev N.P., Bessarabov A.N., Shkandina Yu.V., Soboleva M.A. Reasonable choice of a surgical method of rehabilitation of patients with defects of the iris. Saratov Journal of Medical Scientific Research. 2020; 16 (2): 652–5 (In Russ.).

2. Bessarabov A.N., Khodzhaev N.S., Sobolev N.P., Shkandina Y.V. Method for determining the area of the iris defect. RU Patent # 2704598; 2019 (In Russ.).

3. Stepanov A.V., Kirichenko V.O. Peculiarities of laser’s coreoplasty in posttraumatic pupil’s ectopy. Cataractal and refractive surgery. 2011; 11 (4): 41–3 (In Russ.).

4. Gamidov A.A. Laser opticoreconstructive iris surgery. Practical medicine. 2012; 59 (4): 221–3 (In Russ.).

5. Malyugin B.E., Golovin A.V., Sholokhova V.R., Troshina A.A. Method of correcting pupil shape and position (embodiments). RU Patent # 2827850, 2024 (In Russ.).

6. McCannel MA. A retrievable suture idea for anterior uveal problems. Ophthalmic Surg. 1976 Summer; 7 (2): 98–103. PMID: 778720.

7. Ferro Desideri L, Arun K, Doherty G, Bernardi E, Anguita R. Iris reconstruction: A surgeon’s guide. J Clin Med. 2024; 13 (9): 2706. doi: 10.3390/jcm13092706

8. Lian RR, Siepser SB, Afshari NA. Iris reconstruction suturing techniques. Curr Opin Ophthalmol. 2020; 31(1): 43–9. doi: 10.1097/ICU.0000000000000628

9. Narang P, Agarwal A. Single-pass four-throw pupilloplasty knot mechanics. J Refract Surg. 2019; 35 (3): 207–8. doi: 10.3928/1081597X-20190125-01

10. Narang R, Narang P. Reverse four-throw technique for pupilloplasty. Eur J Ophthalmol. 2023; 33 (5): 2042–6. doi: 10.1177/11206721231165452

11. Karabaş VL, Seyyar SA, Tokuc EO, Şahin Ö. A novel iridoplasty suture technique to repair iris defects and traumatic mydriasis. Indian J Ophthalmol. 2023; 71 (5): 2254–6. doi: 10.4103/ijo.IJO_1910_22

12. Bobrova N.F. Classification and tactics of surgical treatment of combined injuries of the anterior segment of the eye in children. Ophthalmological Journal. 1992; 2: 91–5 (In Russ.).

13. Shanturova M.A., Stashkevich S.V., Senchenko N.Ya. Method for correcting traumatic defects of the iris. RU Patent # 2209055; 2003 (In Russ.).

14. Shanturova M.A., Stashkevich S.V. Reconstructive microinvasive surgery of the anterior segment of the eyeball. Acta Biomedica Scientifica (East Siberian Biomedical Journal). 2009; (5–6): 49–51 (In Russ.).

15. Frisina R, Parrozzani R, Tozzi L, Pilotto E, Midena E. Pupil cerclage technique for treatment of traumatic mydriasis. Eur J Ophthalmol. 2020; 30 (3): 480–6. doi: 10.1177/1120672119839304