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Sadahide A, Ohara H, Oda R, Harada Y. Ciliochoroidal Detachment After Intrascleral Lens Fixation Using the Yamane Technique. Cureus 2024; 16:e66562. [PMID: 39132092 PMCID: PMC11316275 DOI: 10.7759/cureus.66562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2024] [Indexed: 08/13/2024] Open
Abstract
PURPOSE The purpose of this study was to compare the incidence of ciliochoroidal detachment (CCD) after intrascleral lens fixation using the Yamane technique and other vitrectomy procedures. METHODS This retrospective study evaluated patients who underwent intrascleral lens fixation using the Yamane technique at Hiroshima University Hospital between March 2023 and February 2024 and who could be followed up for at least one month. Patients who underwent vitrectomy for macular disease without air-fluid exchange comprised the control group. The frequency of CCD was compared using anterior segment optical coherence tomography imaging. RESULTS Forty-five eyes of 45 patients (26 men and 19 women, mean age 70.8 years) were included. There were no significant differences in the population means or proportions between the intrascleral fixation and control groups for age, sex ratio, right-to-left eye ratio, preoperative visual acuity, preoperative intraocular pressure (IOP), ocular axis, and corneal thickness. The population mean of IOP on the day after surgery was significantly lower in the Yamane intrascleral fixation group (8.4 mmHg) than in the control group (11.5 mmHg) (P < 0.05). There was no significant difference in the population proportions of CCD on the day after surgery between the Yamane intrascleral fixation group and the control group. However, the CCD incidence was 20 eyes (80%) for the Yamane intrascleral fixation group and 12 eyes (60%) for the control group, which was higher in the intrascleral fixation group. There was no significant difference in population means of IOP or population proportions of CCD at one week and one month. CONCLUSIONS There was no significant difference in population proportions of CCD on the day after surgery, although the CCD rate for the Yamane intrascleral fixation group was higher, and the population mean of the IOP was significantly lower. The Yamane technique assumedly lowered IOP because of the stress placed on the ciliary body. One week after the procedure, the IOP in the intrascleral fixation group normalized.
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Affiliation(s)
- Ayako Sadahide
- Department of Ophthalmology and Visual Science, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, JPN
| | - Hiromi Ohara
- Department of Ophthalmology and Visual Science, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, JPN
| | - Ryoya Oda
- Mathematics Program, Graduate School of Advanced Science and Engineering, Hiroshima University, Hiroshima, JPN
| | - Yosuke Harada
- Department of Ophthalmology and Visual Science, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, JPN
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Choi S, Jun JW, Kim Y, Ahn J, Yim S, Lee K, Kim CY, Choi W. Capsular Tension Ring for Hypotony Maculopathy Secondary to Traumatic Cyclodialysis Cleft: A Case Report. KOREAN JOURNAL OF OPHTHALMOLOGY 2024; 38:269-271. [PMID: 38615692 PMCID: PMC11175975 DOI: 10.3341/kjo.2023.0122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 03/08/2024] [Accepted: 04/05/2024] [Indexed: 04/16/2024] Open
Affiliation(s)
- Sungchul Choi
- Department of Medicine, Yonsei University College of Medicine, Seoul,
Korea
| | - Jae Won Jun
- Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul,
Korea
| | - Younghyun Kim
- Department of Medicine, Yonsei University College of Medicine, Seoul,
Korea
| | - Junyeong Ahn
- Department of Medicine, Yonsei University College of Medicine, Seoul,
Korea
| | - Sanghyuk Yim
- Department of Medicine, Yonsei University College of Medicine, Seoul,
Korea
| | - Kyubae Lee
- Department of Medical Engineering, Yonsei University College of Medicine, Seoul,
Korea
| | - Chan Yun Kim
- Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul,
Korea
| | - Wungrak Choi
- Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul,
Korea
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3
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Yalcinbayir O, Gunduz GU, Yildiz M, Baykara M. Indirect cylopexy in cases with cyclodialysis using flanged prolene cylopexy technique. Indian J Ophthalmol 2024; 72:S303-S307. [PMID: 38146975 DOI: 10.4103/ijo.ijo_808_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 10/05/2023] [Indexed: 12/27/2023] Open
Abstract
This study aims to describe a new technique of indirect cyclopexy in the treatment of cyclodialysis. Cases who had cyclodialysis for more than 3 h of extent and were resistant to medical treatment underwent flanged prolene cyclopexy (FPC) technique. Five cases were included in this study. Mean duration between the initial surgery and FPC was 4.6 ± 4.3 months. Hypotony maculopathy was present in all cases. All cases underwent FPC in combination with pars plana vitrectomy and silicone oil injection. Circumferential FPC was applied in four cases, while focal FPC was performed in one case. Postoperatively, no complications occurred, visual acuity increased in four cases, and cyclodialysis closed in all cases. In the follow-up, silicone oil was removed in three cases, but silicone oil could not be removed in two cases with ongoing hypotony. Preliminary results showed that FPC is a promising technique in the surgical treatment of cyclodialysis.
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Affiliation(s)
- Ozgur Yalcinbayir
- Department of Ophthalmology, Bursa Uludag University School of Medicine, Bursa, Turkey
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4
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Gunay M, Uzlu D, Akyol N. Outcomes of Gonioscopy-Assisted Transluminal Trabeculotomy as a Primary Surgical Treatment for Glaucoma Secondary to Juvenile Idiopathic Arthritis-Associated Uveitis. Ocul Immunol Inflamm 2023; 31:2060-2064. [PMID: 37343596 DOI: 10.1080/09273948.2023.2221965] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 05/31/2023] [Indexed: 06/23/2023]
Abstract
Gonioscopy-assisted transluminal trabeculotomy (GATT) has been used as a safe and effective procedure in the treatment of open angle glaucoma. In the present report, we demonstrated successful IOP control in two uveitic glaucoma cases secondary to juvenile idiopathic arthritis (JIA) following 360° GATT. Case 1 was a 7-year-old pseudophakic male with a preoperative IOP of 38 mmHg; his IOP stabilized at 17 mmHg with two topical antiglaucoma medications over 18 months. Case 2 was a 8-year-old aphakic male with a preoperative IOP of 42 mmHg; his IOP decreased to 12 mmHg over 15 months. We observed postoperative IOP spike in case 1 which was successfully controlled conservatively. Peripheral anterior synechia formation also occured in both cases during follow-up. One should be vigilant for possible complications after GATT in such cases. As glaucoma surgery success can have a tendency to decline with time in pediatric cases with uveitis-associated glaucoma, we believe that further evidence is still required to shed more light about the benefits of GATT technique in complex cases of pediatric secondary glaucoma subtypes like JIAU-induced glaucoma.
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Affiliation(s)
- Murat Gunay
- Faculty of Medicine, Department of Ophthalmology, Karadeniz Technical University, Trabzon, Turkey
| | - Dilek Uzlu
- Faculty of Medicine, Department of Ophthalmology, Karadeniz Technical University, Trabzon, Turkey
| | - Nurettin Akyol
- Department of Ophthalmology, Kuzey Eye Hospital, Trabzon, Turkey
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5
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Chan L, Moster MR, Bicket AK, Sheybani A, Sarkisian SR, Samuelson TW, Ahmed IIK, Miller-Ellis E, Smith OU, Cui QN. New Devices in Glaucoma. Ophthalmol Ther 2023; 12:2381-2395. [PMID: 37558818 PMCID: PMC10441989 DOI: 10.1007/s40123-023-00780-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 07/20/2023] [Indexed: 08/11/2023] Open
Abstract
Glaucoma remains a leading cause of blindness globally. Minimally invasive treatment techniques are rapidly expanding the availability of therapeutic options for glaucoma. These include devices aimed at enhancing outflow through the subconjunctival space, Schlemm's canal, and suprachoroidal space, sustained-release drug delivery devices, and extraocular devices aiming to reduce glaucomatous progression through other novel means. In this review, we provide an overview of several novel devices either newly available or in development for the medical and surgical management of glaucoma. Further studies are required to determine the long-term efficacy of these devices and how they will integrate into the current landscape of glaucoma management.
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Affiliation(s)
- Lilian Chan
- Department of Ophthalmology, Scheie Eye Institute, University of Pennsylvania Perelman School of Medicine, 51 North 39th St., Philadelphia, PA, 19104, USA
| | | | - Amanda K Bicket
- Kellogg Eye Center, Department of Ophthalmology and Visual Sciences, Medical School, University of Michigan, 1000 Wall St, Ann Arbor, MI, 48105, USA
| | - Arsham Sheybani
- Washington University School of Medicine, 660 South Euclid Ave, Campus Box 8096, St Louis, MO, 63110, USA
| | - Steven R Sarkisian
- Oklahoma Eye Surgeons, 5600 N Portland Ave, Oklahoma City, OK, 73112, USA
| | - Thomas W Samuelson
- Minnesota Eye Consultants, University of Minnesota, 909 Fulton St SE, Minneapolis, MN, 55455, USA
| | - Iqbal Ike K Ahmed
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada
- Prism Eye Institute, Mississauga, Canada
- John A. Moran Eye Center, University of Utah, 65 Mario Capecchi Drive, Salt Lake City, UT, 84132, USA
| | - Eydie Miller-Ellis
- Department of Ophthalmology, Scheie Eye Institute, University of Pennsylvania Perelman School of Medicine, 51 North 39th St., Philadelphia, PA, 19104, USA
| | - Oluwatosin U Smith
- Glaucoma Associates of Texas, 10740 N. Central Expy, Suite 300, Dallas, TX, 75231, USA
| | - Qi N Cui
- Department of Ophthalmology, Scheie Eye Institute, University of Pennsylvania Perelman School of Medicine, 51 North 39th St., Philadelphia, PA, 19104, USA.
