Late Iris Cerclage Suture Cheese-Wiring

Purpose: Mydriatic pupil repair by cerclage has been thought to be a permanent fix for glare, visual function and cosmesis. Iris repair can develop late cheese-wiring of cerclage sutures with resultant loss of benefits. We describe a case series of cerclage failures due to cheese-wiring. Setting: Cincinnati Eye Institute, Cincinnati, Ohio. Design: Retrospective single-surgeon case series. Methods: A retrospective chart review sought patients that underwent iris cerclage at the Cincinnati Eye Institute who later developed suture cheese-wiring. The patient symptoms, demographics, cerclage size, suture type, knot type, iris status, and suture status at final follow up were ascertained. Results: Six cases of cerclage suture cheese-wiring with loss of the original surgical benefit were identified. 10-0 polypropylene suture and a 3-1-1 knot were utilized in each case. The suture remained intact with an intact knot and suture loop in all cases. Conclusion: Cheese-wiring with return of mydriasis is a potential long-term outcome of iris cerclage suture placement, with return of pre-operative symptoms. Awareness of this potential eventuality provides physicians and patients a broader perspective when selecting between cerclage suture, iris prosthesis placement or other surgical and non-surgical options.