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In order to study the pathophysiological alterations of the ciliary body (CB) during persistent hypotony, it is necessary to develop an animal model without CB injury. In this study, we successfully established a modified model of persistent hypotony without CB injury in New Zealand rabbits. A 23-gauge pars plana vitrectomy (PPV) was performed and a trocar-formed fistula was allowed to remain in situ, to produce a continuous outflow of intraocular fluid. Both eyes underwent PPV with normal intraocular pressure (IOP); eyes with no surgical intervention were used as controls. The IOP was monitored and used to evaluate the reliability of the model. Secondary changes of hypotony were evaluated by slit-lamp biomicroscopy and B scans while morphological changes of the CB were observed by haematoxylin and eosin staining. The mean IOP in the hypotony groups were consistently lower than 6 mmHg. Furthermore, there were no significant differences in IOP between the PPV control group and normal eyes. Collectively, our data indicate that this model successfully simulates the secondary changes of hypotony, including a reduction in corneal size, corneal oedema, anterior chamber inflammation, morphological alterations of the CB, cataract, retinal detachment, and choroidal detachment. The morphological structure of the CB tissue changed dramatically after persistent hypotony, indicating that normal IOP may be required in order to maintain normal function in the CB. This model of persistent hypotony potentially represents a valuable tool for future studies aiming to investigate the pathophysiological mechanisms underlying CB dysfunction and other secondary changes that occur during hypotony., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Cyclodialysis is the result of the separation of the longitudinal ciliary muscle fibers from the scleral spur, which creates an abnormal pathway for aqueous humor drainage that may lead to ocular hypotony. For many years cyclodialysis was considered a treatment option for glaucoma. However, today it usually occurs as a complication of blunt trauma or more rarely as a complication of anterior segment ocular surgery. Ocular hypotony can lead to cataract development, optic disk swelling, refractive changes, and several retinal complications, making accurate identification and timely intervention of the cleft mandatory. Traditionally gonioscopy was the only available technique to diagnose and localize the cleft. However, other tests such as optical coherence tomography, magnetic resonance imaging, transillumination, and specially ultrasound biomicroscopy are now available for the diagnosis of cyclodialysis. Multiple treatment options are also available for this condition. Although medical treatment can be effective to close small clefts, surgery is needed in most patients to restore ocular pressure.

Purpose: To determine the clinical features of traumatic ciliochoroidal detachment (CCD), and to evaluate the surgical outcomes., Methods: We retrospectively reviewed the records of 37 consecutive patients with traumatic CCD who underwent surgical procedures, including ciliary body suturing, transscleral cyclophotocoagulation, and cyclocryopexy. A complete ocular examination was performed at pre-surgery and at periodical post-surgery follow-ups. We compared visual acuity (VA), intraocular pressure (IOP), and morphologic changes with UBM among the different surgical procedures at the pre-surgery and periodical follow-ups., Results: The mean IOP was 6.62 mmHg, and the median VA was 20/200 at baseline. The mean final IOP was 11.03 mmHg, and the final median VA improved to 20/50. IOPs were significantly different in post-surgery compared with those at baseline (P = 0.000) among the ciliary body suturing, cyclophotocoagulation, and cyclocryopexy groups. However, no significant differences were noted at each follow-up among the 3 groups (P > 0.05). The post-surgical morphological figures consisted of complete reattachment, partial reattachment, and the complete detachment. Cyclocryopexy (71.4%), suturing (68.4%), and cyclophotocoagulation (63.6%) produced similar surgical outcomes of the complete reattachment based on UBM images., Conclusion: Prompt treatment and periodic follow-ups are necessary after traumatic CCD, based on accurate dimensions and configuration by UBM. The appropriate choice of surgical procedures is pivotal for an optimal outcome.

We report here a case in which ciliary detachment related to the preparation of a scleral wound was suspected as the cause of persistent hypotony following 23-gauge vitrectomy for proliferative diabetic retinopathy. Ultrasound biomicroscopy (UBM) was performed following injection of a viscoelastic substance into the anterior chamber to carefully investigate the treatment and cause of persistent hypotony. Deepening the anterior chamber by means of the viscoelastic substance enabled UBM identification of ciliary detachment that had not been detected in the shallow anterior chamber. The extent of ciliary detachment was approximately 8 degrees; however, the detachment could not be seen on gonioscopy. UBM showed no continuity between the anterior chamber and choroid, with findings suggesting that the two structures had been split by posterior traction. The ciliary detachment site was the same site at which a three-port system had been prepared. One advantage of a 23-gauge system is that few complications are associated with the insertion and retraction of instruments. However, the difference in level between the cannula and trocar may result in ciliary detachment even if no resistance is felt when the trocar is inserted.

