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Purpose: To evaluate the long-term visual prognosis and intraocular pressure (IOP) control following direct and indirect cycloplexy for the surgical treatment of traumatic cyclodialysis clefts., Methods: Retrospective consecutive case series of 17 eyes of 17 patients. All eyes showing signs of ocular hypotony were treated with either cleft cyclocryotherapy and/or direct surgical cycloplexy. Cycloplexy was performed by directly suturing the ciliary body to the scleral spur under a double-lamellar limbal-based scleral flap. The main outcome measures were IOP, best-corrected visual acuity (BCVA), and the occurrence of postoperative complications., Results: The cyclodialysis clefts were post-traumatic in all the 17 eyes and extended for 2.1 ± 1.6 clock-hours (range, 0.5-6 clock-hours). The mean follow-up time was 43.7 ± 24.6 months (range, 12-110 months). Preoperatively, the mean IOP was 6.9 ± 4.0 mm Hg (range, 2-14 mm Hg). Postoperatively, painful reversible IOP spikes of up to 70 mm Hg developed in 13 eyes. The final mean postoperative IOP was 12.2 ± 4.1 mm Hg with no cases of secondary glaucoma. Preoperatively, BCVA was 6/12 or better in 4 eyes (24%), which rose to 12 eyes (71%) at final follow-up. Of the 12 patients who underwent direct cycloplexy, 75% achieved a final BCVA of 6/12 or better. There were no serious complications related to direct cycloplexy, including suprachoroidal haemorrhage or endophthalmitis., Conclusions: Successful cyclodialysis cleft repair can lead to a good long-term visual prognosis and stable IOP control, even in cases with a protracted history of ocular hypotony.

Purpose of Review: To report the most recent developments in the diagnosis and management of cyclodialysis clefts., Recent Findings: Cyclodialysis clefts are rare. The most common reason for presentation is blunt-ocular trauma followed by various iatrogenic interventions. Diagnosis is particularly challenging and various new noninvasive techniques have been described to facilitate this process, such as ultrasound biomicroscopy (UBM) and the anterior segment OCT (AS-OCT). The management of cyclodialysis clefts should be conservative initially followed by a variety of nonsurgical and surgical modalities to achieve closure., Summary: The management of cyclodialysis clefts requires a step-wise approach. Initially, it is of particular importance to identify the full extent and location of the cleft as in some cases more than one cleft may be present requiring a variety of nonsurgical and surgical interventions. Nonincisional interventions include the application of various lasers and cryotherapy in the vicinity of the cleft. The traditional approach of direct cyclopexy has more recently been complemented by recent reports of employing modified external plombage procedures, vitrectomy and gas assisted endotamponade. There are insufficient studies formally evaluating these techniques to be able to assess their safety and efficacy.

Introduction: The optical coherence tomography (OCT) exploration of the retina has become almost routine and its semiology is well known. In contrast, the OCT exploration of the anterior segment is still in its preliminary stages., Case Report: We report the clinical aspects and the OCT Visante((R)) imaging of the anterior segment in a 35-year-old patient, victim of a penetrating injury of the left eye who required several operations including iterative vitrectomy for recurrent retinal detachment caused by proliferative vitreoretinopathy, use of high-density silicone oil, cataract surgery with in-the-bag intraocular lens implantation, and YAG-laser capsulotomy., Discussion: The correlation between slit lamp examination and OCT imaging is very good. We debate in a nonexhaustive manner the different imaging possibilities of this new technology and discuss its advantages in the postsurgical exam and its value in medicolegal expert reports as well as in comparison with pictures acquired by OCT normally used to image the posterior segment., Conclusion: Future research will undoubtedly confirm the contribution of this new tool to explore the anterior segment in numerous contexts, including ophthalmological trauma medicine.

Objectives: 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.