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Zhang X, Wang N, Zheng G, Liu D, Zhang Q, Lei W, Xia X, Xiong S. A Modified Single-Armed Suture Technique for Traumatic Cyclodialysis Cleft with Vitreoretinal Injury. J Clin Med 2023; 12:4252. [PMID: 37445287 DOI: 10.3390/jcm12134252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 06/12/2023] [Accepted: 06/21/2023] [Indexed: 07/15/2023] Open
Abstract
Our aim was to assess the therapeutic efficacy of a modified single-arm suture technique on traumatic cyclodialysis cleft with vitreoretinal injury. The procedure involved fixing a detached ciliary body using a single-armed 10-0 polypropylene suture under the assistance of a 29-gauge needle. Patients with a traumatic cyclodialysis cleft combined with an anterior and posterior segment injury who underwent modified internal cyclopexy together with vitreoretinal surgery were enrolled in this study. Ultrasound biomicroscopy (UBM) was used to diagnose and evaluate the cyclodialysis and anterior segment injury. B-scan ultrasonography was performed to assess the condition of the vitreous, retina and choroid. The surgical time and successful rate for repairing the cyclodialysis cleft were recorded. Preoperative and postoperative best-corrected visual acuity (BCVA), and intraocular pressure (IOP) were documented for assessment. The study included 20 eyes. The extent of the cyclodialysis cleft was from 30° to 360°. Besides a traumatic cyclodialysis cleft, the included cases also combined this with vitreous hemorrhages, retinal detachment, macular holes, choroid avulsion, and suprachoroidal hemorrhage. All the clefts were anatomically closed in one surgery. The average surgical time for fixing the cyclodialysis cleft was 2.68 ± 0.54 min/30° cleft. A significant improvement in LogMAR BCVA was observed from 2.94 ± 0.93 preoperatively to 1.81 ± 1.11 at the 6-month follow-up. IOP was elevated from 10.90 ± 6.18 mmHg preoperatively to 14.45 ± 2.35 mmHg at the 6-month follow-up. The modified single-armed suture technique was proved to be an effective method to fix the traumatic cyclodialysis cleft, which could facilitate the use of the procedure to repair chorioretinal disorders. It improved the BCVA and maintained the IOP with less postoperative complications.
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Affiliation(s)
- Xueyong Zhang
- Eye Center of Xiangya Hospital, Central South University, Changsha 410008, China
- Hunan Key Laboratory of Ophthalmology, Central South University, Changsha 410008, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Nan Wang
- Eye Center of Xiangya Hospital, Central South University, Changsha 410008, China
- Hunan Key Laboratory of Ophthalmology, Central South University, Changsha 410008, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Guoli Zheng
- Eye Center of Xiangya Hospital, Central South University, Changsha 410008, China
- Hunan Key Laboratory of Ophthalmology, Central South University, Changsha 410008, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Die Liu
- Eye Center of Xiangya Hospital, Central South University, Changsha 410008, China
- Hunan Key Laboratory of Ophthalmology, Central South University, Changsha 410008, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Quyan Zhang
- Eye Center of Xiangya Hospital, Central South University, Changsha 410008, China
- Hunan Key Laboratory of Ophthalmology, Central South University, Changsha 410008, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Wenbo Lei
- Eye Center of Xiangya Hospital, Central South University, Changsha 410008, China
- Hunan Key Laboratory of Ophthalmology, Central South University, Changsha 410008, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Xiaobo Xia
- Eye Center of Xiangya Hospital, Central South University, Changsha 410008, China
- Hunan Key Laboratory of Ophthalmology, Central South University, Changsha 410008, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Siqi Xiong
- Eye Center of Xiangya Hospital, Central South University, Changsha 410008, China
- Hunan Key Laboratory of Ophthalmology, Central South University, Changsha 410008, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha 410008, China
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Laroche D, Nkrumah G, Ng C. Real-world efficacy of the intrascleral ciliary sulcus suprachoroidal microtube technique in Black and Afro-Latinx patients with glaucoma: a 1-year retrospective study. Ther Adv Ophthalmol 2023; 15:25158414221147445. [PMID: 36714383 PMCID: PMC9880568 DOI: 10.1177/25158414221147445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 12/07/2022] [Indexed: 01/26/2023] Open
Abstract
Background Suprachoroidal surgery can lower intraocular pressure and medication use. There is currently no commercial suprachoroidal product on the market. Here, we report our 1 year results of a novel ciliary sulcus suprachoroidal microtube technique. Purpose To determine the real-world efficacy of intrascleral ciliary sulcus suprachoroidal microtube technique in Black and Afro-Latinx patients with glaucoma refractory to topical ocular hypertensive medications. Methods A retrospective non-comparative single center study of 36 Black and Afro-Latinx patients with glaucoma and pseudophakia who underwent intrascleral ciliary sulcus suprachoroidal microtube surgery for glaucoma as a stand-alone procedure at a single practice. Investigated parameters were number of medications, visual acuity (VA), intraocular pressure (IOP), mean deviation on visual field (VF) test. Success was defined as (a) IOP ⩽ 15 mmHg and or ⩾ 20% reduction in IOP and (b) a reduction in number of medications. We used paired t-test to compare baseline and follow-up parameters. Results We reviewed a total of 36 patients who had undergone the procedure. Twenty had success with 12-month follow-up in the study. The mean number of medications decreased significantly from 4.2 ± 1.0 preoperatively to 2.4 ± 1.7 in 12 months (p = 0.021) with five patients being medication free. In addition, the IOP decreased significantly from 21 ± 8.2 to 13.5 ± 4.4 mmHg (p = 0.032). In the 20 patients who had 12-month follow-up, the VA remained stable from Log Mar 0.62 ± 0.6-0.46 ± 0.6 (p = 0.052). VF in patients with successful procedure (no further interventions) remained stable from baseline mean deviation of -16.53 ± 10.04 to -16.82 ± 9.80 dB at 6-12 months. Adverse effects were transient and included IOP spike, hypotony, hyphema, and cornea edema that were treated and resolved. Conclusions This 12-month retrospective study demonstrated that intrascleral ciliary sulcus suprachoroidal microtube surgery can reduce IOP and medication burden in pseudophakic patients with glaucoma. However, despite several successes, surveillance should take place for IOP spikes, possible tube obstruction, and need for additional glaucoma surgery.
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Affiliation(s)
| | - Gideon Nkrumah
- University of Pittsburgh School of Medicine,
Pittsburgh, PA, USA,Advanced Eyecare of New York, New York, NY,
USA
| | - Chester Ng
- Advanced Eyecare of New York, New York, NY,
USA
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8
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Intrascleral sewing-machine technique: A Grooveless/flapless cyclopexy technique for large traumatic Cyclodialysis cleft repairs in pars plana vitrectomy. Retina 2023; 43:152-157. [PMID: 32134801 DOI: 10.1097/iae.0000000000002772] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
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.
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Encircling Scleral Buckling Surgery for Severe Hypotony with Ciliary Body Detachment on Anterior Segment Swept-Source Optical Coherence Tomography: A Case Series. J Clin Med 2022; 11:jcm11164647. [PMID: 36012882 PMCID: PMC9410166 DOI: 10.3390/jcm11164647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 08/03/2022] [Accepted: 08/06/2022] [Indexed: 11/21/2022] Open
Abstract
This study aimed to evaluate the usefulness of an encircling scleral buckling procedure to manage severe hypotony secondary to proliferative vitreoretinopathy (PVR)-induced retinal detachment. This retrospective study included six eyes of six patients (five women and one man) with hypotony (intraocular pressure [IOP] ≤ 6 mmHg) after multiple reattachment surgeries for PVR-induced retinal detachment. In patients with failure of hypotony resolution after conservative treatment (dexamethasone drops five times daily), 360° scleral buckling was performed under periocular anesthesia. The light perception was evaluated immediately postoperatively. The anatomic parameters were evaluated pre- and postoperatively observed on anterior segment swept-source optical coherence tomography. Ciliary body detachment (CBD) secondary to advanced cyclitic membranes associated with PVR grades C and D was detected in all eyes with hypotony. The mean IOP increased in all eyes (4.83 mmHg preoperatively vs. 10.17 mmHg postoperatively, p = 0.006), with subsequent improvement in best-corrected visual acuity (1.91 logMAR preoperatively vs. 1.50 logMAR postoperatively, p = 0.034). However, no eye showed any significant changes in CBD postoperatively. Scleral buckling surgery might be useful to increase IOP in eyes with persistent severe hypotonia secondary to PVR-induced CBD. Further studies are needed to improve outcomes in eyes with severe PVR-induced retinal detachment.
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Berk TA, Peretz D, Mofti A, Marchais BD, Saheb H. Non-invasive monitoring of cyclodialysis cleft using anterior segment optical coherence tomography and its role in informing clinical treatment decisions. Am J Ophthalmol Case Rep 2022; 26:101410. [PMID: 35243153 PMCID: PMC8866679 DOI: 10.1016/j.ajoc.2022.101410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 02/03/2022] [Accepted: 02/03/2022] [Indexed: 11/24/2022] Open
Abstract
Purpose Anterior segment optical coherence tomography (AS-OCT) is an emerging imaging modality with an expanding role in glaucoma diagnosis and management. We present a series of two cases of iatrogenic cyclodialysis cleft and their conservative management being directly informed by non-invasive AS-OCT monitoring. Observations Retrospective case series. A 51 year-old male and a 29 year-old male each underwent gonioscopy-assisted transluminal trabeculotomy for uncontrolled glaucoma with a cyclodialysis cleft being diagnosed postoperatively and then monitored using serial AS-OCT images. In both cases, conservative medical management was initially employed. Worsening hypotony maculopathy and decreasing best corrected visual acuity were evident in both cases at times when gonioscopy yielded inadequate visualization to meaningfully inform treatment decisions. Escalation to more invasive therapies was therefore considered. AS-OCT imaging revealed consistent anatomical improvement at each follow-up and ultimately both clefts closed without treatment escalation. Conclusions and Importance AS-OCT played a critical role in the diagnosis and directly informed the conservative management of both of these cases. This non-invasive imaging modality may allow for deferral of invasive treatment escalation in some cases of cyclodialysis cleft. Anterior segment optical coherence tomography can diagnose and monitor cyclodialysis clefts This non-invasive imaging modality can directly inform clinical treatment decisions These images may display improvement when other clinical metrics suggest progression This information may help the patient avoid treatment escalation in some cases
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Affiliation(s)
- Thomas Andrew Berk
- Department of Ophthalmology & Visual Sciences, McGill University, 5252, Boulevard de Maisonneuve West, 4th Floor Montréal, Québec, H4A 0A4, Canada
| | - Daniel Peretz
- Department of Ophthalmology & Visual Sciences, McGill University, 5252, Boulevard de Maisonneuve West, 4th Floor Montréal, Québec, H4A 0A4, Canada
| | - Alaa Mofti
- Department of Ophthalmology & Visual Sciences, McGill University, 5252, Boulevard de Maisonneuve West, 4th Floor Montréal, Québec, H4A 0A4, Canada
- Department of Ophthalmology, Ministry of the National Guard - Health Affairs, 2383, Al ‘Ulayya Dist, JEDDAH, 22384 – 7864, Saudi Arabia
- King Abdullah International Medical Research Center, 7719, Al ‘Ulayya Dist, JEDDAH, 22384 – 2565, Saudi Arabia
- King Saud Bin Abdulaziz University for Health Sciences, 2686, Al ‘Ulayya Dist, JEDDAH, 22384 – 7607, Saudi Arabia
| | - Béatrice Des Marchais
- Centre Universitaire d’Ophtalmologie, CHU de Québec-Université Laval, 1050, Chemin Ste-Foy, Québec City, Québec, G1S 4L8, Canada
| | - Hady Saheb
- Department of Ophthalmology & Visual Sciences, McGill University, 5252, Boulevard de Maisonneuve West, 4th Floor Montréal, Québec, H4A 0A4, Canada
- Corresponding author.
