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

Abstract

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.

Central serous chorioretinopathy resolution after traumatic cyclodialysis repair

“…Traumatic cyclodialysis may resolve spontaneously, 16 , 17 , 18 while ciliary body suturing is required when the preservative treatment fails. 19 , 20 Previously, both ab externo 20 and ab interno 19 approaches have been reported as surgical procedures for ciliary body suturing. Because of the ab interno approach and no requirement for vitreous manipulation or conjunctival/scleral incisions, our procedure seems minimally invasive to the ocular tissues.…”