Reverse four-throw technique for pupilloplasty.

PURPOSE: To describe Reverse four-throw (RFT) technique for pupilloplasty.

METHODS: The technique involves making a single pass through the anterior chamber that helps achieve a posteriorly directed suture knot. A single arm 9-0 polypropylene suture attached to long arm needle engages the iris defects with the tip of the needle piercing the iris tissue from the posterior surface and emerging from the anterior aspect. The suture end is passed from the loop with four throws taken consecutively in the same direction that create a self-sealing and self-retaining lock like single-pass four-throw technique but with the difference that the knot slides on the posterior surface of the iris tissue.

RESULTS: The technique was performed in 9 eyes and the suture-loop easily slided along the posterior surface of iris tissue. The iris defect was well approximated in all the cases and the suture knot or suture tail was not visible in the anterior chamber. Anterior segment optical coherence tomography depicted smooth iris configuration with no suture extrusion in the anterior chamber.

CONCLUSIONS: The RFT technique provides an effective measure to seal the iris defect with the absence of knot in AC.