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

Abstract

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.

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.…”

Encircling Scleral Buckling Surgery for Severe Hypotony with Ciliary Body Detachment on Anterior Segment Swept-Source Optical Coherence Tomography: A Case Series

“…Surgical management in such cases is indicated when medical treatment of hypotony fails. There are a few different techniques described to treat this complication [ 3 , 4 , 5 , 6 , 7 ] but there is no effective method in the literature to treat hypotony after PVR-related CBD.…”

“…The treatment options described in the literature include ciliary body suturing, external transconjunctival cryotherapy, direct cyclopexy, ciliochoroidal diathermy, scleral buckling, vitrectomy with gas, and injection of a high-molecular-weight viscoelastic substance into the anterior chamber. Such treatments have mostly been applied to traumatic cases with cyclodialysis cleft [ 3 , 4 , 5 , 6 , 7 ].…”

Traumatische Zyklodialyse – von der Zyklopexie ab interno bis zur DMEK: ein Fallbericht

“…Die wissenschaftliche Evidenz dieser verschiedenen operativen Techniken ist als gering einzuschätzen, da diese hauptsächlich auf Einzelfallberichten beruhen. Gegenwärtig mangelt es an randomisierten Studien, die sich mit dieser Fragestellung auseinandersetzen.In der operativen Behandlung der Zyklodialyse wurden unterschiedliche Techniken beschrieben, die darauf beruhen, den abgelösten Ziliarkörper wieder an das ursprüngliche Sklerabett anzulegen [4,6,7]. Unterschieden werden diese Zyklopexietechniken in extern (von außen) oder intern (von innen), direkt oder indirekt und ob die Anheftung mithilfe von Nähten geschieht [3].…”

“…Zur Vermeidung möglicher Komplikationen wurden die angewandten chi-rurgischen Techniken im Laufe der Zeit modifiziert. Heutzutage bietet sich bei persistierender Hypotonia bulbi nach traumatischer Zyklodialyse die direkte Zyklopexie ab interno als risikoarme Alternative an [7,10]…”