Iridodialysis suturing method
A simplified surgical method for iridodialysis using a Hoffman pocket and continuous suture technique addresses the complexity and trauma of existing methods, enhancing surgical efficiency and reducing infection risk.
Patent Information
- Authority / Receiving Office
- RU · RU
- Patent Type
- Patents
- Current Assignee / Owner
- AKTSIONERNOE OBSHCHESTVO EKATERINBURGSKIJ TSENTR MNTK MIKROKHIRURGIJA GLAZA
- Filing Date
- 2025-09-03
- Publication Date
- 2026-06-30
Smart Images
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Abstract
Description
[0001] The invention relates to surgery of the iris of the eye, in particular to methods for suturing a torn root of the iris to the sclera in order to restore the diaphragmatic function of the iris.
[0002] Iridodialysis is a separation of the iris root from the ciliary body, caused by a blunt impact, which causes the intraocular fluid to push the iris inward, while causing brief stretching of the fibrous membrane of the eye. Iridodialysis accounts for 23.2% of anterior segment eye diseases and 8.6% of all iris injuries.
[0003] Iridodialysis, located in the area from 1 to 3 o'clock on the clock face and in the upper parts of the eyeball, is asymptomatic and does not require surgical treatment.
[0004] In other cases, iridodialysis requires surgical treatment, as in addition to cosmetic defects, it leads to decreased visual acuity, photophobia, glare, hyphema, corectopia, and monocular diplopia. Massive iridodialysis (detachment of the iris by more than half the circumference) leads to post-traumatic mydriasis and impaired iris blood supply, often causing iritis, iridocyclitis, and rubeosis iridis.
[0005] A known method for iridodialysis suturing using a flange technique has been selected as the closest analogue (RU Patent No. 2818179, published April 25, 2024, IPC A61F9 / 007). At the beginning of the surgery, the conjunctiva is separated from the limbus opposite the iris root avulsion and a corneal paracentesis is performed, through which a needle with a thread is passed into the anterior chamber. The needle is inserted into the end of the iris root avulsion and withdrawn through the sclera. Then, through the paracentesis, the needle with the second end of the thread is passed into the anterior chamber, with the needle inserted into the other end of the iris root avulsion and withdrawn through the sclera. The needle is withdrawn from the anterior chamber and bent at a 45° angle. Two pockets, 1.5 mm long and 1 mm deep, are created in the sclera above the pinholes where the ends of the thread were punctured from the limbus. The thread is then threaded through the needle, passed through the sclera, and brought out to the first created pocket. The thread is pulled until the desired iris-sclera tension is achieved, and then cut off.The tip of the thread is melted under tension on the iris to form a spherical thickening, which is then flattened and inserted into a pocket in the sclera. Similarly, the needle with the other end of the thread is passed to the second pocket and the thread is cut, tension is applied, and a second thickening is formed by melting the thread to form a spherical thickening, which is then flattened and inserted into a pocket in the sclera.
[0006] The significant number of manipulations during the surgical procedure (separating the conjunctiva from the limbus, performing a corneal paracentesis, creating pockets in the sclera to insert the ends of the thread with thickenings, moving the needle from one free end of the thread to the other, and creating thickenings at the ends of the threads by melting them) complicates the surgical technique. Furthermore, separating the conjunctiva from the limbus, performing a corneal paracentesis, and creating pockets in the sclera to insert the ends of the thread with thickenings increases trauma to the ocular tissue. Compromising the integrity of the external tissues of the eyeball facilitates the filtration of intraocular fluid, which leads to the penetration of infections into the internal structures of the eye and the development of postoperative infectious complications such as endophthalmitis.
[0007] The technical problem that the claimed invention is aimed at solving is the creation of a simple to perform, low-traumatic method for suturing iridodialysis, ensuring the restoration of the normal anatomical position of the iris and the improvement of vision.
[0008] The technical result of the claimed invention is to simplify the technique of performing the operation, reduce trauma to the eye tissue and infectious postoperative complications.
[0009] The technical result is achieved due to the fact that in the claimed method of suturing iridodialysis in the sclera at the central part of the iris root tear, a Hoffman pocket is formed from the limbus, which is located within one hour of the conventional clock face (30°) from the perpendicular to the center of the iris root tear line, then a curved needle with a thread is passed through the center of the Hoffman pocket into the anterior chamber, leaving the free end of the thread on the conjunctiva, then the curved needle is inserted into the end of the central part of the iris root tear that is farthest from the Hoffman pocket and the needle is punctured through the sclera behind the limbus from the side of the same end of the central part of the iris root tear, after which the curved needle is turned and the needle is punctured into the sclera next to the puncture, then the curved needle is punctured into the end of the central part of the iris root tear from the side of the Hoffman pocket,In this case, needle punctures into the ends of the central part of the iris root tear are performed within one and a half hours of the conventional clock face (45°) from the perpendicular to the center of the iris root tear line, finally, the curved needle with the thread is brought out through the Hoffman pocket near the place of needle insertion, the thread is cut, the surgical suture is tightened by the free ends of the threads, a knot is tied, which is dipped into the Hoffman pocket.
