A Novel Method for the Localization and Management of Traumatic Cyclodialysis Cleft

Abstract

Purpose. To propose a novel surgical method for the localization and management of traumatic cyclodialysis clefts. Methods. Five patients with traumatic cyclodialysis clefts who underwent the innovative surgery were retrospectively reviewed. The new method was introduced to repair a cyclodialysis cleft with two running sutures from the middle to each end of the cleft under the guidance of a probe. Preoperative and postoperative visual acuity (VA), intraocular pressure (IOP), slit lamp and gonioscopic results, ultrasound biomicroscopy (UBM), and optical coherence tomography (OCT) findings were recorded. Results. Cyclodialysis clefts were completely closed postoperatively in four patients (four eyes); this was confirmed by progressively improved VA, restoration into the normal range of the IOP, disappearance of suprachoroidal fluid, and reduced macular edema. Only one patient with multiple clefts had an incomplete reattachment. Conclusions. This clinical study offers a novel and efficient method to localize and repair the cyclodialysis clefts.

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

“…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]. UBM can identify extremely small clefts in high resolution images and is most widely used clinically.…”

Novel surgical management of cyclodialysis cleft via anterior chamber perfusion

“…[14] This method is excellent, as the actual localization and range of the cleft may be different from that discovered before the operation. This method also avoids excessive or insufficient sutures, but it may miss hidden clefts, causing the operation to be ultimately unsuccessful.…”

“…A novel method was introduced to repair a cyclodialysis cleft with 2 running sutures from the middle to each end of the cleft under the guidance of a probe. [ 14 ] This method is excellent, as the actual localization and range of the cleft may be different from that discovered before the operation. This method also avoids excessive or insufficient sutures, but it may miss hidden clefts, causing the operation to be ultimately unsuccessful.…”

“…However, unsuccessful cases of cleft repair continue to be reported in clinical practice because small linear ends of a cleft might not easily be detected by UBM or gonioscopy, or due to presence of more than 1 cyclodialysis cleft, not uncommon. [ 14 ] Careful preoperative determination of the extent and localization of cyclodialysis clefts is therefore essential for accurate intraoperative detection and successful surgery. We performed direct cyclopexy via anterior chamber perfusion to ensure that the cyclodialysis cleft was closed.…”

Use of anterior segment imaging and direct cyclopexy repair of cyclodialysis cleft

“…Conventionally, gonioscopy was the only available technique to diagnose and localize the cyclodialysis clefts. However, other examinations such as ultrasound biomicroscopy (UBM),[ 1 13 14 15 ] anterior segment optical coherence tomography (ASOCT)[ 1 13 14 ] and magnetic resonance imaging[ 16 ] are now available for the diagnosis of cyclodialysis clefts. Slit-lamp gonioscopy can be difficult due to corneal opacity, hyphema, chronic hypotony after globe trauma or obscuration of the cleft by peripheral anterior synechiae.…”