A technique for repair of iridodialysis in children

Iridodialysis can occur with blunt or penetrating trauma or inadvertently during intraocular surgery. A small dialysis may not need treatment. A larger iridodialysis that causes polycoria and diplopia, or a grossly eccentric pupil, needs to be reapproximated. A number of surgical techniques for repair, using double-armed polypropylene suture, have been reported. The suture is either left external on the surface of the sclera with the knot buried, covered with a triangular scleral flap, or retrieved with special forceps and buried in a scleral "groove." These techniques have also been used to allow posterior fixation of intraocular lens implants in the absence of capsular support; a complication of this approach is suture erosion through sclera, conjunctiva, or both. The pediatric sclera is softer and more elastic than adult sclera, and surgical repairs must last for decades. Concern about late suture erosion, and a desire for minimal scleral manipulation, led me to develop a simple technique for iridodialysis repair using a scleral tunnel incision and double-armed 10-0 polypropylene suture.