This video introduces a novel approach to anterior segment surgeries, specifically addressing the challenges of iridodialysis repair and modified capsular tension ring fixation. Unlike routine cataract surgeries, these procedures demand a high level of expertise due to their infrequent occurrence and intricate nature. The proposed technique, named the “Easy pass technique,” involves the creation of a scleral pocket, precise needle handling, and innovative use of a carrier-cannula system, eliminating the need for a needle holder. The method was successfully applied in cases of iridodialysis repair and modified capsular tension ring fixation, showcasing its adaptability. The technique is superior for novice surgeons, enhancing stability and control, especially when using the nondominant hand. The modified approach of reverse docking within the anterior chamber proves valuable in challenging scenarios. Furthermore, the technique allows for bimanual handling, offering an extra hand for delicate maneuvers. This innovative approach provides a simplified and effective method for training novice surgeons and presents potential advancements in safety and applicability through future customization. Background: Among anterior segment surgeries, procedures such as iridodialysis repair and modified capsular tension ring fixation demand a high level of expertise and ambidextrity. Many existing techniques involve the intricate handling of a lengthy needle with nonabsorbable suture. 1,2 This makes the learning curve for mastering these surgeries quite prolonged. We introduce an innovative technique in this video, named the “Easy pass technique,” designed to facilitate the learning process for novice surgeons in performing these intricate procedures. Purpose: The proposed technique simplifies iridodialysis repair by using a carrier-cannula attached to a syringe, providing better control and preventing inadvertent upward, downward, or sideward movements. This technique also minimizes difficulties during maneuvers in cases of nasal iridodialysis, especially in patients with short palpebral fissures or deep sockets, where using the non-dominant hand is challenging. Synopsis: The reverse scleral pocket technique is used for iridodialysis and zonular dialysis after localized limbal conjunctival peritomy. A 1 mm paracentesis is made opposite the scleral pocket site, and a hypodermic 26G needle is bent at the proximal 1/4 th site. A long straight needle of the 9-0 prolene suture is docked inside the bent needle, ensuring the needle remains in the cannula. The needle-cannula complex is then introduced through the paracentesis, guided through the iris tissue, and exited through the scleral pocket. A modification, introducing the 26G cannula initially through the paracentesis and reverse docking inside the anterior chamber, would ease the procedure. If an inadvertent needle exit occurs, the cannula can be withdrawn first, allowing the long needle, which is 16 mm long, to remain in the paracentesis and be pulled out using a needle holder. Highlights: The technique is similar to the modified sewing machine technique described by Kumar KV R et al ., 3 which involves passing a hypodermic needle (threaded with Prolene suture) through iris tissue, creating a larger hole (external diameter of 26G cannula is 0.46 mm) 4 than the one created by fine needle (diameter is 0.15 mm). 5 A smaller hole made in the iris would decrease the chance of cheese wiring during suture tying in thin, floppy iris. The alternate iris bypass technique is another technique described by Balamurugan et al ., 6 in which a needle is inserted entirely into a 26G cannula for an ab interno approach, with the cannula used to pierce the sclera. While this method benefits from using the cannula as a carrier, our technique differs in that the needle is inserted straight, and it is the needle—not the cannula—that pierces the iris and sclera, resulting in a tiny hole and exit point. In conclusion, the easy pass technique simplifies both iridodialysis repair and modified capsular tension ring fixation. It is especially beneficial for beginners, allowing them to perform these procedures more easily and with increased safety, owing to the creation of minimal entry and exit points. Additionally, it proves advantageous for surgeons in situations where one needs to operate using their nondominant hand. Video Link: https://youtu.be/0rOFz0iTv68
Fathima et al. (Tue,) studied this question.