Minimally invasive knotless iridodialysis repair (MIKIR)- A review article

Here, we review and summarize the evolution of surgical techniques and outcomes of minimally invasive, knotless (flanged) approaches for the repair of iridodialysis. A thorough literature search was performed using PubMed, Medline, Cochrane Library, and Embase databases to identify studies related to iridodialysis repair. Iridodialysis repair, flanged polypropylene suture, knotless iridodialysis repair, and ab-interno and ab-externo procedures were the keywords used. Their bibliographies provided further references. Articles on surgical repair of iridodialysis that were published before April 2025 were included. Five relevant studies were found and reviewed in depth. The conventional methods, though effective, were technically demanding, time-consuming, and associated with complications such as suture slippage, iris prolapse, conjunctival erosion, and postoperative astigmatism. Recent advancements introduced minimally invasive and knotless suture techniques, notably those using flanged polypropylene sutures. Both ab-interno and ab-externo approaches have been described by various authors including Kausaka et al ., Rosenberg et al ., Peng et al ., Ramakrishnan et al ., and Khadia et al . These techniques employ simple ophthalmic instruments, minimize intraocular manipulation, and eliminate conjunctival dissection and suture knots. These methods ensure iris reattachment, shorter operative time, improved cosmetic outcomes, and a shorter learning curve for surgeons. Minimal invasive knotless iridodialysis techniques represent a significant advancement in anterior segment reconstruction surgeries. They offer a minimally invasive, safe, and efficient alternative to traditional suturing methods, with reduced complication rates and enhanced patient comfort. Regular follow-up focusing on visual recovery, intraocular pressure, and gonioscopic evaluation remains essential to ensure long-term success.