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11
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Imamachi K, Ichioka S, Takayanagi Y, Tsutsui A, Shimizu H, Tanito M. Central serous chorioretinopathy resolution after traumatic cyclodialysis repair. Am J Ophthalmol Case Rep 2022; 26:101507. [PMID: 35372709 PMCID: PMC8968012 DOI: 10.1016/j.ajoc.2022.101507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 03/11/2022] [Accepted: 03/21/2022] [Indexed: 10/29/2022] Open
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12
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Castillo Capponi F, Romera Romero P, Broc Iturralde L, Loscos Arenas J. Management of cyclodialysis cleft with transscleral cryotherapy. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2022; 97:165-167. [PMID: 35248398 DOI: 10.1016/j.oftale.2021.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 01/08/2021] [Indexed: 06/14/2023]
Abstract
A cyclodialysis cleft is a rare disease that is produced as a result of a separation of the longitudinal fibers of the ciliary body muscle from the scleral spur. A stepwise approach is the best course of action to treat cyclodialysis, starting with medical therapy and continuing with more invasive surgical options. We report a case of ocular hypotony due a traumatic cyclodialysis successfully resolved with transscleral cryotherapy.
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Affiliation(s)
- F Castillo Capponi
- Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain.
| | - P Romera Romero
- Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - L Broc Iturralde
- Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - J Loscos Arenas
- Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
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13
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Effect of Different Preoperative Intraocular Pressures on the Prognosis of Traumatic Cyclodialysis Cleft Associated with Lens Subluxation. Ophthalmol Ther 2022; 11:689-699. [PMID: 35107814 PMCID: PMC8808273 DOI: 10.1007/s40123-022-00468-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 01/14/2022] [Indexed: 12/02/2022] Open
Abstract
Purpose To evaluate the prognosis of patients with blunt trauma-mediated cyclodialysis cleft and lens subluxation treated by dual capsular tension rings (CTRs) with different preoperative intraocular pressures (IOPs). Methods Twenty-five patients with cyclodialysis cleft and lens subluxation after blunt trauma were recruited in this study. They were categorized into the low IOP group (IOP < 10 mmHg) and normal IOP group (between 10 mm and 21 mmHg). A modified CTR (MCTR) or CTR was sutured into the ciliary sulcus, and another MCTR or CTR was implanted in the capsular bag. The prognosis outcome measurements, including BCVA (LogMAR), IOP, UBM, and macular character on OCT, were collected during the regular outpatient follow-up after surgery until the recovery of cyclodialysis cleft was found. Measures of cyclodialysis cleft recovery included successful IOP control (defined as an IOP within 10–21 mmHg), confirmation of cleft closure on UBM, and confirmation of IOL centration under slit-lamp examination. Follow-up period or recovery time was regarded as the duration between discharge from the hospital after the operation and the recovery of cyclodialysis cleft. The longest follow-up period was 1 year. Results Cyclodialysis cleft was successfully treated in 21/25 eyes, whereas lens subluxation was treated effectively in all 25 eyes. CTRs and IOLs were stable in all eyes. BCVA (P < 0.001) and IOP (P < 0.001) were significantly improved after surgery. The primary surgical complication included reversible IOP spike in seven eyes. Postoperative BCVA was found to have correlation with the preoperative IOP (P = 0.016), maculopathy (P = 0.002,), and trauma duration (P = 0.046). Worse BCVA (P = 0.037) and more severe grade of maculopathy (P = 0.030) were observed in the low IOP group (14 eyes). In contrast, a better prognosis and greater probability of IOP spike (P = 0.021) were observed in the normal IOP group (11 eyes). Conclusion Timely and proper intervention for traumatic cyclodialysis cleft associated with lens subluxation is essential. Lower preoperative IOP is associated with worse prognosis and prolonged recovery time, while caution should be taken in IOP spike monitoring in patients with normal preoperative IOP. Supplementary Information The online version contains supplementary material available at 10.1007/s40123-022-00468-0.
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14
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Martin C, Berger T, Daas L, Seitz B, Suffo S. [Traumatic Cyclodialysis - from Cyclopexy ab Interno to DMEK: Case Report]. Klin Monbl Augenheilkd 2021; 240:278-282. [PMID: 34749409 DOI: 10.1055/a-1651-0587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Cristina Martin
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes (UKS), Homburg (Saar), Deutschland
| | - Tim Berger
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes (UKS), Homburg (Saar), Deutschland
| | - Loay Daas
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes (UKS), Homburg (Saar), Deutschland
| | - Berthold Seitz
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes (UKS), Homburg (Saar), Deutschland
| | - Shady Suffo
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes (UKS), Homburg (Saar), Deutschland
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15
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Leuzinger-Dias M, Lima-Fontes M, Oliveira-Ferreira C, Macedo JP, Falcão-Reis F, Freitas-da-Costa P, Benevides-Melo A. Traumatic Cyclodialysis Cleft Treatment Combined with Cataract Surgery: An Original Triple Procedure. Ophthalmol Ther 2021; 10:1171-1179. [PMID: 34370278 PMCID: PMC8589922 DOI: 10.1007/s40123-021-00382-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 07/27/2021] [Indexed: 11/24/2022] Open
Abstract
Introduction To describe a “triple” surgical procedure, which combined traumatic cataract extraction by phacoemulsification with gas endotamponade and cyclocryotherapy in the successful treatment of a traumatic cyclodialysis cleft. Methods A 44-year-old man who suffered severe left eye blunt trauma with an elastic band developed a 4-hour extent cyclodialysis cleft with consequent hypotony. After 7 weeks of persistent hypotonic maculopathy unresponsive to medical treatment, and with an evolving traumatic cataract, the patient underwent cataract surgery combined with intravitreal gas endotamponade (20% SF6) and cyclocryotherapy. Results Two weeks after the procedure the intraocular pressure increased to 12 mmHg and remained steady during the next 14 months of follow-up. Hypotonic maculopathy resolved and successful closure of the cyclodialysis cleft was confirmed by gonioscopy and ultrasound biomicroscopy. Conclusion Gas endotamponade and cyclocryotherapy constitute a promising option in the treatment of cyclodialysis clefts unresponsive to medical therapy. In our case, this minimally invasive technique was innovatively combined with cataract surgery. Despite early postoperative intraocular inflammation, a successful outcome was achieved.
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Affiliation(s)
- Mariana Leuzinger-Dias
- Department of Ophthalmology, Centro Hospitalar e Universitário de São João, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal.
| | - Mário Lima-Fontes
- Department of Ophthalmology, Centro Hospitalar e Universitário de São João, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | - Cláudia Oliveira-Ferreira
- Department of Ophthalmology, Centro Hospitalar e Universitário de São João, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | - João Paulo Macedo
- Department of Ophthalmology, Centro Hospitalar e Universitário de São João, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | - Fernando Falcão-Reis
- Department of Ophthalmology, Centro Hospitalar e Universitário de São João, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal.,Department of Surgery and Physiology, Faculty of Medicine of University of Porto, Porto, Portugal
| | - Paulo Freitas-da-Costa
- Department of Ophthalmology, Centro Hospitalar e Universitário de São João, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal.,Anatomy Unit, Biomedicine Department, Faculty of Medicine of University of Porto, Porto, Portugal
| | - António Benevides-Melo
- Department of Ophthalmology, Centro Hospitalar e Universitário de São João, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
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16
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Fernández-Vigo JI, Kudsieh B, Shi H, De-Pablo-Gómez-de-Liaño L, Fernández-Vigo JÁ, García-Feijóo J. Diagnostic imaging of the ciliary body: Technologies, outcomes, and future perspectives. Eur J Ophthalmol 2021; 32:75-88. [PMID: 34233517 DOI: 10.1177/11206721211031409] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The ciliary body (CB) is part of the uvea and is a complex, highly specialized structure with multiple functions and significant relationships with nearby structures. Its functions include the aqueous humor (AH) production in the ciliary processes, the regulation of the AH output through the uveoscleral pathway, and accommodation, which depends on the ciliary muscle. Also, the CB is an important determinant of angle width as it forms part of the ciliary sulcus. Until recently, knowledge of the CB was based on histological studies. However, this structure can currently be assessed in vivo using imaging techniques such as ultrasound biomicroscopy (UBM) and optical coherence tomography (OCT). Both techniques have shown good reproducibility of their measurements allowing for quantification of CB dimensions and their localization. In effect, studies have shown a larger CB in myopia and its diminishing size with age. Swept-source OCT devices offer fast, non-invasive high-resolution imaging allowing the identification of multiple structures. UBM requires contact and is uncomfortable for the patient. However, this technique offers deeper imaging and therefore remains the gold standard for assessing the posterior chamber, ciliary processes, or zonula. The clinical utility of CB imaging includes its assessment in different types of glaucoma such as angle-closure, malignant or plateau iris. Diagnostic CB imaging is also invaluable for the assessment of ciliochoroidal detachment when suspected, the position after the implantation of a pre-crystalline or sulcus-sutured lenses, diagnosis or monitoring of cysts or tumors, sclerotomies after retinal surgery, intermediate uveitis, or accommodation.
