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

Abstract

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.

Cyclodialysis: an updated approach to surgical strategies

“…Also, the rate of gas resorption and reattachment of the ciliary body may not exactly synchronise with each other (Chen et al. ). Again, these techniques can only be performed by posterior segment surgeons, thus needing a concerted effort by an anterior segment surgeon to diagnose and localise the cleft and the posterior segment surgeon to operate.…”

“…Chen et al. () compared endocyclotamponade and exocyclopexy and concluded that cleft closure occurred equally in both groups (62.5%), however, the former group had improved best‐corrected visual acuity. Also, five eyes of the exocyclopexy group required secondary intervention at a later date due to cataract progression, similar to that reported by Popovic et al.…”

Placement of dual capsular tension rings for the combined management of traumatic cyclodialysis cleft and zonular dialysis

“…Various non-surgical and surgical methods to close the cyclodialysis cleft and center the dislocated lens have been proposed [ 4 – 13 ]. Gupta et al [ 11 ] reported a case of cataract, zonular dialysis, cyclodialysis, and iridodialysis following blunt trauma that was successfully treated in a single procedure by placing two capsular tension rings (CTRs).…”

“…Gupta et al [ 11 ] reported a case of cataract, zonular dialysis, cyclodialysis, and iridodialysis following blunt trauma that was successfully treated in a single procedure by placing two capsular tension rings (CTRs). We previously performed phacoemulsification combined with an internal tamponade by insertion of a modified capsular tension ring (MCTR) into the ciliary sulcus to close cyclodialysis clefts and treat cataracts [ 12 , 13 ]. Appropriate positioning of a polymethyl methacrylate CTR or Cionni MCTR in the sulcus apposing the detached ciliary body against the sclera provides stable endocyclotamponade and endocyclopexy (in-out suture to aid fixation), which promotes cleft closure [ 8 , 9 , 13 , 14 ].…”

“…We previously performed phacoemulsification combined with an internal tamponade by insertion of a modified capsular tension ring (MCTR) into the ciliary sulcus to close cyclodialysis clefts and treat cataracts [ 12 , 13 ]. Appropriate positioning of a polymethyl methacrylate CTR or Cionni MCTR in the sulcus apposing the detached ciliary body against the sclera provides stable endocyclotamponade and endocyclopexy (in-out suture to aid fixation), which promotes cleft closure [ 8 , 9 , 13 , 14 ]. Similarly, implantation of an MCTR, an adjacent zonular apparatus, achieved the best possible outcomes in terms of long-term stability and centering of the intraocular lens (IOL) in patients with ectopia lentis following continuing refinement of surgical techniques [ 15 – 17 ].…”