Direct cyclopexy surgery for post-traumatic cyclodialysis with persistent hypotony: ultrasound biomicroscopic evaluation

Murta, Fabíola; Mitne, Somaia; Allemann, Norma; Paranhos, Augusto

doi:10.5935/0004-2749.20140013

Cited by 14 publications

(14 citation statements)

References 11 publications

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“…To date, lots of methods are available for diagnosis of cyclodialysis cleft. The preoperative diagnostic methods include gonioscopy, UBM [7, 8], anterior segment optical coherence tomography (AS-OCT) [9], and magnetic resonance imaging (MRI) [10] . The intraoperative diagnostic methods include scleral transillumination [11], anterior chamber perfusion [12], and combined probe exploration [13].…”

Section: Discussionmentioning

confidence: 99%

Continuous ab interno repairing of traumatic cyclodialysis cleft using a 30-gauge needle in severe ocular trauma: a clinical observation

Cai

2019

BMC Ophthalmol

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BackgroundTo investigate the efficacy and safety of continuous ab interno repairing of traumatic cyclodialysis cleft in severe ocular trauma using a 30-gauge (G) needle.MethodsFifteen patients (15 eyes) with traumatic cyclodialysis cleft admitted to the ocular trauma department of our hospital from July 2014 to December 2018 were included in this study. After the bulbar conjunctiva corresponding to the ciliary body was incised along the corneal limbus, an incision was made along the corneal limbus on the opposite side. A 30G needle with a 10–0 suture entered the anterior chamber from the incision and passed through the ciliary body with clefts and the sclera to fixate the ciliary body on the sclera wall with continuous mattress suture. The best corrected visual acuity (BCVA) and intraocular pressure (IOP) were observed preoperatively and postoperatively. In vivo ultrasound biomicroscopy (UBM) was performed to observe closure of cyclodialysis cleft before and after surgery.ResultsFifteen patients successfully underwent continuous mattress suture for repair of cyclodialysis cleft. No bleeding and suture breakage were reported during surgery. After surgery, the UBM during follow-up showed satisfactory closure of the cyclodialysis cleft. The BCVA and IOP were improved to different degrees. The difference between the preoperative IOP and the postoperative IOP (1 week) was statistically significant (preoperative: 6.49 ± 0.98 mmHg, postoperative: 16.17 ± 4.65 mmHg, t = − 8.43, P < 0.05), and the difference between the preoperative IOP and the postoperative IOP (1 month) was also statistically significant (preoperative: 6.49 ± 0.98 mmHg, postoperative: 14.63 ± 3.63 mmHg, t = − 8.38, P < 0.05). Duration of outpatient follow-up was 3 to 12 months. No complications, including exposed knots, loose sutures, decompensation of corneal endothelium, sympathetic ophthalmia, endophthalmitis and choroidal detachment, were reported.ConclusionContinuous ab interno repairing of traumatic cyclodialysis cleft in severe ocular trauma using a 30G needle is a safe and effective procedure with simple operation, little tissue damage and few complications.

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Section: Discussionmentioning

confidence: 99%

Continuous ab interno repairing of traumatic cyclodialysis cleft using a 30-gauge needle in severe ocular trauma: a clinical observation

Cai

2019

BMC Ophthalmol

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“…9 Various reported techniques have their own limitations, such as severe intraoperative hypotony, damage to vascular structures with bleeding, disrupted filtering bleb function after trabeculectomy, and long recovery periods after surgery. 10 Another reported surgical option is to combine vitrectomy and endophotocoagulation with silicone oil endotamponade (VEE). 11 However, the intraocular surgery potentially leads to cataract, postoperative IOP spikes, and other tamponade-related complications.…”

Section: Discussionmentioning

confidence: 99%

23-G trocar-assisted cyclopexy: scleral sparing method as a new modality for large cyclodialysis repair

Yoo¹,

Yong²,

Mustapha³

et al. 2019

MyJO

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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.