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Affiliation(s)
- José Ignacio Fernández-Vigo
- Department of Ophthalmology, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria (IdISSC), Madrid, Spain.,Centro Internacional de Oftalmología Avanzada, Madrid, Spain
| | - Bachar Kudsieh
- Centro Internacional de Oftalmología Avanzada, Madrid, Spain.,Department of Ophthalmology, Hospital Puerta de Hierro-Majadahonda, Madrid, Spain
| | - Hang Shi
- Department of Ophthalmology, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria (IdISSC), Madrid, Spain.,Centro Internacional de Oftalmología Avanzada, Madrid, Spain
| | - Lucía De-Pablo-Gómez-de-Liaño
- Centro Internacional de Oftalmología Avanzada, Madrid, Spain.,Department of Ophthalmology, Hospital 12 de Octubre, Madrid, Spain
| | - José Ángel Fernández-Vigo
- Centro Internacional de Oftalmología Avanzada, Madrid, Spain.,Centro Internacional de Oftalmología Avanzada, Badajoz, Spain.,Department of Ophthalmology, Universidad de Extremadura, Badajoz, Spain
| | - Julián García-Feijóo
- Department of Ophthalmology, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria (IdISSC), Madrid, Spain
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17
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Wang A, Zhao Z. COMPARING VITRECTOMY, SILICONE OIL ENDOTAMPONADE WITH/WITHOUT CYCLOPEXY TO TREAT CYCLODIALYSIS CLEFTS WITH SEVERE OCULAR TRAUMA. Retina 2021; 41:1174-1181. [PMID: 33079790 PMCID: PMC8140664 DOI: 10.1097/iae.0000000000002996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
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.
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Affiliation(s)
- Anan Wang
- Department of Ophthalmology, Affiliated Eye Hospital of Nanchang University, Nanchang, China; and
| | - Zhenquan Zhao
- Department of Ophthalmology, Eye Hospital of Wenzhou Medical University, Wenzhou, China
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18
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Masket S. Temporary Ab Interno Suture Cyclopexy For Closing a Cyclodialysis Cleft During Cataract Surgery. J Cataract Refract Surg 2021; 47:1369-1371. [PMID: 33770429 DOI: 10.1097/j.jcrs.0000000000000528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 10/22/2020] [Indexed: 11/25/2022]
Abstract
Cyclodialysis clefts are often associated with ocular hypotony and attendant maculopathy. However, these clefts create an alternative aqueous outflow pathway that can be useful to maintain IOP at physiologic levels under some conditions. At normal levels of IOP they may prevent glaucoma damage and avoid maculopathy of hypotony. Indeed, historically cyclodialysis was a planned surgical method for managing glaucoma, and more recently a MIGS device that created a small stented cyclodialysis was in use until removed from the market for unrelated concerns. Cataract surgery in the presence of a cleft, however, may be complicated by extensive fluid misdirection through the cleft with resultant large suprachoroidal effusion. A technique of ab interno temporary suture cyclopexy was devised for a patient needing cataract surgery with an existing traumatic cyclodialysis cleft that was vital for long-term management of IOP. The suture was used to close the cleft transiently during surgery and was removed at the close of the procedure in order to re-establish patency and preserve the cleft.
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Affiliation(s)
- Samuel Masket
- Advanced Vision Care, Los Angeles.,Stein Eye Institute, Los Angeles
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19
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Castillo Capponi F, Romera Romero P, Broc Iturralde L, Loscos Arenas J. Management of cyclodialysis cleft with transscleral cryotherapy. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2021; 97:S0365-6691(21)00051-4. [PMID: 33663920 DOI: 10.1016/j.oftal.2021.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 12/30/2020] [Accepted: 01/08/2021] [Indexed: 06/12/2023]
Abstract
A cyclodialysis cleft is a rare disease that is produced as a result of a separation of the longitudinal fibers of the ciliary body muscle from the scleral spur. A stepwise approach is the best course of action to treat cyclodialysis, starting with medical therapy and continuing with more invasive surgical options. We report a case of ocular hypotony due a traumatic cyclodialysis successfully resolved with transscleral cryotherapy.
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Affiliation(s)
- F Castillo Capponi
- Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, España.
| | - P Romera Romero
- Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, España
| | - L Broc Iturralde
- Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, España
| | - J Loscos Arenas
- Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, España
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20
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Nahum Y, Galor O, Atar M, Bahar I, Livny E. Real-time intraoperative ultrasound biomicroscopy for determining graft orientation during Descemet's membrane endothelial keratoplasty. Acta Ophthalmol 2021; 99:e96-e100. [PMID: 32578923 DOI: 10.1111/aos.14515] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 05/26/2020] [Indexed: 12/14/2022]
Abstract
PURPOSE To evaluate the intraoperative use of ultrasound biomicroscopy (UBM) during Descemet's membrane endothelial keratoplasty (DMEK) to determine graft's orientation. METHODS Prospective interventional study of eight eyes of seven patients who underwent DMEK. Following the identification of correct graft orientation using 'Blue cannula tip' sign during DMEK surgery, UBM was used to ascertain graft's orientation. The rate of successful DMEK graft orientation determined by the UBM was registered and verified postoperatively by anterior segment-optical coherence tomography (OCT). Intra- and postoperative complications, postoperative clearance of the cornea, corrected distance visual acuity and endothelial cell loss were also noted. RESULTS The study included five males and two females aged 54-82 years with corneal oedema due to Pseudophakic bullous keratopathy (n = 5), Fuchs' endothelial dystrophy (n = 2). In all cases, the technique allowed proper determination of the graft's orientation. In one case, 'blue cannula tip' sign showed correct orientation while UBM identified an upside-down graft. The graft was inverted in the anterior chamber using fluid jets, and repeat 'blue cannula tip' sign and UBM examination both showed correct orientation. In all cases, postoperative anterior segment-OCT demonstrated correct graft orientation. CONCLUSIONS Use of intraoperative UBM to determine graft orientation during DMEK correlated with proper graft orientation, as was verified postoperatively by anterior segment-OCT. The use of UBM can be particularly helpful in cases of poor graft visibility due to opaque corneal stroma, pigment or blood in the anterior chamber during surgery, or when the blue tint of the graft fades rapidly, which may preclude proper determination of graft's orientation.
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Affiliation(s)
- Yoav Nahum
- Department of Ophthalmology Rabin Medical Center Petach Tikva Israel
- Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - Orly Galor
- Department of Ophthalmology Rabin Medical Center Petach Tikva Israel
- Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - Maya Atar
- Department of Ophthalmology Rabin Medical Center Petach Tikva Israel
| | - Irit Bahar
- Department of Ophthalmology Rabin Medical Center Petach Tikva Israel
- Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - Eitan Livny
- Department of Ophthalmology Rabin Medical Center Petach Tikva Israel
- Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
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21
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Abaza A, Dikmetas Ö, Neuhann I, Gelisken F. Posterior Uveal Effusion after Cataract Surgery. Case Rep Ophthalmol 2021; 12:62-67. [PMID: 33613252 PMCID: PMC7879288 DOI: 10.1159/000510390] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 07/22/2020] [Indexed: 11/19/2022] Open
Abstract
We report a case of posterior uveal effusion (UE) with a long-term follow-up that has occurred following cataract surgery. A 64-year-old woman presented with diminished vision of the right eye (RE) 3 weeks after an uneventful phacoemulsification and intraocular lens implantation. Complete ophthalmic examination including fluorescein angiography (FA), indocyanine green angiography (ICGA), echography and optical coherence tomography (OCT) were performed. Best corrected visual acuity (BCVA) of the RE was 20/50. Anterior segment and intraocular pressure were unremarkable. OCT revealed prominent folds of the choroid and retina, subretinal fluid and darkening of the choroid with reduced visibility of the choroidal vessels and the scleral border. The left eye (LE) was unremarkable. BCVA of the LE was: 20/20. After topical anti-inflammatory and systemic corticosteroid therapy for 5 months, no morphological change of the macula was seen. The patient was observed without any treatment. Forty-three months after the cataract surgery and 38 months after cessation of the corticosteroid therapy, OCT revealed a normal macular morphology and the BCVA improved to 20/25. Even though rare, UE at the posterior pole may occur after modern cataract surgery. OCT examination is a reliable tool in monitoring the macular morphology. Since morphological and functional improvement can be seen in long-term, observation may be considered for some cases of posterior UE with resistance to the therapy.
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Affiliation(s)
- Annegret Abaza
- Department of Ophthalmology, Eberhard Karls University, Tuebingen, Germany
| | - Özlem Dikmetas
- Department of Ophthalmology, University of Hacettepe, Hacettepe Mh., Ankara, Turkey
| | | | - Faik Gelisken
- Department of Ophthalmology, Eberhard Karls University, Tuebingen, Germany
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22
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Fernández-Vigo JI, De-Pablo-Gómez-de-Liaño L, Kudsieh B, Fernández-Vigo JÁ. Intermediate segment OCT. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2021; 96:1-2. [PMID: 33268283 DOI: 10.1016/j.oftal.2020.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 09/04/2020] [Accepted: 09/08/2020] [Indexed: 06/12/2023]
Affiliation(s)
- J I Fernández-Vigo
- Servicio de Oftalmología, Hospital Universitario Clínico San Carlos. Instituto de Investigación sanitaria San Carlos, Madrid, España; Centro Internacional de Oftalmología Avanzada, Madrid, España.
| | | | - B Kudsieh
- Centro Internacional de Oftalmología Avanzada, Madrid, España; Servicio de Oftalmología, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, España
| | - J Á Fernández-Vigo
- Centro Internacional de Oftalmología Avanzada, Madrid, España; Departamento de Oftalmología, Facultad de Medicina, Universidad de Extremadura, Badajoz, España
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23
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Chen J, Lan L, Tang Y, Lu Y, Jiang Y. Placement of dual capsular tension rings for the combined management of traumatic cyclodialysis cleft and zonular dialysis. EYE AND VISION 2020; 7:54. [PMID: 33292678 PMCID: PMC7681948 DOI: 10.1186/s40662-020-00219-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 10/29/2020] [Indexed: 11/10/2022]
Abstract
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.
