Ultrasound biomicroscopic imaging of a surgically reattached cyclodialysis cleft

Risk Factors Associated with Failure of Direct Cyclopexy in the Treatment of Small to Moderate Tramatic Cyclodialysis Clefts

BACKGROUND

To evaluate the risk factors associated with failure to correct hypotony using direct cyclopexy in patients with traumatic cyclodialysis cleft.

METHODS

In a series of 116 patients with traumatic cyclodialysis who underwent direct cyclopexy at Zhongshan Ophthalmic Center from January 2008 to August 2018, the clinical correlation between the risk factors and failure of the operation were retrospectively studied, after adjusting for other potential confounders.

RESULTS

The curative ratio after one procedure was 82.76%, whereas 20 (17.24%) eyes experienced treatment failure after the first surgery. The degree of anterior chamber angle closure was significantly wider in patients with a failed first surgery than in patients for whom one procedure was a success (p = .046). The risk of failure to achieve closure increased as the angle-closure exceeded 5 clock hour (odds ratio, 10.39; 95% confidence interval, 1.75-61.72; p = .010). An analysis of the recurrent position indicated that an angle closure exceeding 5 clock hour may impede accurate cleft location and is thus associated with an increased risk of failure to correct hypotony.

CONCLUSION

Exceeding the threshold of 5 clock hour in anterior chamber angle closure may impede accurate cleft location and, thus, present a higher risk of failure to correct hypotony using direct cyclopexy. These patients may need injection of a viscoelastic agent into the anterior chamber by paracentesis to deepen the anterior chamber and to delineate the clefts using gonioscopy pre- or intraoperatively.

Cyclodialysis: an updated approach to surgical strategies

Cyclodialysis is a rare occurrence and is difficult to treat, it being concealed behind the iris. In view of the varied success outcomes of the different available surgical repair techniques, there is at present no clear consensus regarding their management strategies. Through this article, we intend to appraise the established surgical methods, update the novel techniques in vogue, discuss their outcomes and propose a uniform system to codify these corrective techniques. They have been reclassified under the terms 'exocyclopexy', 'endocyclopexy', 'exocyclotamponade' and 'endocyclotamponade' based on the approach used and their mode of action. The ab-interno techniques (endocyclopexy and endocyclotamponade) are easier to perform, offer good success rates and better safety profiles such that they may be considered as a viable alternative to the standard exocyclopexy in either cataractous or pseudophakic and aphakic eyes.

Magnetic Resonance Imaging of Cyclodialysis Cleft Before and After Cyclopexy

PURPOSE

To report the magnetic resonance imaging (MRI) appearance of a man with chronic hypotony caused by unexplained cyclodialysis clefts and the change after laser photocoagulation.

METHODS

A 19-year-old man with hypotonous maculopathy caused by cyclodialysis clefts in the right eye presented to our institution. The etiology and time of onset of the cyclodialysis clefts were obscure, and a MRI was performed to assess the possibility of compressive optic neuropathy.

RESULTS

MRI of the right eye showed a relative decrease in globe volume and diffuse enhancement of the ocular wall compared with the left eye. Conservative management showed no further improvement, and the patient underwent laser photocoagulation within the cyclodialysis clefts. During the 9-month follow-up period, both functional and anatomic reversal and an increase in total globe volume were observed, and the enhancement of the ocular wall was resolved.

CONCLUSIONS

This case demonstrates the specific magnetic resonance appearance of hypotony status caused by a cyclodialysis cleft and the change after laser photocoagulation cyclopexy.