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“…Surgical options for cyclodialysis cleft repair include direct cyclopexy; scleral buckling; pneumocyclopexy; vitrectomy; sulcus CTR, MCTR, or IOL insertion; and gas tamponade [ 13 , 17 – 19 ]. Direct cyclopexy, the gold standard for treatment of large clefts, is probably the most effective approach to close a cyclodialysis cleft, but it has some limitations, such as severe intraoperative hypotony, potential complications, the need for careful surgical procedures, damage to vascular structures, disrupted filtering bleb function after trabeculectomy, and a long recovery period after surgery [ 17 , 24 ]. After direct cyclopexy, most patients require a secondary intervention related to the presence of complicated cataract, lens subluxation, vitreous prolapse, or other small clefts.…”

Section: Discussionmentioning

confidence: 99%

“…Various nonsurgical and surgical methods of closure have been proposed for the management of cyclodialysis cleft [ 1 ]. The nonsurgical options include medical treatment (steroids and atropine) [ 12 ], laser photocoagulation [ 13 ], transscleral diathermy [ 3 , 14 ], and cryocoagulation [ 15 , 16 ], whereas surgical procedures include direct cyclopexy [ 17 ], scleral buckling [ 18 ], internal tamponade [ 19 ], indirect cyclopexy [ 20 ], and novel therapeutic approaches [ 21 , 22 ]. The principle underlying all of these strategies is to restore apposition of the detached ciliary body to the scleral spur using an internal or external procedure.…”

Section: Introductionmentioning

confidence: 99%

Cyclodialysis cleft repair and cataract management by phacoemulsification combined with internal tamponade using modified capsular tension ring insertion

Chen

Jing

Gao

et al. 2018

Graefes Arch Clin Exp Ophthalmol

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PurposeTo evaluate the surgical outcomes of cyclodialysis cleft repair and cataract management by phacoemulsification combined with internal tamponade using a modified capsular tension ring (MCTR) compared with direct cyclopexy.MethodsThe preoperative and postoperative characteristics of patients with cyclodialysis clefts who underwent surgery via insertion of an MCTR into the ciliary sulcus (MCTR group; 16 patients, 16 eyes) or direct cyclopexy (DC group; 16 patients, 16 eyes) were recorded.ResultsThe cyclodialysis extended over 2.6 ± 1.9 clock hours in the MCTR group and 3.5 ± 1.8 clock hours in the DC group (P = 0.094). Postoperatively, the IOP was not significantly different between the MCTR and DC groups (12.9 ± 3.7 mmHg vs. 13.8 ± 6.2 mmHg, P = 0.985); the logarithm of the minimal angle of resolution BCVA was better (0.1 ± 0.2 vs. 1.0 ± 0.9, P < 0.001), and the anterior chamber depth was greater (3.87 ± 0.40 mm vs. 2.59 ± 0.58 mm, P < 0.001) in the MCTR group than in the DC group. Compared with the preoperative parameters, the postoperative BCVA, IOP, and anterior chamber depth values were significantly improved in the MCTR group (P < 0.05), whereas the BCVA showed no significant improvement postoperatively in the DC group (P = 0.174). Logistic regression revealed no significant risk factors for successful IOP control or BCVA improvement.ConclusionPhacoemulsification combined with internal tamponade using MCTR insertion into the ciliary sulcus is a safe and minimally invasive method for effectively closing cyclodialysis clefts and managing cataract.Electronic supplementary materialThe online version of this article (10.1007/s00417-018-4149-8) contains supplementary material, which is available to authorized users.

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Direct cyclopexy surgery for post-traumatic cyclodialysis with persistent hypotony: ultrasound biomicroscopic evaluation

Cited by 14 publications

References 11 publications

Continuous ab interno repairing of traumatic cyclodialysis cleft using a 30-gauge needle in severe ocular trauma: a clinical observation

Continuous ab interno repairing of traumatic cyclodialysis cleft using a 30-gauge needle in severe ocular trauma: a clinical observation

23-G trocar-assisted cyclopexy: scleral sparing method as a new modality for large cyclodialysis repair

Cyclodialysis cleft repair and cataract management by phacoemulsification combined with internal tamponade using modified capsular tension ring insertion

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