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Subspecialties Cornea/Ocular Surface, Comprehensive, Education and Training

SFT: Are You In The Loop?

At a Glance

  • SFT is an alternative method of pupilloplasty, requiring the surgeon to pass the suture end through the loop four times
  • Compared with current pupilloplasty methods, it offers faster visual recovery and reduced postoperative inflammation
  • Reconstructing the pupil this way prevents patients from glare, photophobia and untoward images formed due to reflection of light
  • PPP with SFT is suitable for patients with a range of visual disorders – from high astigmatism and corneal injuries to post-penetrating keratoplasty.

Single-pass four throw (SFT) pupilloplasty is a relatively new surgical technique (1). It was initially described as a modification of the Siepser’s method, but the knot formation has been found to belong to the Timber Hitch method of tying. In this technique, a 10-0 or a 9-0 polypropylene suture attached to a long arm needle is passed through the proximal iris tissue that is to be involved in the pupil reconstruction. A 26 G needle is introduced from the paracentesis in the opposite direction, where it engages the distal iris tissue to be approximated (Figure 1 A). The 10-0 needle is then passed in to the barrel of the 26 G needle, before it is withdrawn from the eye. A Sinskey’s hook withdraws the loop of the suture (Figure 1 B) and the suture end is passed from the loop four times, thereby taking four throws (Figure 1 C). Both the suture ends are pulled, and the loop slides inside the eye, thereby approximating the pupillary edges together (Figure 1 D). A micro-scissor is introduced inside the eye and the suture ends are cut. The helical structure created due to the loop approximation forms a self-locking and a self-retaining knot inside the eye.

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About the Authors

Amar Agarwal

Amar Agarwal is a pioneer of microincisional cataract surgery. He was first to remove cataracts through a 0.7 mm tip; first to develop no-anesthesia cataract surgery; first to implant a glued IOL; first to implant a mirror telescopic IOL in AMD, and first to use Trypan blue as an epiretinal membrane stain. He coined the term “aberropia” to describe uncompensated HOA profiles following refractive surgery, and produced a modified Malyugin ring for miotic pupil cataract surgeries with posterior capsular defects. Most recently, he and Harminder Dua (qv) pioneered Pre-Descemet’s Endothelial Keratoplasty, which allows for the use of younger corneal donors than previous techniques, greatly increasing the donor tissue pool. He’s also chairman of Dr. Agarwal’s Eye Hospital group – a major chain of eye hospitals, headquartered in Chennai, with more than 40 other branches across India, and a further 12 overseas.


Priya Narang

Priya Narang is the Director and Chief consultant at Narang Eye Care and Laser Centre in Ahmedabad, India.

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