Purpose: To report the changes in corneal topography in 2 cases of ocular hypotony induced by cyclodialysis cleft after blunt trauma, which were successfully treated by argon laser photocoagulation., Methods: For both patients, a full ophthalmic clinical examination and corneal topography were performed before and after argon laser cleft closure., Results: In the first case, the corneal topography showed 3.81-D astigmatism at 96 degrees, which was reduced to 1.1 D at 124 degrees 1 week after treatment and 0.66 D at 122 degrees at 3 weeks after treatment. In the second case, the corneal astigmatism was 3.91 D at 104 degrees, which decreased to 1.44 D at 104 degrees and 0.35 D at 118 degrees at 1 week and 4 months after treatment, respectively., Conclusions: In both cases, the with-the-rule astigmatism reduced significantly after successful closure of the cleft and an increase in intraocular pressure.

To treat patients with eye injuries remains a topical problem due to the high incidence of this type of pathology and the severity of clinical outcomes. Ciliochoroidal detachment (CCD) occurring in 1-9% of the victims is one of the most common complications of mechanical eye injury. The purpose of the study was to evaluate the efficiency of pathogenetically substantiated technology for a combined laser surgical reparative intervention in posttraumatic traction CCD. The results of treatment were analyzed in 70 patients with posttraumatic traction detachment of the choroid and ciliary body. There was evidence for the need for vitrectomy and lensectomy in combination with posterior sclerectomy to eliminate traction posttraumatic CCD.

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.

Cyclodialysis clefts occur when the attachment of the ciliary body to the scleral spur is disrupted. The mechanism is usually traumatic or iatrogenic after phacoemulsification or other intraocular manipulation. Treatment becomes necessary when hypotony occurs, with maculopathy being the most visually significant sequela. A patient who failed conventional treatment for hypotony and eventually benefited from a novel surgery to correct his cyclodialysis cleft is described.

In order to evaluate the efficacy of transscleral diode laser therapy for treatment of cyclodialysis cleft associated with ocular hypotony, transscleral diode laser therapy was used in two patients with cyclodialysis cleft. It was applied over the cleft area in two rows of 14 applications in a post-traumatic patient and of 8 applications in a post-trabeculectomy patient at a power setting of 2500 mW and duration of 2000 msec. The clefts were closed with restoration of normal intraocular pressure and recovery of visual function in both patients. Transscleral diode laser therapy seems to be a safe, simple and non-invasive method for closure of the cyclodialysis clefts, especially in patients inappropriate for argon laser photocoagulation and those with opaque cornea.

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.

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.

Background and Objective: To evaluate the efficacy of direct cyclopexy for treatment of traumatic cyclodialysis cleft associated with ocular hypotony., Patients and Methods: Eyes with traumatic cyclodialysis cleft were treated with direct cyclopexy or 1.0% atropine eyedrop., Results: Five eyes with a large cyclodialysis cleft were treated with direct cyclopexy. Postoperatively, these eyes obtained normal intraocular pressure. Four of the 5 eyes had good visual acuity, and 1 eye that had preoperative subretinal hemorrhage in the macula had poor visual acuity. Of the 3 eyes treated with 1.0% atropine eyedrops, 1 had good visual acuity, and 2 with retinal folds had fairly good and poor visual acuity., Conclusion: The present study showed that direct cyclopexy is useful for the treatment of traumatic cyclodialysis cleft associated with ocular hypotony, and that the cyclodialysis should be surgically treated before irreversible retinal folds develop.

The so-called ciliary sulcus of the posterior chamber of the eye is the place of fixation for some of the posterior chamber lenses. It is only recently that this borderline between the iris root and the ciliary processes gained more interest among clinical ophthalmologists. Little is known on tissue reactions in ocular diseases at this very location. Possible reactions are presented based on the material of the Department of Ocular Pathology of the University Eye Hospital München. The main result of this study is the finding of marked fibrovascular proliferative reactions in inflammatory diseases, and vascular proliferations in diabetic and postthrombotic neovascular glaucoma. It is suggested that such proliferations might be the source of intraocular bleeding after posterior chamber lens implantation.