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Purpose: To describe a minimally invasive technique for the repair of large traumatic cyclodialysis clefts using intrascleral sewing machine suture and overhand friction knot techniques in pars plana vitrectomy., Methods: This prospective, noncomparative, interventional case series included seven eyes of seven patients with a large traumatic cyclodialysis cleft. The sewing machine technique was modified by an intrascleral approach. The procedure was transconjunctival or subconjunctival performed without scleral flaps/grooves. An overhand friction knot was used to lead the cutting ends of the suture buried in the scleral tunnel., Results: The closure of the cyclodialysis cleft was achieved in seven eyes. The mean follow-up duration was 49.1 ± 15.6 weeks (range, 30-70 weeks). The intraocular pressure increased from 7.3 ± 2.1 mm Hg (range, 5-11 mmHg) preoperatively to 13.6 ± 2.4 mm Hg (range, 10-17 mmHg) postoperatively ( P < 0.01). The best-corrected visual acuity improved from a mean of 2.76 ± 2.77 logarithm of the minimum angle of resolution preoperatively to 0.63 ± 0.82 logarithm of the minimum angle of resolution at the final follow-up ( P < 0.01)., Conclusion: In conclusion, the present technique is safe and effective in the treatment of large traumatic cyclodialysis clefts with minimal surgical trauma and a decreased surgical duration.

Purpose: Comparing the anatomical and functional outcomes of vitrectomy, silicone oil endotamponade without cyclopexy (VEWOC) and with cyclopexy (VEWC) in patients with traumatic cyclodialysis clefts and severe ocular comorbidities., Methods: A total of 55 patients (55 eyes) with traumatic cyclodialysis clefts were divided into VEWOC and VEWC groups according to the surgery undergone. Besides the cyclodialysis clefts, all study eyes had one or more additional conditions caused by severe ocular trauma: cataract, lens dislocation, vitreous hemorrhage, retinal detachment, choroidal detachment, maculopathy, suprachoroidal hemorrhage, subretinal hemorrhage, or proliferative vitreoretinopathy. The minimum postoperative follow-up period for all patients was six months. The main measures of outcome were rate of successful anatomical repair, intraocular pressure, and best-corrected visual acuity., Results: Both the VEWOC group (33 eyes) and the VEWC group (22 eyes) showed significant improvement in postoperative best-corrected visual acuity and intraocular pressure at the final follow-up. The groups had no significant differences in terms of anatomical success rates (VEWOC 29/33 vs. VEWC 20/22, P = 1.000), final best-corrected visual acuity (VEWOC 1.60 ± 0.76 [median Snellen acuity: counting fingers, range: light perception to 20/20] vs. VEWC 1.46 ± 0.66 [median Snellen acuity: 20/800, range: light perception to 20/32], P = 0.485), and final intraocular pressure (VEWOC 13.40 [8.20-17.80] vs. VEWC 11.40 [6.65-14.00] mmHg, P = 0.311). However, the intraocular pressure on postoperative Day 1 was significantly different between the groups (VEWOC 10.40 [6.40-14.60] vs. VEWC 6.40 [4.70-7.98] mmHg, P = 0.002)., Conclusion: This study showed that both surgical approaches were equally effective in treating cyclodialysis clefts secondary to severe ocular trauma. Therefore, it may be unnecessary to perform cyclopexy in addition to the vitrectomy procedure in such cases., (Copyright © 2020 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the Opthalmic Communications Society, Inc.)

Purpose: To report novel surgical approaches to the management of persistent hypotony after cyclodialysis., Methods: Retrospective review of the medical records of six eyes of six patients with persistent hypotony after traumatic cyclodialysis. The diagnosis accuracy of cyclodialysis was documented by ultrasound biomicroscopy in five patients. The other one underwent an anterior segment optical coherence tomography. The authors performed pars plana vitrectomy and silicone oil-assisted endotamponade in four patients. The remaining eyes underwent a gas tamponade after pars plana vitrectomy., Results: Preoperative visual acuity (Snellen scale) ranged from count fingers to 20/50. The patients' visual acuity improved after the surgery. The intraocular pressure ranged from 2 mmHg to 6 mmHg (mean, 3.33 mmHg) before surgery. The authors did achieve an intraocular pressure normalization postoperatively. After surgery, the ciliary body was completely reattached in all cases. A slight angle recession was documented in one eye., Conclusion: The management of cyclodialysis clefts requires a stepwise approach. In cases where conservative management fails, wide ranges of options have been reported. Based on our results, we consider that silicone oil-assisted or gas-assisted endotamponade, after pars plana vitrectomy, can be an effective alternative approach to the cyclodialysis.

Purpose: Investigate possible risk factors of no light perception (NLP) after open-globe injury. Explore whether these risk factors are predictors for an unfavorable visual outcome., Methods: This case-control study matched 72 eyes with NLP according to type and zone of injury to 2 controls per case with light perception or better vision. Cases were selected from the Eye Injury Vitrectomy Study database. All injured eyes in the study underwent surgical intervention., Results: Ciliary body damage (odds ratio = 2.94), closed funnel retinal detachment (odds ratio = 2.43), and choroidal damage (odds ratio = 2.80) were independent risk factors for NLP after open-globe injury. There were 67 traumatized eyes with NLP that had ≥1 of these risk factors. In 43 of the cases (64.2%), the eyes recovered light perception or better after vitreoretinal surgery. The five traumatized NLP cases without these risk factors obtained a favorable visual outcome after vitreoretinal surgery. There was no statistical significance in visual outcome between them (P = 0.162)., Conclusion: Ciliary body damage, closed funnel retinal detachment, and choroidal damage are independent risk factors for NLP posttrauma but not prognostic indicators for NLP visual outcome. Traumatized eyes with NLP may recover light perception or better vision if appropriate interventional measures are used for treatment of the injured ciliary body, retina, and choroid.

Purpose: To describe the clinical features of retinal detachments caused by traumatic tears in the pars plana ciliaris., Methods: This study is a retrospective review of five cases of retinal detachments secondary to traumatic breaks limited to the nonpigmented epithelium of the pars plana ciliaris. Four patients had a history of recent closed-globe trauma due to a fist blow and the remaining patient had a history of remote closed-globe trauma., Results: In all cases, the tearing of the pars plana developed in the superonasal quadrant. The low-lying configuration of the detachment and the absence of a retinal break, oral tear, or avulsed vitreous base challenged the ability of the initial examiners to establish the correct diagnosis. Each patient underwent successful surgical reattachment of the retina., Conclusions: Retinal detachments may result from traumatic tears in the nonpigmented epithelium of the pars plana ciliaris. These detachments often do not become clinically manifest for several months or longer following ocular contusion. They tend to be shallow with a smooth and flat surface, which makes diagnosis difficult during routine ophthalmoscopy. Scleral depression is almost always necessary to identify the pars plana tear(s).