Cyclopexy versus vitrectomy combined with intraocular tamponade for treatment of cyclodialysis

AIM:Tocomparetheeffectsandcomplicationsof direc cyclopexy (DC) versus vitrectomy, endophotocoagulation, and gas/silicone oil endotamponade (VEE) treatment in patients with cyclodialysis and persistent hypotony.METHODS: This is a prospective, comparative, non-randomized clinical trial which includes 52 patients with cyclodialysis and persisting hypotony. Fifty-two patients suffering from cyclodialysis and persistent hypotony in one eye were divided into 2 groups (groups DC and VEE) and treated, respectively, with direct cyclopexy or vitrectomy, endophotocoagulation, and gas/silicone oil endotamponade. The patients were followed up for 12 months. Assessments included best corrected visual acuity (BCVA), intraocular pressure (IOP), anterior chamber depth (ACD), anterior chamber volume (ACV) and subjective rating of the pain caused by the treatments.RESULTS: After a follow-up of 12 months, significan improvement was seen in postoperative mean BCVA, IOP, ACD and ACV in both treatment groups (which were not significantly different from each other). The success rates for the treatments were not significantly different (DC: 50.0% vs VEE: 62.5% , P =0.383). Postoperative morbidity of cataract and subjective pain rating were significantly higher in the VEE group vs the DC group (P =0.003 and P 【0.001 respectively).CONCLUSION: DC and VEE were effective surgica procedures in treating patients with cyclodialysis and persistent hypotony. Patients had better tolerance to DC treatment and VEE was more likely lead to cataract complications. Taking into consideration the ease of the operation, success rate, and patient comfort, DC treatment seems preferable to VEE treatment in patients with simple cyclodialysis. While VEE has the advantage of treating patients with cyclodialysis combined with vitreous hemorrhage.

Scleral buckling combined with internal cyclopexy for severe traumatic cyclodialysis cleft in open globe injuries

This study aimed to evaluate the effect of scleral buckling combined with internal cyclopexy on the treatment of severe traumatic cyclodialysis cleft in open globe injuries(OGIS). This retrospective study recruited 10 patients of 10 eyes. With our surgical intervention, all the 10 eyes achieved retinal and ciliary body anatomic re-attachment. The choroidal ruptures in nine eyes were closed with complete choroidal reattachment. Postoperative best-corrected visual acuity of nine eyes had various improvements. The mean intraocular pressure was increased from 8.9±2.6 mm Hg to 13.4±4.4 mm Hg. Eventually, six eyes underwent silicone oil(SO) removal without complications, two eyes still had SO tamponade and two eyes became SO-dependent eyes. The result shows that internal direct cyclopexy combined with scleral buckling is an effective treatment for severe traumatic cyclodialysis cleft in OGIS.

Comparison of encirclage and cryotherapy with argon laser in the management of traumatic cyclodialysis cleft

The study compared anatomical and functional outcome of a novel technique of encirclage and cryotherapy with the conventional argon laser in the management of traumatic cyclodialysis cleft in 19 patients(10: encirclage and 9: argon laser). The postoperative anatomical success was taken as rise in intraocular pressure(IOP) more than 6 mm Hg or the closure of cleft on gonioscopy or ultrasound biomicroscopy(UBM). Visual outcome was measured as change in logMAR visual acuity. Traumatic cataract and hypotony were present in majority. IOP>6 mm Hg was noted in 90% of encirclage group and in 77.70% of argon laser group. Two cases had non-closure of cleft. Encirclage is comparable to argon laser in terms of anatomical and functional success with possible advantage of single procedure and use in cases with failed laser.

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

Background:To evaluate the efficacy and safety of placing dual capsular tension rings for the combined management of traumatic cyclodialysis cleft and zonular dialysis.Methods:A modified capsular tension ring was inserted into the ciliary sulcus and a capsular tension ring or modified capsular tension ring was inserted into the capsular bag in 20 eyes in 20 consecutive patients showing signs of ocular hypotony and ectopia lentis.Outcome measures included intraocular pressure,best-corrected visual acuity,and postoperative complications.Results:Dual capsular tension ring placement was performed in 20 patients with a mean age of 48.7 years.The cyclodialysis cleft extended over 2.9 clock hours(range 0.5-6.5).The modified capsular tension ring was successfully inserted into the ciliary sulcus and a capsular tension ring or modified capsular tension ring in the capsular bag in all eyes.At the last follow-up,the cyclodialysis cleft was closed in 16/20(80.0%)eyes.The intraocular lens was stable in all patients postoperatively.Best-corrected visual acuity,in terms of the logarithm of the minimal angle of resolution,improved from 1.3±0.8 before surgery to 0.4±0.3 after surgery(P<0.001).Intraocular pressure increased significantly from 10.6±3.2 mmHg before surgery to 13.0±4.8 mmHg after surgery(P=0.040).Postoperative complications included a painful reversible intraocular pressure spike in four patients(20.0%).Logistic regression revealed no significant factors associated with successful cleft closure and a stable final intraocular pressure of≥10 mmHg.Conclusions:The placement of two capsular tension rings into the ciliary sulcus and the capsular bag is a safe,successful procedure combined for repairing a traumatic cyclodialysis cleft and managing zonular dialysis.

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

Background:To evaluate the efficacy and safety of placing dual capsular tension rings for the combined management of traumatic cyclodialysis cleft and zonular dialysis.Methods:A modified capsular tension ring was inserted into the ciliary sulcus and a capsular tension ring or modified capsular tension ring was inserted into the capsular bag in 20 eyes in 20 consecutive patients showing signs of ocular hypotony and ectopia lentis.Outcome measures included intraocular pressure,best-corrected visual acuity,and postoperative complications.Results:Dual capsular tension ring placement was performed in 20 patients with a mean age of 48.7 years.The cyclodialysis cleft extended over 2.9 clock hours(range 0.5-6.5).The modified capsular tension ring was successfully inserted into the ciliary sulcus and a capsular tension ring or modified capsular tension ring in the capsular bag in all eyes.At the last follow-up,the cyclodialysis cleft was closed in 16/20(80.0%)eyes.The intraocular lens was stable in all patients postoperatively.Best-corrected visual acuity,in terms of the logarithm of the minimal angle of resolution,improved from 1.3±0.8 before surgery to 0.4±0.3 after surgery(P<0.001).Intraocular pressure increased significantly from 10.6±3.2 mmHg before surgery to 13.0±4.8 mmHg after surgery(P=0.040).Postoperative complications included a painful reversible intraocular pressure spike in four patients(20.0%).Logistic regression revealed no significant factors associated with successful cleft closure and a stable final intraocular pressure of≥10 mmHg.Conclusions:The placement of two capsular tension rings into the ciliary sulcus and the capsular bag is a safe,successful procedure combined for repairing a traumatic cyclodialysis cleft and managing zonular dialysis.