Comparison of encirclage and cryotherapy with argon laser in the management of traumatic cyclodialysis cleft

Placement of dual capsular tension rings for the combined management of traumatic cyclodialysis cleft and zonular dialysis

Background

To evaluate the efficacy and safety of placing dual capsular tension rings for the combined management of traumatic cyclodialysis cleft and zonular dialysis.

Methods

A modified capsular tension ring was inserted into the ciliary sulcus and a capsular tension ring or modified capsular tension ring was inserted into the capsular bag in 20 eyes in 20 consecutive patients showing signs of ocular hypotony and ectopia lentis. Outcome measures included intraocular pressure, best-corrected visual acuity, and postoperative complications.

Results

Dual capsular tension ring placement was performed in 20 patients with a mean age of 48.7 years. The cyclodialysis cleft extended over 2.9 clock hours (range 0.5–6.5). The modified capsular tension ring was successfully inserted into the ciliary sulcus and a capsular tension ring or modified capsular tension ring in the capsular bag in all eyes. At the last follow-up, the cyclodialysis cleft was closed in 16/20 (80.0%) eyes. The intraocular lens was stable in all patients postoperatively. Best-corrected visual acuity, in terms of the logarithm of the minimal angle of resolution, improved from 1.3 ± 0.8 before surgery to 0.4 ± 0.3 after surgery (P < 0.001). Intraocular pressure increased significantly from 10.6 ± 3.2 mmHg before surgery to 13.0 ± 4.8 mmHg after surgery (P = 0.040). Postoperative complications included a painful reversible intraocular pressure spike in four patients (20.0%). Logistic regression revealed no significant factors associated with successful cleft closure and a stable final intraocular pressure of ≥ 10 mmHg.

Conclusions

The placement of two capsular tension rings into the ciliary sulcus and the capsular bag is a safe, successful procedure combined for repairing a traumatic cyclodialysis cleft and managing zonular dialysis.

Cyclodialysis cleft repair with scleral band-buckle encirclage without cryopexy in the management of traumatic hypotony maculopathy

Purpose

To describe the technique of traumatic cyclodialysis cleft repair in the management of hypotony maculopathy using anterior placement of encircling scleral band-buckle.

Observations

A 51-year-old male who had sustained blunt trauma in the left eye two months prior to presentation in the clinics, presented with visual acuity of 20/200, a persistent cyclodialysis cleft with hypotony maculopathy and intraocular pressure (IOP) of 6 mm Hg. A silicone band-buckle was passed 360°; with its anterior edge hugging the insertion of rectus muscles along the ‘spiral of Tillaux’. Post-operative course showed closure of the cleft with an IOP of 20 mm Hg at day 4. Patient underwent cataract extraction with intraocular lens implantation at two months and improved to 20/40 at the last follow up visit with a normal IOP.

Conclusion and Importance

We successfully managed a case of hypotony maculopathy due to persistent cyclodialysis cleft using a circumferential band buckle. We avoided the use of cryopexy to avoid the potential risk of inflammation - further worsening choroidal effusion and rare occurrence of suprachoroidal hemorrhage.

Ciliary body suturing using intraocular irrigation for traumatic cyclodialysis: two case reports

Background

We report two cases (two eyes) of traumatic cyclodialysis with prolonged decrease of intraocular pressure that were successfully treated with surgery by ciliary body suturing using intraocular irrigation.

Case presentation

This study involved a 17-year-old Japanese boy (patient 1) and a 31-year-old Japanese man (patient 2) in whom cyclodialysis was sustained in one eye after blunt-force ocular trauma from a thrown ball. Because the hypotony maculopathy in both patients did not resolve after conservative treatment, ciliary body suturing was performed. Briefly, a 25-gauge trocar intraocular irrigation needle for vitrectomy was inserted into the vitreous cavity of the injured eye. A lamellar scleral flap was then made, and an incision was created on the sclera while maintaining intraocular pressure. Next, the detached ciliary body was sutured to the sclera under direct vision. The intraocular fluid at the site of cyclodialysis was then rapidly drained from the scleral wound because of elevated intraocular pressure in the vitreous cavity, and the ciliary body was visually recognized through the scleral wound under direct vision, thus allowing a stable suture fixation of the ciliary body to the sclera. Postoperatively, the treated eye in both cases showed improvement of intraocular pressure and visual function.

Conclusions

The surgical method described in this report was found to be effective for draining intraocular fluid at the site of cyclodialysis and for performing a stable suture fixation of the ciliary body to the sclera through the scleral wound under direct vision, and it should be considered advantageous for avoiding intraoperative bleeding and suturing in a blinded manner.