Cyclodialysis cleft as a complication of cataract surgery: a case report

Abstract

AbstractPurposeWe describe a case report of hypotonic maculopathy secondary to cataract surgery with phacoemulsification and intraocular lens implant (IOL).MethodsA 68‐year‐old man, with medical history of prostatic hyperplasia, and surgical history of uneventful cataract surgery in his left eye (phacoemulsification and IOL implant), underwent cataract surgery in his right eye. Flopy iris syndrome was manifested, with the consequent traumatic manipulation of the iris. The surgery finished successfully with the IOL implantation in the posterior chamber. During the following postoperative visits, the patient presented a best‐corrected visual acuity (BCVA) lower than 1/10 in his right eye, and an intraocular pressure (IOP) of 4 mmHg. The slit‐lamp examination discarded the presence of leakage throught the corneal incisions. The funduscopic examination showed a macular hypotony with radial folds, wich was confirmed by optical coherence tomography. The examination with ultrasonic biomicroscopy, revealed the presence of a superior cyclodialysis of 180°. An anterior YAG laser capsulotomy was performed to release the anterior capsular fibrosis. Despite treatment with topical steroids and atropine for two months, hypotonic maculopathy remained unchanged. Finally, an encircling procedure was performed, 23 g pars plana posterior vitrectomy, an internal limiting membrane peeling, SF6 20% air‐gas exchange, and superior criopexy of the cilliary body at 3 mm of the corneal limbus.ResultThe postoperative evolution was favourable with resolution of the maculopathy, progressive elevation of IOP (12 mmHg), and resolution of the cyclodialysis cleft. The patient recovered a BCVA of 7/10 with his right eye.ConclusionOcular hypotony is an infrequent, yet potentially vision‐threatening entity. The diferential diagnosis is extense, involving any condition that may compromise aqueous humor dynamics or the integrity of the globe and sometimes following medical treatments or procedures.