A simplified slipknot technique for pupilloplasty in the treatment of mydriasis

To evaluate the surgical outcomes of a simplified slipknot pupilloplasty technique for repairing mydriasis, with a focus on postoperative visual recovery, pupil morphological stability, knitting efficiency and knot security.

This prospective case series included patients with mydriasis due to trauma, glaucoma attack or iatrogenic damage, who underwent pupilloplasty (with or without intraocular lens implantation) from October 2022 to July 2025. Postoperative follow-ups were performed at 1, 3, 6, and 12mo. All cases had a minimum follow-up period of 3mo (range 3–12mo). Parameters recorded included best-corrected visual acuity (BCVA, logMAR), pupil diameter, and intraocular pressure (IOP).

A total of 32 consecutive patients (32 eyes, 21 males) were included. The mean age was 57.9±15.9y (21 to 85y). The simplified slipknot technique resulted in significant visual improvement: the mean preoperative logMAR BCVA was 1.15±0.79 (range, 0.22 to 2.5), which improved to 0.35±0.32 (range, 0 to 1.398) postoperatively. Postoperative pupil diameter remained stable, with a mean of 3.0±0.5 mm (range, 2.5 to 4 mm). The duration of the pupilloplasty was 4.3±0.5min and there was no loosening or shedding of the line knot in any case.

The simplified slipknot technique has a similar treatment effect and safety as the traditional technique but requires a shorter time and is easier to perform in pupilloplasty surgery. It causes minimal trauma to intraocular tissues, and is easy to popularize.