Cyclodialysis cleft repair and cataract management by phacoemulsification combined with internal tamponade using modified capsular tension ring insertion

Intrascleral sewing-machine technique: A Grooveless/flapless cyclopexy technique for large traumatic Cyclodialysis cleft repairs in pars plana vitrectomy

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.

Placement of dual capsular tension rings for the combined management of traumatic cyclodialysis cleft and zonular dialysis

Background

To evaluate the efficacy and safety of placing dual capsular tension rings for the combined management of traumatic cyclodialysis cleft and zonular dialysis.

Methods

A modified capsular tension ring was inserted into the ciliary sulcus and a capsular tension ring or modified capsular tension ring was inserted into the capsular bag in 20 eyes in 20 consecutive patients showing signs of ocular hypotony and ectopia lentis. Outcome measures included intraocular pressure, best-corrected visual acuity, and postoperative complications.

Results

Dual capsular tension ring placement was performed in 20 patients with a mean age of 48.7 years. The cyclodialysis cleft extended over 2.9 clock hours (range 0.5–6.5). The modified capsular tension ring was successfully inserted into the ciliary sulcus and a capsular tension ring or modified capsular tension ring in the capsular bag in all eyes. At the last follow-up, the cyclodialysis cleft was closed in 16/20 (80.0%) eyes. The intraocular lens was stable in all patients postoperatively. Best-corrected visual acuity, in terms of the logarithm of the minimal angle of resolution, improved from 1.3 ± 0.8 before surgery to 0.4 ± 0.3 after surgery (P < 0.001). Intraocular pressure increased significantly from 10.6 ± 3.2 mmHg before surgery to 13.0 ± 4.8 mmHg after surgery (P = 0.040). Postoperative complications included a painful reversible intraocular pressure spike in four patients (20.0%). Logistic regression revealed no significant factors associated with successful cleft closure and a stable final intraocular pressure of ≥ 10 mmHg.

Conclusions

The placement of two capsular tension rings into the ciliary sulcus and the capsular bag is a safe, successful procedure combined for repairing a traumatic cyclodialysis cleft and managing zonular dialysis.

Risk Factors Associated with Failure of Direct Cyclopexy in the Treatment of Small to Moderate Tramatic Cyclodialysis Clefts

BACKGROUND

To evaluate the risk factors associated with failure to correct hypotony using direct cyclopexy in patients with traumatic cyclodialysis cleft.

METHODS

In a series of 116 patients with traumatic cyclodialysis who underwent direct cyclopexy at Zhongshan Ophthalmic Center from January 2008 to August 2018, the clinical correlation between the risk factors and failure of the operation were retrospectively studied, after adjusting for other potential confounders.

RESULTS

The curative ratio after one procedure was 82.76%, whereas 20 (17.24%) eyes experienced treatment failure after the first surgery. The degree of anterior chamber angle closure was significantly wider in patients with a failed first surgery than in patients for whom one procedure was a success (p = .046). The risk of failure to achieve closure increased as the angle-closure exceeded 5 clock hour (odds ratio, 10.39; 95% confidence interval, 1.75-61.72; p = .010). An analysis of the recurrent position indicated that an angle closure exceeding 5 clock hour may impede accurate cleft location and is thus associated with an increased risk of failure to correct hypotony.

CONCLUSION

Exceeding the threshold of 5 clock hour in anterior chamber angle closure may impede accurate cleft location and, thus, present a higher risk of failure to correct hypotony using direct cyclopexy. These patients may need injection of a viscoelastic agent into the anterior chamber by paracentesis to deepen the anterior chamber and to delineate the clefts using gonioscopy pre- or intraoperatively.

Cyclodialysis: an updated approach to surgical strategies

Cyclodialysis is a rare occurrence and is difficult to treat, it being concealed behind the iris. In view of the varied success outcomes of the different available surgical repair techniques, there is at present no clear consensus regarding their management strategies. Through this article, we intend to appraise the established surgical methods, update the novel techniques in vogue, discuss their outcomes and propose a uniform system to codify these corrective techniques. They have been reclassified under the terms 'exocyclopexy', 'endocyclopexy', 'exocyclotamponade' and 'endocyclotamponade' based on the approach used and their mode of action. The ab-interno techniques (endocyclopexy and endocyclotamponade) are easier to perform, offer good success rates and better safety profiles such that they may be considered as a viable alternative to the standard exocyclopexy in either cataractous or pseudophakic and aphakic eyes.