Trifold technique for pupil reconstruction in large non-appositional iris defects

Large iris defects are challenging to close due to shortage of tissue and opposite vector force. By using two pupilloplasty methods, we can close large iris defects with less tractional force or tethering. The trifold technique is a combination of trocar-assisted iris repair and single-pass four-throw (SFT) pupilloplasty for non-appositional large iris defects. The initial two trocar-assisted iris repair sutures oppose the unopposed iris ends and the subsequent SFT seals the defect. The combination procedure is less manipulative with no complications for the iris and pupil diaphragm.