Surgical Management Of Chronic Cyclodialysis Cleft And Traumatic Cataract

Published 2025 - 43rd Congress of the ESCRS

Reference: CC01.04 | Type: Case Report | DOI: 10.82333/mvpc-c443

Authors: Julia Seco Orriols* ¹ , Sara Carlota Labay ¹ , Pau Marjalizo ¹ , Inés Bourleau ¹ , Sonia Marias ¹ , Elena Brotons-Muñoz ¹ , Xavier Corretger ¹ , Elena Milla ¹

¹Hospital Clinic Barcelona,Barcelona,Spain

Purpose

To investigate the efficacy and safety of surgical repairing of traumatic cyclodialysis cleft in severe ocular trauma

Setting

Cyclodialysis is the result of the separation of the longitudinal ciliary muscle fibers from the scleral spur, which creates an abnormal pathway for aqueous humor drainage that may lead to persistent ocular hypotonia, morphological changes, and progressive visual loss. