Terminological and Metrological Aspects in Siepser-Type Iris Suture Procedures

Review Article

Austin J Clin Ophthalmol. 2021; 8(1): 1115.

Terminological and Metrological Aspects in Siepser-Type Iris Suture Procedures

Bordeianu CD*

Private Practice, Ploiesti, Prahova, Romania

*Corresponding author: Bordeianu Constantin- Dan, 15, Cameliei st., Bl. 26, sc. B, et. I, Ap. 26, Ploiesti, Romania

Received: March 29, 2021; Accepted: April 14, 2021; Published: April 21, 2021


Instead of contemporary plethora, with tenths of different terms for only 7 elements, I suggest a system in which the main criterion is the length of the 2 filament ends just before the loop is externalized: L: long end, and S: short end. The name of the 2 corneal pathways, and 2 iris bites will rely on the name of the corresponding filament end that passes through, just before the loop is externalized: Sp/SP: short-end puncture/paracentesis, Lp/LP: long-end puncture/paracentesis, SIB: short-end iris bite, LIB: long-end iris bite. When the loop is externalized, the “intermediary segment”: (I) is created from L. The limits of (I) have been adjusted: instead of generally admitted limits from the middistance between SIB and LIB, to the middle of the externalized loop, I suggest that the S/(I) limit be situated at 1mm after the exit point of the loop from SP, and the (I)/L limit be situated at the re-entry point of the loop in SP.

The suggested terminology and limits of (I) allow a clear and unequivocal description of techniques, simplify the repartition of functions per filament segment, avoid misunderstanding as cause of failure, facilitate the establishment of rules for success valid in any Siepser-type suture, and allow a new systematization of all iris suture procedures in a structure with a common stem, 2 branches (McCannel, Siepser) and leaves represented by technical variants.

Keywords: Siepser knot; New terms; New segment limits; Rules for success; Isometric manner of performing endocular maneuvers


Classical terms

C: Caudal End; F: Frontal End; (I): Iris Segment; fib: First Iris Bite; lib: Last Iris Bite; np: Entry Puncture; nP: Entry Paracentesis; xp: Exit Puncture; xP: Exit Paracentesis; f: Angled Forceps

Suggested terms

S: Short End; L: Long End; (I): Intermediary Segment; SIB: Short End Iris Bite; LIB: Long End Iris Bite; Sp: Short End Puncture; SP: Short End Paracentesis; Lp: Long End Puncture; LP: Long End Paracentesis; f: Angled Forceps


After 1994, when Siepser [1] suggested the slip knot, the iris suture tended to become popular, either to close iris wounds, to cover iris defects, to treat paralytic mydriasis, to achieve PC IOL fixation when the capsular bag is absent, or to induce firm iris/capsule synechia when the bag/IOL complex is displaced because of localized zonule absence, or of its general weakness. The last purpose is achieved either directly - by capsule/iris suture [2,3], or indirectly - by a suture between the iris and an implanted capsular tension ring [4,4’].

In any iris suture (Figure 1A), the frontal end attached to the needle passes through the entry corneal pathway, and the first iris bite; performs the suture purpose, takes the last iris bite, and gets out through the exit corneal pathway. When the entry pathway is a paracentesis, the needle must advance with lateral movements, to avoid nailing stromal strands from the cornea. When the exit pathway is a paracentesis, a “guiding cannula” [5] will avoid both the endothelial trauma while searching the internal opening, and the accidental corneal stroma bites.