Cyclodialysis cleft results from separation of longitudinal ciliary muscle fibres from the scleral spur. The separation increases the uveoscleral outflow, leading to severe hypotony. Complexity in managing such condition relies on the extent of the injury and its collateral damage. We reported an alternative method of surgical repair for large cyclodialysis. The procedure was less invasive utilizing a scleral sparing technique. A 66-year-old gentleman presented with severe blunt trauma injury to the globe secondary to shuttlecock injury while playing badminton. He presented with a vision of hand motion. There was hyphaema (filling up half of the anterior chamber), complete posterior dislocation of the crystalline lens, and minimal vitreous haemorrhage. Posterior globe rupture was excluded with further imaging of the orbit. Despite significant amount of hyphaema, intraocular pressure (IOP) remained low several days post injury. Further investigations revealed the presence of almost 270° of cyclodialysis. Surgical repair was indicated. In order to avoid an extensive cut on the sclera, the treating surgeon decided to explore a less invasive method utilizing a small gauge vitrectomy trocar. The main instruments used were the trocar, a straight prolene needle, and a bent 25-G needle. The direction of trocar insertion plays a pivotal role in bringing the detached ciliary body back to its original position. The simplified technique did not require the creation of a scleral flap or direct visualization of the ciliary body. The technique was fast and less invasive, with early improvement of IOP post intervention.
A 69-year-old Chinese woman with underlying perinuclear anti-neutrophil cytoplasmic antibody associated with vasculitis (p-ANCA vasculitis) with no previous history of ocular involvement experienced one week of blurred vision in both eyes associated with pain. Ophthalmological evaluation demonstrated severe visual loss in both eyes, with pale optic discs but without other signs of ocular vasculitis. Magnetic resonance imaging (MRI) of the brain and orbit revealed bilateral enhancement of the optic nerve sheath with classical tram-track and doughnut signs. Intravenous methylprednisolone was given for five days and marked improvement of vision was seen. In patients with p-ANCA vasculitis, bilateral optic perineuritis (OPN) is uncommon but can be one of the treatable causes to be considered, with good response to prompt steroid treatment.
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