[0010] The claimed method of iridodialysis suturing is simple to perform, since the suturing of the iris root tear to the sclera is carried out with a simple continuous suture, in which a Hoffman pocket is formed in the sclera, which is located within one hour of the conventional clock face (30°) from the perpendicular to the center of the iris root tear line.
[0011] is simultaneously used to insert a curved needle and thread into the anterior chamber, withdraw the needle and thread, and insert a surgical knot. Fixation of the iris root avulsion to the sclera is performed by inserting the needle into the ends of the central portion of the iris root avulsion within the 1.5 o'clock position (45°) of the perpendicular to the center of the iris root avulsion line. This ensures that the iris is optimally positioned anatomically when the surgical suture is tightened. This minimizes trauma to the ocular tissue during surgery, reducing the risk of infectious complications in patients in the postoperative period.
[0012] The method of suturing iridodialysis is explained by Figures 1–6.
[0013] Fig. 1–3 show the main stages of the method, where
[0014] Fig. 1 – the first stage of the method: in the sclera at the central part of the detachment of the root of the iris from the limbus, a Hoffman pocket is formed,
[0015] Fig. 2 – the second stage of the method: a curved needle with a thread is inserted through the center of the Hoffman pocket into the anterior chamber, the needle is inserted into the end of the central part of the iris root tear that is farthest from the Hoffman pocket and is punctured through the sclera behind the limbus from the side of the same end of the central part of the iris root tear,
[0016] Fig. 3 – the third stage of the method: the curved needle is unfolded, the needle is inserted into the sclera next to the puncture, then into the end of the central part of the iris root tear from the side of Hoffman's pouch and the needle with the thread is removed through Hoffman's pouch next to the insertion site of the needle.
[0017] Fig. 4, 5 illustrate a surgical suture, where Fig. 4 is a suture before tightening the free ends of the threads, Fig. 5 is a suture at the end of the operation.
[0018] Fig. 6 illustrates a clinical example of the claimed method of iridodialysis suturing, where A is the patient’s right eye before surgery, B is the patient’s right eye three months after surgery.
[0019] The method of suturing iridodialysis is carried out as follows.
[0020] After local anesthesia, treating the surgical field with an antiseptic solution, dividing the iris root avulsion into three (central and two lateral) parts, a Hoffman's pouch is formed in the sclera at the central part of the iris root avulsion from the limbus, which is located within one o'clock position (30°) from the perpendicular to the center of the iris root avulsion line (Fig. 1). An atraumatic curved needle 12 mm long with a 10-0 polypropylene suture is inserted through the center of the Hoffman's pouch into the anterior chamber, leaving the free end of the suture on the conjunctiva. The curved needle is inserted into the end of the central part of the iris root avulsion farthest from the Hoffman's pouch and exits the needle through the sclera behind the limbus from the side of the same end of the central part of the iris root avulsion (Fig. 2). After this, the curved needle is turned around, an injection is made into the sclera near the injection site and an injection is made into the end of the central part of the iris root tear from the side of Hoffman's pouch.Needle insertions into the ends of the central portion of the iris root avulsion are performed within the 1.5 o'clock position of a conventional clock face (45°) from the perpendicular to the center of the iris root avulsion line. The curved needle and thread are then brought out through Hoffman's pouch near the site of needle entry into the anterior chamber (Fig. 3), and the thread is cut. Thus, before tightening the threads, the resulting surgical suture has the appearance shown in Fig. 4. At the end of the operation, the free ends of the thread are pulled out of Hoffman's pouch with a microhook, the surgical suture is tightened, ensuring the necessary tension of the iris to the sclera, and a triple surgical knot is tied, which is inserted into Hoffman's pouch (Fig. 5).
[0021] The claimed invention is illustrated by a clinical example.
[0022] Patient K., 51 years old, with a history of blunt trauma to the right eye. Diagnosis: massive post-traumatic iridodialysis in the right eye from 1 to 5 o'clock on a conventional clock face, traumatic cataract, traumatic mydriasis (Fig. 6A). Visual acuity is 0.05. The doctor performed surgical treatment of the patient's right eye, during which he sutured the iridodialysis using the claimed method, simultaneously performed phacoemulsification, implantation of an intraocular lens, and iris plastic surgery. Visual acuity became 0.35 the next day after surgery, 0.5 three months after surgery. An examination of the right eye was performed three months after the surgery. Biomicroscopy revealed a clear cornea, a moderately deep anterior chamber, iridodialysis sutured, and a 3.5 mm pupil (Fig. 6B). OCT revealed retinal profile deformity in the macular area, which is not a complication of the surgical procedure.
[0023] In 2025, ophthalmologists at the Yekaterinburg Center of the Scientific and Technical Complex "Microsurgery of the Eye" performed post-traumatic iridodialysis using the stated method in 5 patients, who did not experience infectious postoperative complications.