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Affiliation(s)
- Jiahui Chen
- Eye Institute and Department of Ophthalmology, Eye Ear Nose and Throat Hospital, Fudan University, 83 Fenyang Rd, Shanghai, 200031, China.,NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, 200031, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, 200031, China
| | - Lina Lan
- Eye Institute and Department of Ophthalmology, Eye Ear Nose and Throat Hospital, Fudan University, 83 Fenyang Rd, Shanghai, 200031, China.,NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, 200031, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, 200031, China
| | - Yating Tang
- Eye Institute and Department of Ophthalmology, Eye Ear Nose and Throat Hospital, Fudan University, 83 Fenyang Rd, Shanghai, 200031, China.,NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, 200031, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, 200031, China
| | - Yi Lu
- Eye Institute and Department of Ophthalmology, Eye Ear Nose and Throat Hospital, Fudan University, 83 Fenyang Rd, Shanghai, 200031, China. .,NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, 200031, China. .,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, 200031, China.
| | - Yongxiang Jiang
- Eye Institute and Department of Ophthalmology, Eye Ear Nose and Throat Hospital, Fudan University, 83 Fenyang Rd, Shanghai, 200031, China. .,NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, 200031, China. .,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, 200031, China.
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24
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Guzmán-Almagro E, Fernandez-Sanz G, Herrero-Escudero D, Contreras I, González Martín-Moro J. Open-globe-injury: A single center Spanish retrospective 5-year cohort study. Eur J Ophthalmol 2020; 31:2710-2716. [PMID: 33043690 DOI: 10.1177/1120672120962039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To review and analyze the epidemiological profile, clinical characteristics and visual outcomes in patients attended for traumatic open globe injury (OGI) at our hospital over a 5-year period. DESIGN Retrospective chart review study. METHODS Retrospective analysis of all patients attended at Fundación Jiménez Díaz University Hospital for OGI between 2011 and 2015. Data from 104 patients including demographics, ocular examination, medical and surgical treatment, visual outcomes, and complications were analyzed. RESULTS Most patients were male (79.8%) and the median age at the time of injury was 41 years (interquartile range 31.5-58 years). Work-related accidents represent more than half of the cases and their main mechanism was penetrating trauma or foreign body. This type of accident had good prognosis (median final visual acuity in decimal scale 0.8; interquartile range 0.4-1). Falls were the second most common cause of OGI, predominantly affecting senior women (50%), with a high incidence of ocular rupture (50%) and associating a poor visual prognosis (median final visual acuity 0.01; interquartile range 0-0.5). There was a strong correlation (0.75; p < 0.001) between ocular trauma score (OTS) and final best corrected visual acuity. CONCLUSIONS Two different patterns of OGI were identified in our sample. Work-related trauma in young males was the most common form of OGI and was associated with good prognosis. However, falls in senior women were associated with poor prognosis.
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Affiliation(s)
- Elena Guzmán-Almagro
- Servicio de Oftalmología, Hospital Universitario del Henares, Madrid, Spain.,Servicio de Oftalmología, Fundación Jiménez Díaz, Madrid, Spain
| | - Guillermo Fernandez-Sanz
- Servicio de Oftalmología, Fundación Jiménez Díaz, Madrid, Spain.,Departamento de Oftalmología, Clínica Universidad de Navarra, Madrid, Spain
| | | | - Inés Contreras
- Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigaciones Sanitarias, Madrid, Spain.,Clínica Rementería, Madrid, Spain
| | - Julio González Martín-Moro
- Servicio de Oftalmología, Hospital Universitario del Henares, Madrid, Spain.,Departamento de Medicina, Universidad Francisco de Vitoria, Madrid, Spain
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Vitrectomy with Air Endotamponade for Traumatic Cyclodialysis. J Ophthalmol 2020; 2020:3742306. [PMID: 33005445 PMCID: PMC7508220 DOI: 10.1155/2020/3742306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 08/13/2020] [Accepted: 08/23/2020] [Indexed: 11/17/2022] Open
Abstract
Background Various techniques have been described for repairing cyclodialysis clefts, but there is no consensus regarding the optimal treatment. This study investigated the clinical efficacy of a novel surgical approach that is used to manage traumatic cyclodialysis. Methods We prospectively enrolled 7 patients (7 eyes) with traumatic cyclodialysis of the concomitant lens and other vitreous diseases. Ultrasound biomicroscopy was used to diagnose cyclodialysis, and all eyes underwent pars plana vitrectomy with air endotamponade. The main outcome measures were postoperative anatomical success rates, best-corrected visual acuity (BCVA), and intraocular pressure (IOP). Results All patients were male, and their age ranged from 46 to 64 years (mean: 54.3 years). After the surgical intervention, the extent of the cyclodialysis cleft ranged from 1 to 4 clock hours (mean: 2.3 clock hours) and the detached ciliary body of all cases was completely restored; the anatomical success rate was 100%. The BCVA significantly increased from 1.40 ± 0.49 to 0.42 ± 0.31 (P = 0.002). The IOP increased from 8.91 ± 1.77 to 14.67 ± 6.38, but the difference was not significant (P = 0.056). The postoperative IOP of most patients was temporarily elevated or lowered after surgery. At the last follow-up, there were still two abnormal cases, including one with ocular hypertension and one with hypotony. Conclusions This study revealed that vitrectomy with air endotamponade is an effective and minimally invasive alternative surgical approach for small traumatic cyclodialysis clefts.
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Vitrectomy + transscleral diode laser cyclopexy treatment for 360 degree traumatic cyclodialysis and hypotony maculopathy: Case report. Retin Cases Brief Rep 2020; 16:625-630. [PMID: 32890080 DOI: 10.1097/icb.0000000000001045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND/PURPOSE To report a surgical approach of combined vitrectomy, gas endotamponade and transscleral diode laser cyclopexy treatment for hypotony maculopathy induced by traumatic cyclodialysis. METHODS A case of a 37-year-old male patient with decreased vision in his right eye due to hypotony maculopathy and 360° traumatic cyclodialysis is reported. Patient was initially treated conservatively with topical steroid + cycloplegic eye drops and repeated periocular corticosteroid injections with no improvement in the intraocular pressure and the anatomical defect. The patient underwent 23G pars plana vitrectomy with 20% SF6 gas endotamponade and supine position. Transscleral 810 nm laser burns were applied at 1.5 mm from the scleral limbus around the cornea in 2 confluent rows avoiding the horizontal meridians. Parameters employed were 700 - 1000 mW of power with a 2 seconds exposure in continuous-wave mode and postoperative supine positioning of the head was indicated. RESULTS Preoperative intraocular pressure improved from 2 mmHg to 10 mmHg at one week after surgical treatment and achieved 16 mmHg at one month to remain stable during a 6 months follow-up period. Presenting visual acuity was 1.0 logMAR (20/200 Snellen) and improved to 0.3 logMAR (20/40 Snellen) at month 1 and achieved 0.1 logMAR (20/20 Snellen) at the third month. Complete closure of the cyclodialysis cleft and peripheral anterior synechiae formation were also observed at 3 months after treatment with complete reattachment of the ciliary body demonstrated by ultrasound biomicroscopy and significant improvement of the macular anatomy demonstrated by spectral domain optical coherence tomography. CONCLUSION The combination of pars plana vitrectomy, supine positioning with gas endotamponade and transscleral laser cyclopexy can succesfuly improve the visual and anatomical outcomes in patients with hypotony maculopathy and 360° traumatic cyclodialysis.
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Case Report: Cyclodialysis Cleft in a Case of Open-globe Injury and Role of Swept-source Anterior Segment Optical Coherence Tomography in Diagnosis. Optom Vis Sci 2020; 97:395-399. [PMID: 32511160 DOI: 10.1097/opx.0000000000001518] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
SIGNIFICANCE Cyclodialysis clefts can potentially develop secondary to open globe injury. The swept-source anterior segment optical coherence tomography (SS-AS-OCT) may be a valuable diagnostic tool for the identification and estimation of the circumferential extent of cyclodialysis clefts. It could be considered an alternative when ultrasound biomicroscopy cannot be performed successfully. PURPOSE The purpose of this study was to report a case of open-globe injury associated with cyclodialysis cleft and the utility of SS-AS-OCT in its diagnosis. CASE REPORT A 12-year-old boy presented to the clinic because of penetrating ocular trauma to his left eye with a projectile stone. He was diagnosed with limbal perforation with uveal tissue prolapse and cataract. He underwent limbal repair with cataract extraction and posterior chamber intraocular lens implantation. However, even at the 6 weeks' post-operative period, he did not gain vision and had persistent hypotony with hypotonic maculopathy. Gonioscopy showed a 2-clock-hour superonasal cyclodialysis cleft. However, on SS-AS-OCT, it was discovered that the cleft extended along 5 clock hours, involving both superonasal and inferonasal quadrants. Recognizing the large extent of the cleft, endocyclopexy by modified sewing-machine technique was planned and performed. An IOP spike and improvement in vision were noted on the next post-operative day. The SS-AS-OCT confirmed cleft closure. CONCLUSIONS Although rare, cyclodialysis can occur in cases of open globe injury. The SS-AS-OCT is a useful diagnostic tool to study the circumferential extent of cyclodialysis and may unravel detachments hidden behind intact anterior ciliary body face.
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Abstract
PURPOSE To evaluate outcomes of an ab externo surgical technique combining cyclopexy with partial-thickness scleral flap dissection and suture reattachment of ciliary muscle and cryopexy through partial-scleral bed for cyclodialysis cleft repair. MATERIALS AND METHODS Consecutive patients in a tertiary academic practice with cyclodialysis cleft confirmed by gonioscopy or ultrasound biomicroscopy and had received the combined procedure were reviewed. Primary outcomes included differences between the preoperative and postoperative best-corrected visual acuity (BCVA) and intraocular pressure (IOP). Secondary outcomes included complications and additional surgeries. RESULTS Six consecutive patients (eyes) from October 2006 to November 2012 (6 y) were enrolled. No patient had received prior laser or surgical treatment for cyclodialysis cleft. Patient's age ranged from 14 to 81 years (median=37 y). Follow-up ranged from 1 to 72 months (median=12 mo). The cyclodialysis clefts of 3 patients (50%) were caused by blunt injuries and the other 3 (50%) from complicated intraocular surgery. Preoperative BCVA ranged from 20/40 to counting fingers with mean IOP of 2.3±2.1 mm Hg (range, 0 to 6 mm Hg). Final postoperative BCVA ranged from 20/20 to hand motions with mean IOP of 11.3±5.7 mm Hg (range, 3 to 18 mm Hg). Five patients (83%) had an increase in IOP and recovery of vision to 20/50 or better at the final visit (including further surgeries). No complication was noted and no additional cyclopexy was required. CONCLUSIONS Combined ab externo cyclopexy with partial-thickness scleral flap dissection and suture reattachment of the ciliary muscle and cryopexy delivered on the partial-thickness scleral bed is safe and effective as primary surgical repair for cyclodialysis cleft.
