Sir,

We read with interest the article by Mavrikakis et al (Eye 2005; 19: 205–209) on the surgical management of iris defects with prosthetic iris devices. In this case series, the authors presented nine patients with iris defects managed by prosthetic iris device with excellent results. While we share the same experience with the authors that large iris defect like those with more than 90° are most effectively managed by prosthetic device. Small iris defect (less than 90°) may benefit from pupilloplasty. After pupilloplasty, the pupil may be slightly displaced but this can be managed by selective sphincterotomy at the opposite iris margin to achieve a well-centred pupil.

Sphincterotomy can be achieved by cutting the iris margin with vennas scissors or simply stretching the iris margin with iris retractors. While this approach may be associated with slightly more early postoperative inflammation due to iris manipulation, the inflammation typically settles in the first week. This method particularly useful in patients without an intact capsule in which iris prosthesis cannot be placed. This technique can also avoid migration the iris prosthesis as the capsular bag contracts.