Objective: To prospectively analyze the clinical and ultrasonographic biomicroscopy (UBM) features in eyes with closed globe injury, at the initial examination, that would predict the occurrence of chronic traumatic glaucoma during a 6-month follow-up., Methods: Forty consecutive eyes with closed globe injury and a chronically elevated intraocular pressure (IOP) of at least 21 mm Hg for a minimum of 3 months were diagnosed as having traumatic glaucoma and compared with 52 eyes with closed globe injury and no evidence of glaucoma., Results: The median grade of trabecular pigmentation on gonioscopy in eyes with traumatic glaucoma was 3 compared with 2 in eyes without glaucoma (P = .001). On UBM findings, 18 eyes with closed globe injury without glaucoma showed evidence of cyclodialysis, compared with 7 eyes with glaucoma (P = .001). The relative risk of developing traumatic glaucoma was also significantly higher with hyphema, elevated baseline IOP, angle recession of more than 180 degrees, lens displacement, and wider angles on UBM., Conclusions: Clinically, the presence of increased pigmentation at the angle, elevated baseline IOP, hyphema, lens displacement, and angle recession of more than 180 degrees were significantly associated with the occurrence of chronic glaucoma after closed globe injury. On UBM findings, a wider angle and the absence of cyclodialysis were significant predictors for the subsequent development of traumatic glaucoma.

Elevation of intraocular pressure is often seen immediately after blunt trauma of the eye, but it can occur even years after the primary impact. A retrospective study was performed in 144 patients with contusion to the eye. After a mean observation period of 6.1 years, a significant rise in intraocular pressure was found in the engaged eye (P < 0.05). In more than 8% of the patients the level of intraocular pressure exceeded 22 mmHg, but only 3 cases developed a glaucomatous visual field and optic nerve head changes. Thus, the risk of secondary glaucoma after contusion of the eye is low.

Persisting hypotony in 8 eyes due to traumatic cyclodialysis extending from 75 degree - 240 degree was cured by a modified technique of "direct cyclopexy". Our approach consists of the following elements: 1.4 mm lamella limbal based scleral window in the area of the cyclodialysis. 2. Incision of the basal scleral lamella directly behind and parallel to the scleral spur. 3. Bipolar cautery of the ciliary muscle. 4. Under direct visual control, suture of the insertion of the ciliary muscle to the scleral spur with 10/0 nylon. In all cases intraocular pressure was normalized, no anterior synechiae and no secondary glaucoma ensued. Postoperative tonographic C-values were below the upper normal limit. The degree of functional improvement depends on the duration of hypotony and other contusional changes. Early "direct cyclopexy" is recommended.

Importance There is a paucity of evidence analysing the treatment of cyclodialysis clefts. Background: We describe outcomes following the treatment of this rare condition at six centres internationally. Design Retrospective case series. Participants: Thirty‐six patients with a cyclodialysis cleft from 2003 to 2017 were recruited. Methods: Clefts were treated with cycloplegic agents, laser therapy and/or surgery. Main Outcome Measures: Postoperative best recorded visual acuity (BRVA), intraocular pressure (IOP) and the rate of cleft closure. Results: The mean age was 45 ± 17 years and 29 (80.6%) patients were male. One eye (2.8%) received only medical therapy, 5 (13.9%) received laser, 14 (38.9%) underwent surgery after laser failure and 16 (44.4%) eyes received exclusively surgery. Over 80% of eyes had a BRVA improvement of more than two lines. Closure was attained in 30 eyes (93.8%; n = 32), with postoperative stabilized IOP ≥ 12 mmHg in 29 eyes (80.6%; n = 36) and postoperative BRVA ≤20/50 in 20 eyes (58.8%; n = 34). Improved postoperative BRVA was related to better preoperative BRVA (P = 0.006) and preoperative IOP ≥ 4 mmHg (P = 0.03). There was no significant difference between treatment approach for IOP ≥ 12 mmHg (P = 0.85) or postoperative BRVA ≤20/50 (P = 0.80). Only two eyes at last follow‐up required IOP lowering medication. Conclusions and Relevance: There was a high closure rate with most eyes eventually requiring surgery. Clinically significant improvements in BRVA were found in most eyes. Improved postoperative BRVA was significantly related to better preoperative BRVA and IOP. [ABSTRACT FROM AUTHOR]