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Concurrent Phacoemulsification and Encircling for Hypotony Maculopathy after Blunt Trauma. Case Rep Med 2020; 2020:6594170. [PMID: 32454836 PMCID: PMC7240647 DOI: 10.1155/2020/6594170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 04/20/2020] [Indexed: 11/17/2022] Open
Abstract
A 37-year-old Japanese man had his right eye hit by a fist. His right eye developed hypotony maculopathy and secondary cataract, and his visual acuity decreased to 20/200 with an intraocular pressure of 4 mmHg. He underwent phacoemulsification and aspiration, implantation of the intraocular lens, and encircling with a silicone tire. His visual acuity improved to 20/20 and stable for more than one year postoperatively. The intraocular pressure in his right eye increased to 12 mmHg, and maculopathy was resolved entirely. It was suggested that an encircling buckle obstructed the uveoscleral outflow through the cyclodialysis and increased intraocular pressure. Concurrent cataract surgery and encircling was sufficient to improve the vision.
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Abstract
Purpose The suprachoroidal pathway can potentially provide a viable target for intraocular pressure (IOP) control. We present efficacy and safety result for the CyPass® Micro-Stent that provides insight into the use of the suprachoroidal space for IOP reduction. Materials and methods A retrospective, noncomparative audit of patient records in a university-affiliated National Health Service (NHS) hospital between June 2017 and August 2018. Main outcome measures were IOP reduction and the number of glaucoma drops taken at each time point. Failure and adverse events were noted for each patient. Results Seventy-seven consecutive case records of 69 patients underwent the CyPass® procedure between August 2017 and August 2018. A stand-alone procedure was performed in 37 (58%) of cases and combined phacoemulsification and CyPass® procedures were performed in 27 (42%) of cases. At baseline, the mean IOP was 24.6 ± 7.2 mm Hg. The mean IOP at 12 months’ follow-up was 16.4 ± 4.5 mm Hg (p < 0.05). At baseline, the mean number of medications was 2.41 ± 0.98, which decreased at 12 months to 1.1 ± 1.3 (p < 0.05). Best corrected visual acuity analysis did not show statistically significant change preoperatively and at each postoperative time point. At 12 months’ postoperative time point, 24% of eyes had failed. Significant IOP spikes were noted in 18 (28.1%) of cases. Conclusion The suprachoroidal pathway appears to potentially offer an alternative to the classic subconjunctival pathways, yet present a new set of challenges. Further studies would have to address these concerns of endothelial cell loss, IOP spikes, and high failure rate. How to cite this article Gabbay IE, Ruben S. CyPass® Micro-Stent Safety and Efficacy at One Year: What Have We Learned? J Curr Glaucoma Pract 2019;13(3):99–103.
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Affiliation(s)
- Itay E Gabbay
- Department of Ophthalmology, Rabin Medical Center, Petah Tikva, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Simon Ruben
- Department of Ophthalmology, Southend University Hospital NHS Foundation Trust, Southend-on-Sea, UK
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Li H, Cai J, Li X. Continuous ab interno repairing of traumatic cyclodialysis cleft using a 30-gauge needle in severe ocular trauma: a clinical observation. BMC Ophthalmol 2019; 19:266. [PMID: 31878971 PMCID: PMC6933675 DOI: 10.1186/s12886-019-1274-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 12/11/2019] [Indexed: 11/10/2022] Open
Abstract
Background To investigate the efficacy and safety of continuous ab interno repairing of traumatic cyclodialysis cleft in severe ocular trauma using a 30-gauge (G) needle. Methods Fifteen patients (15 eyes) with traumatic cyclodialysis cleft admitted to the ocular trauma department of our hospital from July 2014 to December 2018 were included in this study. After the bulbar conjunctiva corresponding to the ciliary body was incised along the corneal limbus, an incision was made along the corneal limbus on the opposite side. A 30G needle with a 10–0 suture entered the anterior chamber from the incision and passed through the ciliary body with clefts and the sclera to fixate the ciliary body on the sclera wall with continuous mattress suture. The best corrected visual acuity (BCVA) and intraocular pressure (IOP) were observed preoperatively and postoperatively. In vivo ultrasound biomicroscopy (UBM) was performed to observe closure of cyclodialysis cleft before and after surgery. Results Fifteen patients successfully underwent continuous mattress suture for repair of cyclodialysis cleft. No bleeding and suture breakage were reported during surgery. After surgery, the UBM during follow-up showed satisfactory closure of the cyclodialysis cleft. The BCVA and IOP were improved to different degrees. The difference between the preoperative IOP and the postoperative IOP (1 week) was statistically significant (preoperative: 6.49 ± 0.98 mmHg, postoperative: 16.17 ± 4.65 mmHg, t = − 8.43, P < 0.05), and the difference between the preoperative IOP and the postoperative IOP (1 month) was also statistically significant (preoperative: 6.49 ± 0.98 mmHg, postoperative: 14.63 ± 3.63 mmHg, t = − 8.38, P < 0.05). Duration of outpatient follow-up was 3 to 12 months. No complications, including exposed knots, loose sutures, decompensation of corneal endothelium, sympathetic ophthalmia, endophthalmitis and choroidal detachment, were reported. Conclusion Continuous ab interno repairing of traumatic cyclodialysis cleft in severe ocular trauma using a 30G needle is a safe and effective procedure with simple operation, little tissue damage and few complications.
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Affiliation(s)
- Haibo Li
- Department of Ophthalmology, Xiamen Eye Centre of Xiamen University, Xiamen, 361016, Fujian Province, China.
| | - Jinhong Cai
- Department of Ophthalmology, Xiamen Eye Centre of Xiamen University, Xiamen, 361016, Fujian Province, China
| | - Xiaofeng Li
- Department of Ophthalmology, Xiamen Eye Centre of Xiamen University, Xiamen, 361016, Fujian Province, China
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Zhao R, Lou B, Yang Y, Duan F, Lin L, Yuan M, Wang Z, He L, Long C, Lin X. Risk Factors Associated with Failure of Direct Cyclopexy in the Treatment of Small to Moderate Tramatic Cyclodialysis Clefts. Curr Eye Res 2019; 45:797-804. [PMID: 31797695 DOI: 10.1080/02713683.2019.1698052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
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.
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Affiliation(s)
- Ruijuan Zhao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University , Guangzhou, China
| | - Bingsheng Lou
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University , Guangzhou, China
| | - Yao Yang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University , Guangzhou, China
| | - Fang Duan
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University , Guangzhou, China
| | - Lixia Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University , Guangzhou, China
| | - Miner Yuan
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University , Guangzhou, China
| | - Zhenfang Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University , Guangzhou, China
| | - Liwen He
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University , Guangzhou, China
| | - Chongde Long
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University , Guangzhou, China
| | - Xiaofeng Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University , Guangzhou, China
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Selvan H, Gupta V, Gupta S. Cyclodialysis: an updated approach to surgical strategies. Acta Ophthalmol 2019; 97:744-751. [PMID: 31386805 DOI: 10.1111/aos.14210] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 07/08/2019] [Indexed: 11/30/2022]
Abstract
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.
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Affiliation(s)
- Harathy Selvan
- Glaucoma Services Dr Rajendra Prasad Centre for Ophthalmic Sciences All India Institute of Medical Sciences New Delhi India
| | - Viney Gupta
- Glaucoma Services Dr Rajendra Prasad Centre for Ophthalmic Sciences All India Institute of Medical Sciences New Delhi India
| | - Shikha Gupta
- Glaucoma Services Dr Rajendra Prasad Centre for Ophthalmic Sciences All India Institute of Medical Sciences New Delhi India
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Zhao R, Lin L, Zeng J, Duan F, Yang Y, Su SB, Lou B, Lin X. Development of a rabbit model of persistent hypotony without ciliary body injury. Exp Eye Res 2019; 190:107858. [PMID: 31669044 DOI: 10.1016/j.exer.2019.107858] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 10/01/2019] [Accepted: 10/22/2019] [Indexed: 11/26/2022]
Abstract
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.
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Affiliation(s)
- Ruijuan Zhao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, 510060, China
| | - Lixia Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, 510060, China
| | - Jieting Zeng
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, 510060, China
| | - Fang Duan
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, 510060, China
| | - Yao Yang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, 510060, China
| | - Shao Bo Su
- Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Bingsheng Lou
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, 510060, China.
| | - Xiaofeng Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, 510060, China.
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Alvarez-Ascencio D, Jimenez-Roman J, Castañeda-Diez R, Lazcano-Gomez G. Full-thickness scleral incisions technique for the treatment of a cyclodialysis cleft following ab interno trabeculotomy. Int J Ophthalmol 2019; 12:1662-1665. [PMID: 31637207 DOI: 10.18240/ijo.2019.10.23] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 05/21/2019] [Indexed: 11/23/2022] Open
Affiliation(s)
- Daniela Alvarez-Ascencio
- Glaucoma Department, Asociación Para Evitar la Ceguera en México, IAP. Vicente García Torres 46, Coyoacán, Barrio San Lucas, Mexico City 11550, Mexico
| | - Jesus Jimenez-Roman
- Glaucoma Department, Asociación Para Evitar la Ceguera en México, IAP. Vicente García Torres 46, Coyoacán, Barrio San Lucas, Mexico City 11550, Mexico
| | - Rafael Castañeda-Diez
- Glaucoma Department, Asociación Para Evitar la Ceguera en México, IAP. Vicente García Torres 46, Coyoacán, Barrio San Lucas, Mexico City 11550, Mexico
| | - Gabriel Lazcano-Gomez
- Glaucoma Department, Asociación Para Evitar la Ceguera en México, IAP. Vicente García Torres 46, Coyoacán, Barrio San Lucas, Mexico City 11550, Mexico
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Abstract
During blunt ocular trauma, the anteroposterior compressive forces confronted lead to consequent equatorial expansion of the globe. This may result in ciliary body trauma, typically manifesting as angle recession or cyclodialysis. The authors hypothesize that a likely asymmetric contraction between the longitudinal and circular ciliary fibers, and an intrinsic weak "oblique buffer zone" creates a plane of separation between the 2, resulting in angle recession. When stronger forces are met with, the equatorial expansion of the sclera may outperform the ability of the ciliary body to follow it, and the taut longitudinal ciliary fibers may subsequently disinsert from the scleral spur causing cyclodialysis. In addition to this, the routinely thought dismembering aqueous jets directed toward the angle may also accentuate ciliary body trauma. Therefore, the vivid distractive external forces along with the complex ciliary muscle anatomy and differential functionality may play a crucial role in causation of post-traumatic angle recession and cyclodialysis.
