Skilled pupilloplasty improves patients’ visual function and appearance

Surgical repair of the iris is a frequent procedure for the consultative ophthalmic surgeon. My first introduction to suture repair of the iris came from one of my early mentors, Malcolm McCannel, MD. He developed the so-called McCannel suture technique primarily to help stabilize subluxated iris-supported IOLs following intracapsular cataract extraction in the 1970s. Malcolm also applied his suture technique to repair irises damaged by trauma. He traveled the world teaching his McCannel suture technique with surgical movies, not videos, and often quipped while lecturing that his “reputation hung on a thread.”In addition, in the ICCE era, many small pupil cases were treated by creating a sector iridectomy. I was taught in my residency how to close these after surgery with two interrupted 10-0 nylon sutures. Today this is never required, but occasionally we need to close a peripheral iridectomy that is too large. We now have many pupilloplasty or iridoplasty techniques that can be used to close an iris defect, make a fixed dilated pupil smaller, center a pupil on a diffractive multifocal IOL, close a congenital iris coloboma, close a large symptomatic peripheral iridectomy or iridotomy, or round up an irregular pupil.