Abstract
BackgroundA cyclodialysis cleft is a gap resulting from disruption of the longitudinal fibers constituting the ciliary body attachment to the scleral spur. The cyclodialysis cleft can be of traumatic or iatrogenic origin, and it may occur during intraocular surgery or as a result of a glaucoma operation. In this report we present a surgical technique to treat cyclodialysis: cyclopexy combined with phacoemulsification subluxation lens, transscleral suturing of Cionni ring, and intraocular lens implantation with iris cerclage suture.Case presentationA 44-year-old Polish woman experienced a traumatic cyclodialysis cleft in her left eye, complicated by persistent hypotony, maculopathy, lens subluxation, and pupillary sphincter injury. Her corrected distance visual acuity was 0.1 (Snellen chart) and intraocular pressure 3.0 mmHg. We performed direct cyclopexy, anterior vitrectomy, removal of the subluxated lens by phacoemulsification, followed by an insertion of a capsular tension ring with 1-point scleral suture fixation with implantation of intraocular lens in the capsular bag and suturing around the pupil. Anterior segment optical coherence tomography revealed closure of the cleft by reattachment of the ciliary body to the sclera spur. Her corrected distance visual acuity was 0.8 and intraocular pressure 18 mmHg.ConclusionsThe choice of operating technique depends on the area of the ciliary body dialysis, the number of clefts and their location, the presence of other abnormalities of the ocular structures, and the surgical skills of the operator. Cyclopexy combined with phacoemulsification and transscleral suturing of Cionni ring and intraocular lens implantation with iris cerclage suture can be a good solution in cases of this type. The applied surgical technique proved to be effective.
Highlights
A cyclodialysis cleft is a gap resulting from disruption of the longitudinal fibers constituting the ciliary body attachment to the scleral spur [1]
The cyclodialysis cleft can be of traumatic or iatrogenic origin; it may occur during intraocular surgery, for example extracapsular cataract extraction, phacoemulsification, secondary intraocular lens (IOL) placement, or phakic IOL removal or as a result of a glaucoma operation [2]
Case presentation A 44-year-old Polish woman who was involved in a car crash presented to our Military Institute of Medicine with a head injury and blunt ocular trauma: she had trauma to her left eye with eye pain and decreased visual acuity
Summary
In case of cyclodialysis the basic purpose is always a reduction of fluid flow from the anterior chamber and an increase of the intraocular pressure, preventing possible occurrence of the previously described complications and consequences. Cyclopexy combined with phacoemulsification and transscleral suturing of Cionni ring and intraocular lens implantation with iris cerclage suture can be a good solution in the cases of this type. 1. Currently, the treatment for trauma is based on many individual multiple step operating techniques. 2. There is no one surgical technique for these trauma cases which has been recognized as the most cost efficient and least traumatic to the patient. 1. Our technique presents a comprehensive treatment for post-traumatic cyclodialysis cleft with a subluxated intracapsular cataract using I OL implantation, involving the previously described separate surgical methods.
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