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We describe a modified sewing machine technique that is ab interno and minimally invasive. The single-suture, single-knot endocyclopexy (internal suture fixation) is performed to correct cyclodialysis. This inside-out technique is an alternative to existing standard cleft repair procedures, such as external direct/indirect cyclopexy and endocyclotamponade (internal mechanical tamponade using extraneous agents). Results in 1 case indicate that the modified technique can be used as a primary procedure and in eyes in which previous cyclopexy failed., (Copyright © 2018 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.)

We present the case of a 69-year-old woman who presented with hypotony several years after an inadvertent cannula detachment presumably formed a cyclodialysis cleft during phacoemulsification cataract extraction and posterior chamber intraocular lens implantation in her right eye. To our knowledge, this is the first report of late hypotony maculopathy as a result of inadvertent cannula release., (Crown Copyright © 2015. Published by Elsevier Inc. All rights reserved.)

A 48-year-old man presented with hyphema, iridocyclitis, iridophacodonesis, and maculopathy after a contusive trauma. Ultrasound biomicroscopy identified a 90-degree cyclodialysis cleft with severe damage of the zonular fibers. Echographic B-scan examination revealed intravitreal hemorrhage and a 360-degree choroidal detachment. One month later, phacoemulsification was performed and a single-piece poly(methyl methacrylate) intraocular lens was inserted into the ciliary sulcus, with the haptic rotated toward the cyclodialysis cleft area. Postoperatively, the visual acuity improved and the intraocular pressure returned to normal. Ultrasound biomicroscopy showed closure of the cleft by reattachment of the ciliary body to the scleral spur. Optical coherence tomography revealed complete resolution of the macular and choroidal folds. Ultrasound biomicroscopy is a useful method for appropriate management of traumatic cyclodialysis cleft. In cases of small cyclodialysis clefts, with the surgical method we describe, the lens haptics apply directional force toward the sclera, fostering adherence of the ciliary body fibers.

We present a patient who had decreased visual acuity and hypotony in the left eye 2 months after removal of an anterior chamber phakic intraocular lens (pIOL). Gonioscopy demonstrated a cyclodialysis cleft at the 6 o'clock position in the region of the IOL footplate, which was confirmed by ultrasound biomicroscopy. A cyclodialysis cleft formation is one possible complication of pIOL removal. Careful gonioscopy evaluation before removal of pIOLs should be mandatory to assess the amount of fibrosis and the presence of synechia between the IOL and the surrounding tissues.

A 44-year-old man suffered traumatic 360-degree cyclodialysis in the left eye complicated by persistent hypotony, disc edema, maculopathy, and cataract. Treatment was removal of the cataract with phacoemulsification followed by insertion of a capsular tension ring with 2-point scleral suture fixation with polypropylene in the ciliary sulcus. A foldable acrylic posterior chamber intraocular lens was implanted in the capsular bag through the 4.1 mm corneal tunnel incision. The intraocular pressure responded well with resolution of hypotony, choroidal detachment, disc edema, and maculopathy. Ultrasound biomicroscopy showed complete closure of the cyclodialysis cleft.

A retrospective noncomparative case-note analysis of 3 men presenting with persistent hypotony after routine phacoemulsification cataract surgery was performed. All patients had a previous history of significant blunt ocular trauma. All patients had surgical repair of the cyclodialysis clefts, 1 with cleft cryopexy and 2 with formal cleft closure with a limbal-based double scleral flap technique. All patients achieved closure of the cyclodialysis clefts following surgical intervention with complete resolution of hypotony. Mean preoperative intraocular pressures improved from 3, 4 and 3 mm Hg in the 3 cases to 11, 16, and 17 mm Hg postoperatively. Visual acuities improved from preoperative readings of counting fingers, 6/36 and 6/24 in the 3 cases to 6/6, 6/9, and 6/9 postoperatively. Persistent hypotony because of possible activation of a preexisting doormant cyclodialysis cleft following routine atraumatic phacoemulsification cataract surgery in previously traumatized eyes has not been reported.

We describe a closed-system technique of iridodialysis repair using a 22.0 mm, plastic handled, 27 gauge straight needle with a hole 1.0 mm proximal to the tip. The distal hole is suitable for passage of 9-0 or 10-0 mm polypropylene or nylon sutures. The technique was effective in 8 patients with traumatic iridodialysis in the upper and inferior temporal quadrants.

An aphakic patient with severe chronic hypotony had an alternative treatment of a traumatic cyclodialysis cleft: a 3-port pars plana vitrectomy, cryotherapy of the cleft, and fluid-gas exchange with subsequent supine positioning. The therapeutic principle was mechanical apposition of the detached ciliary muscle to the scleral spur by the gas bubble and scar induction by cryotherapy. Intraocular pressure increased to within normal ranges, and visual acuity improved over a 15 month follow-up.

Objective: To anatomically and histologically evaluate suturing techniques for sulcus fixation of posterior chamber intraocular lenses., Setting: Kitano Hospital, Osaka, Japan., Methods: The reproducibility of three suturing techniques (perpendicular to the eye wall; parallel to the iris; midway between perpendicular to the eye wall and parallel to the iris) were evaluated in a postmortem eye. Histologic sections of another eye and ultrasound biomicroscopy (UBM) images of 21 normal eyes were evaluated to determine the safety zone for the needle to avoid damaging adjacent structures., Results: The ciliary sulcus was completely penetrated in the three techniques in 100, 40, and 70% of cases, respectively. The histologic sections and the UBM images showed that when sutures were placed perpendicular to the eye wall, there was the possibility of postoperative angle closure and suturing parallel to the iris might damage adjacent structures because of a narrow safety zone., Conclusions: The needle should penetrate obliquely, as in the technique in which the suturing is midway between perpendicular to the eye wall and parallel to the iris. This technique provides better reproducibility and causes less damage to adjacent tissue.