Reverse 4-Throw Pupilloplasty for Endothelial Keratoplasty.

Purpose: The aim of this study was to describe the feasibility and applicability of a reverse 4-throw (RFT) pupilloplasty technique for endothelial keratoplasty.

Methods: In RFT, the 9-0 polypropylene suture needle and a 26-Gauge needle pierce the iris tissue from the posterior surface to emerge on the anterior surface along the proximal and distal portion of iris tissue to be apposed, respectively. The 9-0 needle is threaded into the barrel of a 26-Gauge needle and is withdrawn from the eye. The suture loop is withdrawn and the suture end is passed through the loop 4 times. Both suture ends are pulled, which leads to the sliding of the loop inside the eye, thereby apposing the iris tissue with the knot lying on the posterior surface.

Results: The procedure was performed in 11 eyes of 11 patients who were scheduled to undergo an endothelial keratoplasty procedure. The anterior segment optical coherence tomography image of the RFT pupilloplasty did not denote any presence of the suture in the anterior chamber or along the anterior surface of the iris plane. No incidence of primary graft failure or graft rejection during the entire follow-up period was reported in any of the eyes.

Conclusions: RFT serves as an effective technique for performing pupilloplasty in endothelial keratoplasty cases without the presence of a knot or suture tail in the anterior chamber.