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Morin A, Delbarre M, Friang C, Marechal M, Froussart-Maille F. [Cyclodialysis, a therapeutic challenge: Review of the literature on current practices]. J Fr Ophtalmol 2019; 42:852-863. [PMID: 31202775 DOI: 10.1016/j.jfo.2019.03.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 03/23/2019] [Accepted: 03/28/2019] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Cyclodialysis is a rare condition that is difficult to manage. We present the case of a woman with a cyclodialysis complicated by chronic hypotony requiring two surgeries to achieve reattachment of the ciliary body. We also report the results of a review of the literature regarding the treatment of this condition. DESCRIPTION This is a 46-year-old woman with history of trauma to the right eye. Examination revealed an intra-ocular pressure (IOP) of 7mmHg, a shallow anterior chamber and signs of chronic hypotony on fundus examination (vascular tortuosity, hypotony maculopathy) due to an extensive 360° cyclodialysis, confirmed by ultrasound biomicroscopy. Transcleral cryotherapy as a first-line approach did not achieve reattachment of the ciliary body. Secondary pars plana vitrectomy with gas tamponade (C2F6) reattached the ciliary body and restored the intraocular pressure (12mmHg) and normal fundus appearance. The patient recovered corrected visual acuity of 20/20. DISCUSSION To our knowledge, there is no standardized management for cyclodialysis. The study of the literature available on the Medline database showed that direct cyclopexy remains the most common treatment, followed by vitrectomy with internal tamponade. Neither the extent nor the duration of the cyclodialysis can predict the visual recovery, which can be major even after weeks of hypotony. CONCLUSION The management of cyclodialysis is not well-defined; it remains a true therapeutic challenge.
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Affiliation(s)
- A Morin
- Hôpital d'instruction des armées Percy, 1, rue du Lieutenant Raoul-Batany, 92190 Clamart, France.
| | - M Delbarre
- Hôpital d'instruction des armées Percy, 1, rue du Lieutenant Raoul-Batany, 92190 Clamart, France
| | - C Friang
- Hôpital d'instruction des armées Percy, 1, rue du Lieutenant Raoul-Batany, 92190 Clamart, France
| | - M Marechal
- Hôpital d'instruction des armées Percy, 1, rue du Lieutenant Raoul-Batany, 92190 Clamart, France
| | - F Froussart-Maille
- Hôpital d'instruction des armées Percy, 1, rue du Lieutenant Raoul-Batany, 92190 Clamart, France
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Wang Q, Thau A, Levin AV, Lee D. Ocular hypotony: A comprehensive review. Surv Ophthalmol 2019; 64:619-638. [PMID: 31029581 DOI: 10.1016/j.survophthal.2019.04.006] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 04/11/2019] [Accepted: 04/15/2019] [Indexed: 02/08/2023]
Abstract
Ocular hypotony is an infrequent, yet potentially vision-threatening, entity. The list of differential causes is extensive, involving any condition that may compromise aqueous humor dynamics or the integrity of the globe and sometimes following medical treatments or procedures. Depending on the cause and the clinical impact, treatment options aim to correct the underlying pathology and to reestablish anatomical integrity, as well as visual function. We review the pathophysiology, clinical presentation, different causes, and associated therapeutic options of ocular hypotony.
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Affiliation(s)
- Qianqian Wang
- Wills Eye Hospital, Philadelphia, Pennsylvania, USA; Department of Ophthalmology, University of Montreal Hospital Center, Montreal Quebec, Canada
| | - Avrey Thau
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Alex V Levin
- Wills Eye Hospital, Philadelphia, Pennsylvania, USA; Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Daniel Lee
- Wills Eye Hospital, Philadelphia, Pennsylvania, USA; Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
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Park HS, Choi SY, Jang HJ, Ahn JH. Transscleral Cyclopexy Using Partial-Thickness Scleral Flap for Repairing Cyclodialysis Cleft: a Case Report. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2019. [DOI: 10.3341/jkos.2019.60.4.393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Han Seok Park
- Department of Ophthalmology, Ajou University School of Medicine, Suwon, Korea
| | - Shin Young Choi
- Department of Ophthalmology, Ajou University School of Medicine, Suwon, Korea
| | - Hyo Ju Jang
- Department of Ophthalmology, Ajou University School of Medicine, Suwon, Korea
| | - Jae Hong Ahn
- Department of Ophthalmology, Ajou University School of Medicine, Suwon, Korea
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Statler B, Miller KV, Chen W. An Unusual Complication of Ocular Trauma in a 10-Year-Old Girl. JAMA Ophthalmol 2018; 136:1412-1413. [PMID: 30286241 DOI: 10.1001/jamaophthalmol.2018.2599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Brittney Statler
- Division of Ophthalmology, Brown University Alpert Medical School, Providence, Rhode Island
| | - Kimberly V Miller
- Division of Ophthalmology, Brown University Alpert Medical School, Providence, Rhode Island
| | - Wendy Chen
- Division of Ophthalmology, Brown University Alpert Medical School, Providence, Rhode Island
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41
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Selvan H, Gupta S. Cyclodialysis cleft repair: A multi‐centred, retrospective case series—Comment. Clin Exp Ophthalmol 2018; 47:303. [DOI: 10.1111/ceo.13422] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 09/15/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Harathy Selvan
- Glaucoma ServicesDr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences New Delhi India
| | - Shikha Gupta
- Glaucoma ServicesDr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences New Delhi India
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42
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Popovic M, Shareef S, Mura JJ, Valenzuela F, González Martín‐Moro J, Schlenker MB, Barton K, Muñoz‐Negrete F, Razeghinejad MR, Ahmed IIK. Cyclodialysis cleft repair: A multi‐centred, retrospective case series. Clin Exp Ophthalmol 2018; 47:201-211. [DOI: 10.1111/ceo.13378] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 08/01/2018] [Accepted: 08/19/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Marko Popovic
- Faculty of MedicineUniversity of Toronto Toronto Ontario Canada
| | - Shakeel Shareef
- Flaum Eye Institute, University of Rochester School of Medicine and Dentistry Rochester New York
| | - Juan J. Mura
- Centro de la Visión, Hospital Del Salvador, Universidad de Chile Santiago Chile
| | | | | | - Matthew B. Schlenker
- Department of Ophthalmology and Vision SciencesUniversity of Toronto Toronto Ontario Canada
| | - Keith Barton
- Glaucoma Service, Moorfields Eye Hospital London UK
| | | | - Mohammad Reza Razeghinejad
- Glaucoma Service, Wills Eye Institute Philadelphia Pennsylvania
- Poostchi Eye Research CenterShiraz University of Medical Sciences Shiraz Iran
| | - Iqbal Ike K. Ahmed
- Department of Ophthalmology and Vision SciencesUniversity of Toronto Toronto Ontario Canada
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43
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Gupta S, Selvan H, Gupta V. Single-suture single-knot ab interno cyclopexy for extensive posttraumatic cyclodialysis: Modified sewing machine technique. J Cataract Refract Surg 2018; 45:3-7. [PMID: 30391153 DOI: 10.1016/j.jcrs.2018.08.031] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 08/09/2018] [Accepted: 08/17/2018] [Indexed: 10/28/2022]
Abstract
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.
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Affiliation(s)
- Shikha Gupta
- Glaucoma Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.
| | - Harathy Selvan
- Glaucoma Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Viney Gupta
- Glaucoma Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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44
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Gupta S, Selvan H, Kishan A, Jayaraman N, Gupta V. Single-point pivot for combined repair of concurrent iridodialysis and cyclodialysis. J Cataract Refract Surg 2018; 44:1306-1309. [PMID: 30368349 DOI: 10.1016/j.jcrs.2018.08.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 07/28/2018] [Accepted: 08/07/2018] [Indexed: 11/26/2022]
Abstract
Iridodialysis and cyclodialysis can occur simultaneously in patients with blunt trauma to the eye, and both might necessitate surgical correction when symptoms emerge. Numerous techniques are used to repair each dialysis individually; thus, the patient will have to return to the operating room for each additional surgery. To our knowledge, the literature lacks techniques to manage both conditions simultaneously. We developed a new approach in which both dialyses can be repaired using a single suture, pivoting both at the same point. The suture that passes through the eyelet of the capsular tension ring placed in the sulcus (for internal cyclopexy) is further passed through the detached iris root and retracted via the ciliary cleft to be tied over the scleral bed, facilitating closure of both dialyses at the same time. This is an effective approach for the repair of concurrent iridodialysis and cyclodialysis.
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Affiliation(s)
- Shikha Gupta
- From the Glaucoma Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.
| | - Harathy Selvan
- From the Glaucoma Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Azmira Kishan
- From the Glaucoma Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Navarosh Jayaraman
- From the Glaucoma Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Viney Gupta
- From the Glaucoma Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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45
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Gupta S, Selvan H, Shakrawal J, Gupta V. One-step management of post-traumatic triple dialysis using two rings. Eur J Ophthalmol 2018; 29:NP9-NP13. [PMID: 30270659 DOI: 10.1177/1120672118803520] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To report a case that presented with post blunt trauma cataract, zonular dialysis, cyclodialysis and iridodialysis and its successful single-sitting management. METHODS After lens aspiration, a capsular tension ring and multipiece intraocular lens were placed in the bag to support the zonules, a single eyelet Cionni ring was fixed in the sulcus to provide endocyclotamponade, and iridodialysis repair was done using the 'stroke and dock technique'. RESULT Successful centration of the intraocular lens, closure of the cleft and apposition of the iris root to its base were achieved at the end of the surgery. CONCLUSION A single-sitting surgery correcting all the three dialysis can curtail the burden of repeated surgeries and their complications, providing early visual recovery and cost-effectivity.
