Ultrasonic Biomicroscopic Evaluation of Cyclodialysis Before and After Direct Cyclopexy

Abstract

To investigate the clinical manifestations and surgical prognoses after direct cyclopexy in patients with traumatic cyclodialysis according to the cleft extent as determined by ultrasound biomicroscopy (UBM).Methods: A detailed ophthalmologic examination, which included gonioscopy and UBM, was performed before and after direct cyclopexy in 32 eyes of 31 patients with traumatic cyclodialysis clefts.Results: Cyclodialysis clefts were accurately diagnosed and delineated in all 32 eyes using UBM. Cyclodialysis resulted in hypotony with a mean intraocular pressure of 3.2 mm Hg irrespective of cleft size. On A-scan ultrasonography, mean (SD) preoperative and postoperative lens thicknesses were 4.4 (0.4) mm (range, 3.71-4.92 mm) and 4.1 (0.4) mm (range, 3.42-4.57 mm), respectively, and mean (SD) preoperative and postoperative axial lengths were 23.2 (0.7) mm (range, 21.91-24.57 mm) and 23.6 (0.7) mm (range, 22.47-24.56 mm), respectively. The larger a cleft was, the longer it took for a postoperatively elevated intraocular pressure to normalize after direct cyclopexy. Postoperative visual acuities were significantly better than preoperative values, even when direct cyclopexy was performed 54 months after trauma.Conclusions: Even small clefts usually resulted in hypotony and visual prognosis was better after cyclopexy, even in cases with a protracted history. Larger clefts need longer postoperative follow-up to check for intraocular pressure normalization after direct cyclopexy.

Direct cyclopexy surgery for post-traumatic cyclodialysis with persistent hypotony: ultrasound biomicroscopic evaluation

“…It can be used as an aid in the diagnosis of cyclodialysis undetectable by gonioscopy (5,11) . Although gonioscopy is the gold …”

“…In addition, UBM has been shown to be an important tool for confirming anatomical results after treating cyclodialysis clefts not only by a direct cyclopexy procedure (5,11) but also by any other kind of incisional or nonincisional procedure. Another useful imaging tool for the anterior segment is anterior segment optical coherence tomography (OCT), and in a recent publication, authors have shown that UBM and anterior segment OCT offer similar quality of images of the anterior segment for diagnosing cyclodialysis clefts (12) .…”

“…Furthermore, some reports in the literature documented spontaneous closure of cyclodialysis clefts (2) within the first 6 weeks (6) . Although there are some doubts about the effectiveness of medical treatment, some studies have proposed that medical treatment should be attempted first, and if hypotony with retinopathy persists, surgical intervention should be considered (11) . The Ormerod et al algorithm (6) is generally followed: 1% atropine sulfate for cyclodialysis clefts for less than 6 weeks, argon laser photocoagulation if medical treatment is un successful, and direct cyclopexy if laser treatment fails to control the IOP.…”

“…According to Kuchle and Naumann's (1) study, laser photocoagulation can normalize the IOP over the long term only in patients with cyclodialysis clefts smaller than 2 h of extension. Recent papers favor direct cyclopexy after medical treatment has fai led (11) and for moderate to large cyclodialysis clefts. However, a good visual outcome after cyclodialysis repair has been reported even Figure 3.…”

“…Several modalities for surgical and nonsurgical treatment of hypotony maculopathy have been proposed (6) : medical treatment (10) (longacting cycloplegic agents such as 1% atropine sulfate), argon laser cleft photocoagulation, ciliochoroidal diathermy, anterior scleral buckle, transscleral Nd:YAG laser cyclophotocoagulation, transscleral diode laser therapy, direct cyclopexy (1,11) , vitrectomy, transscleral cryo therapy with or without gas endotamponade, endoscopic sur gery, indirect cyclopexy, and other surgical techniques. The best treat ment for these cases remains controversial, although recent publica tions show better results with direct cyclopexy surgery (4) .…”