Pupil size is commonly associated with visual quality. Inadequate vision often results from a permanently dilated pupil. Symptoms such as glare, photophobia, and visual distortions are exacerbated by a dilated pupil, especially when accompanied by an uneven cornea. These symptoms also affect the patient’s daily activities, such as reading, driving, and more.
Pupillary reconstruction methods vary, but they all work toward the same end: improving visual quality by restoring the original size and shape of the pupil. Some examples are:
- Pupil cerclage is a surgical procedure used to reduce the size of a dilated pupil in symptomatic patients. A running suture is used to construct a purse-string suture along the pupillary edge
- Single-pass-four-throw: Pupilloplasty is an iris surgical technique used to correct or change the appearance of dilated pupils. This is the simplest method of surgical pupilloplasty, with the shortest learning curve. The modified Siepser slipknot technique is used to create a helical configuration in the surgical procedure for pupilloplasty following a single needle pass through the edges of the iris defect along the pupillary margin. This helical configuration is self-retaining and self-locking.
- Pinhole pupilloplasty is a variation on the single-pass four-throw (SFT) technique used to reduce the size of the pupil (approximately 1.3 mm in diameter).
- The McCannel technique includes making two paracenteses that are perpendicular to the edge of an iris defect and then threading a 10-0 polypropylene suture through them.
The Pupilloplasty procedure involves the following steps:
- To approach the proximal iris tissue, a needle with a 10-0 polypropylene suture attached to its long arm is inserted through the cornea’s limbus and into the iris.
- After making a paracentesis incision, a 30-gauge needle is inserted into the wound.
- The 30-gauge needle is now withdrawn from the paracentesis incision, and the 10-0 suture needle is inserted into the barrel of the needle and the iris tissue. This drags the needle and suture outside of the anterior chamber.
- With the help of a Sinskey hook, a loop is taken out, and the suture end is passed through the loop four times, making sure to pass it in the same direction each time.
- Both suture ends are then pulled, causing the loop to slide within the anterior section.
- Microscissors are used to cut the suture after that.
- The process is carried out again and again until all iris flaws are repaired.
In the postoperative phase, many individuals often experience an increase in inflammation and require more time to recover. The outcome is only seen with patience throughout the postoperative period. Pupilloplasty is a great procedure to aid in reviving the function and appearance of damaged iris tissue, provided that the patients possess reasonable expectations.
During the passage of the 10-0 suture needle, the surgeon is advised to take extreme caution to avoid engaging the ocular tissue. Failure to treat this causes the loop to not slide within the anterior chamber, resulting in surgical failure. The technique is then repeated after cutting the suture. Some other complications associated with this surgical technique are:
- Impaired night vision (in pinhole pupilloplasty).
- Cataract (mechanical injury in phakic cases).
- Retinal detachment.
- Iris dialysis.
Most of the time, a pupilloplasty is done to fix damage to the iris and pupil. This surgery is also required if the pupil is decentered following intraocular lens implantation. A pupilloplasty restores the eyesight to normal if the pupil is significantly distant from the center and the iris casts a shadow on the lens. This increases light sensitivity and minimises glares and halos created by the unusual placement of the eye’s parts. In addition, it is a method that saves both time and cost, while at the same time just requiring one operation to achieve excellent results.