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Affiliation(s)
- Shikha Gupta
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Harathy Selvan
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Jyoti Shakrawal
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Viney Gupta
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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46
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Chen J, Jing Q, Gao W, Zhang M, Ji Y, Chen J, Jiang Y, Lu Y. Cyclodialysis cleft repair and cataract management by phacoemulsification combined with internal tamponade using modified capsular tension ring insertion. Graefes Arch Clin Exp Ophthalmol 2018; 256:2369-2376. [PMID: 30267206 PMCID: PMC6224016 DOI: 10.1007/s00417-018-4149-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 08/30/2018] [Accepted: 09/18/2018] [Indexed: 11/15/2022] Open
Abstract
Purpose To evaluate the surgical outcomes of cyclodialysis cleft repair and cataract management by phacoemulsification combined with internal tamponade using a modified capsular tension ring (MCTR) compared with direct cyclopexy. Methods The preoperative and postoperative characteristics of patients with cyclodialysis clefts who underwent surgery via insertion of an MCTR into the ciliary sulcus (MCTR group; 16 patients, 16 eyes) or direct cyclopexy (DC group; 16 patients, 16 eyes) were recorded. Results The cyclodialysis extended over 2.6 ± 1.9 clock hours in the MCTR group and 3.5 ± 1.8 clock hours in the DC group (P = 0.094). Postoperatively, the IOP was not significantly different between the MCTR and DC groups (12.9 ± 3.7 mmHg vs. 13.8 ± 6.2 mmHg, P = 0.985); the logarithm of the minimal angle of resolution BCVA was better (0.1 ± 0.2 vs. 1.0 ± 0.9, P < 0.001), and the anterior chamber depth was greater (3.87 ± 0.40 mm vs. 2.59 ± 0.58 mm, P < 0.001) in the MCTR group than in the DC group. Compared with the preoperative parameters, the postoperative BCVA, IOP, and anterior chamber depth values were significantly improved in the MCTR group (P < 0.05), whereas the BCVA showed no significant improvement postoperatively in the DC group (P = 0.174). Logistic regression revealed no significant risk factors for successful IOP control or BCVA improvement. Conclusion Phacoemulsification combined with internal tamponade using MCTR insertion into the ciliary sulcus is a safe and minimally invasive method for effectively closing cyclodialysis clefts and managing cataract. Electronic supplementary material The online version of this article (10.1007/s00417-018-4149-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jiahui Chen
- Department of Ophthalmology and Vision Science, Eye Ear Nose and Throat Hospital of Fudan University, 83 Fenyang Rd., Shanghai, 200031, China.,NHC Key Laboratory of Myopia (Fudan University), Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Key Laboratory of Visual Impairment and Restoration of Shanghai, Shanghai, China
| | - Qinghe Jing
- Department of Ophthalmology and Vision Science, Eye Ear Nose and Throat Hospital of Fudan University, 83 Fenyang Rd., Shanghai, 200031, China.,NHC Key Laboratory of Myopia (Fudan University), Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Key Laboratory of Visual Impairment and Restoration of Shanghai, Shanghai, China
| | - Wei Gao
- Department of Ophthalmology and Vision Science, Eye Ear Nose and Throat Hospital of Fudan University, 83 Fenyang Rd., Shanghai, 200031, China.,NHC Key Laboratory of Myopia (Fudan University), Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Key Laboratory of Visual Impairment and Restoration of Shanghai, Shanghai, China
| | - Min Zhang
- Department of Ophthalmology and Vision Science, Eye Ear Nose and Throat Hospital of Fudan University, 83 Fenyang Rd., Shanghai, 200031, China.,NHC Key Laboratory of Myopia (Fudan University), Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Key Laboratory of Visual Impairment and Restoration of Shanghai, Shanghai, China
| | - Yinghong Ji
- Department of Ophthalmology and Vision Science, Eye Ear Nose and Throat Hospital of Fudan University, 83 Fenyang Rd., Shanghai, 200031, China.,NHC Key Laboratory of Myopia (Fudan University), Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Key Laboratory of Visual Impairment and Restoration of Shanghai, Shanghai, China
| | - Junyi Chen
- Department of Ophthalmology and Vision Science, Eye Ear Nose and Throat Hospital of Fudan University, 83 Fenyang Rd., Shanghai, 200031, China.,NHC Key Laboratory of Myopia (Fudan University), Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Key Laboratory of Visual Impairment and Restoration of Shanghai, Shanghai, China
| | - Yongxiang Jiang
- Department of Ophthalmology and Vision Science, Eye Ear Nose and Throat Hospital of Fudan University, 83 Fenyang Rd., Shanghai, 200031, China. .,NHC Key Laboratory of Myopia (Fudan University), Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China. .,Key Laboratory of Visual Impairment and Restoration of Shanghai, Shanghai, China.
| | - Yi Lu
- Department of Ophthalmology and Vision Science, Eye Ear Nose and Throat Hospital of Fudan University, 83 Fenyang Rd., Shanghai, 200031, China.,NHC Key Laboratory of Myopia (Fudan University), Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Key Laboratory of Visual Impairment and Restoration of Shanghai, Shanghai, China
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47
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Gupta S, Selvan H, Agrawal S, Gupta V. Dynamic gonioscopy and ultrasound biomicroscopy for diagnosis of latent or low‐lying cyclodialysis clefts. Clin Exp Ophthalmol 2018; 46:960-962. [DOI: 10.1111/ceo.13316] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Accepted: 04/05/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Shikha Gupta
- Glaucoma Services, Dr Rajendra Prasad Centre for Ophthalmic SciencesAll India Institute of Medical Sciences New Delhi India
| | - Harathy Selvan
- Glaucoma Services, Dr Rajendra Prasad Centre for Ophthalmic SciencesAll India Institute of Medical Sciences New Delhi India
| | - Surbhi Agrawal
- Glaucoma Services, Dr Rajendra Prasad Centre for Ophthalmic SciencesAll India Institute of Medical Sciences New Delhi India
| | - Viney Gupta
- Glaucoma Services, Dr Rajendra Prasad Centre for Ophthalmic SciencesAll India Institute of Medical Sciences New Delhi India
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48
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Abdul-Rahman A. Retraction gonioscopy: a novel method in the diagnosis of cyclodialysis clefts. Clin Exp Ophthalmol 2018; 46:833-835. [PMID: 29442427 DOI: 10.1111/ceo.13175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 02/06/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Anmar Abdul-Rahman
- Department of Ophthalmology, Counties Manukau DHB, Auckland, New Zealand
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49
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Jing Q, Chen J, Chen J, Tang Y, Lu Y, Jiang Y. Cionni-modified capsular tension ring for surgical repair of cyclodialysis after trabeculectomy: a case report. BMC Ophthalmol 2017; 17:196. [PMID: 29078747 PMCID: PMC5659030 DOI: 10.1186/s12886-017-0582-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 09/27/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To report a case for repair of cyclodialysis after trabeculectomy with Cionni-modified capsular tension ring. CASE PRESENTATION A 64-year-old man who had undergone trabeculectomy of his left eye 3 months earlier visited our clinic owing to blurred vision. His visual acuity was 20/2000 and the intraocular pressure (IOP) was 6 mmHg. Slit-lamp examination showed a shallow anterior chamber and dense cataract. Ultrasound biomicroscopy revealed 360 ° detachment of the ciliary body and suspected cyclodialysis of the trabeculectomy incision. Choroidal detachment was confirmed by B-scan ultrasonography and optical coherence tomography. Phacoemulsification was performed in which a foldable intraocular lens (IOL) was implanted in the capsular bag and a Cionni-modified capsular tension ring (MCTR) was inserted into the ciliary sulcus. The maximum focal point of the MCTR was rotated to the site of the most severe cyclodialysis and the MCTR was sutured to the sclera through its two eyelets. The patient's best-corrected visual acuity improved to 30/50 and the IOP increased to 16 mmHg after surgery. Gonioscopy and ultrasound biomicroscopy confirmed closure of the cyclodialysis and resolution of choroidal detachment. CONCLUSIONS Phacoemjulsification with implantation of an intraocular lens combined with insertion of an MCTR into the ciliary sulcus appears to be a relatively safe, effective, minimally invasive method for repairing cyclodialysis in cataract patients. Although the technique yielded good results and appeared to be safe in one patient, further studies are necessary to validate the findings on more patients and with a long-term follow-up.
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Affiliation(s)
- Qinghe Jing
- Department of Ophthalmology and Vision Science, Eye and ENT Hospital of Fudan University, 83 Fenyang Rd, Shanghai, 20031 China
- Key Laboratory of Myopia of State Health Ministry, and Key Laboratory of Visual Impairment and Restoration of Shanghai, Shanghai, China
| | - Jiahui Chen
- Department of Ophthalmology and Vision Science, Eye and ENT Hospital of Fudan University, 83 Fenyang Rd, Shanghai, 20031 China
- Key Laboratory of Myopia of State Health Ministry, and Key Laboratory of Visual Impairment and Restoration of Shanghai, Shanghai, China
| | - Junyi Chen
- Department of Ophthalmology and Vision Science, Eye and ENT Hospital of Fudan University, 83 Fenyang Rd, Shanghai, 20031 China
- Key Laboratory of Myopia of State Health Ministry, and Key Laboratory of Visual Impairment and Restoration of Shanghai, Shanghai, China
| | - Yating Tang
- Department of Ophthalmology and Vision Science, Eye and ENT Hospital of Fudan University, 83 Fenyang Rd, Shanghai, 20031 China
- Key Laboratory of Myopia of State Health Ministry, and Key Laboratory of Visual Impairment and Restoration of Shanghai, Shanghai, China
| | - Yi Lu
- Department of Ophthalmology and Vision Science, Eye and ENT Hospital of Fudan University, 83 Fenyang Rd, Shanghai, 20031 China
- Key Laboratory of Myopia of State Health Ministry, and Key Laboratory of Visual Impairment and Restoration of Shanghai, Shanghai, China
| | - Yongxiang Jiang
- Department of Ophthalmology and Vision Science, Eye and ENT Hospital of Fudan University, 83 Fenyang Rd, Shanghai, 20031 China
- Key Laboratory of Myopia of State Health Ministry, and Key Laboratory of Visual Impairment and Restoration of Shanghai, Shanghai, China
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50
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Mustafa OM, Yassine DJ. Delayed spontaneous closure of postsurgical cyclodialysis cleft. Int Ophthalmol 2017; 38:1-2. [PMID: 28108903 DOI: 10.1007/s10792-017-0442-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 01/02/2017] [Indexed: 11/25/2022]
Affiliation(s)
- Osama M Mustafa
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Daoud J Yassine
- Cornea Division, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA.
- Cornea, Cataract, and Refractive Surgery Services, Maumenee 327, Wilmer Eye Institute, Johns Hopkins Medical Institutions, 600 North Wolfe Street, Baltimore, MD, 21287, USA.
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