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

Abstract

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.