BACKGROUND: The Siepser Double Sliding Knot method offers a "closed chamber" slipping suture technique for iris repairs. Unlike preceding methods, the Siepser Double Sliding Knot technique allows sutures to be tied within the eye without impairing delicate uveal tissue thus keeping a well-maintained anterior chamber in the process. This technique has proven to be especially valuable in cases where iris repair is required in the inferior ocular quadrant. Pupilloplasty may be used in conjunction with the sliding suture technique to further enhance the cosmesis of a malformed pupil. In Pupilloplasty, multiple partial sphincterectomies are created through the use of Argon laser in order to adequately enlarge a deformed and potentially miotic pupil.
CASE REPORT(S): A 73-year-old male presented with gradual vision loss and photophobia OS. Past ocular history revealed long standing ocular trauma OS. Best Corrected Visual Acuity and Brightness Acuity Testing was 20/80 and 20/400 OS, respectively. Clinical findings revealed a hypermature traumatic cataract in conjunction with an irregular, inferiorly drawn pupil OS. Retinal anatomy was clear of any abnormalities. The findings were consistent with prior ocular trauma OS. The patient underwent cataract extraction with implantation of Crystalens multifocal IOL OS. The Siepser Double Sliding Knot iris repair method was used prior to Argon Laser Pupilloplasty in efforts to repair the inferiorly displaced pupil OS. The outcome of the two combined procedures resulted in a central pupil displacement, improved cosmesis and decreased photophobia.
CONCLUSIONS: With the advent of more sophisticated small incision surgical techniques, the repair of a torn or irregular iris and malformed pupil has changed radically. The collective use of the Siepser Double Sliding Knot and Pupilloplasty technique offers an excellent recovery of the physiologic function and cosmesis post-operatively in patient with pre-existing traumatic iris dysfunctions.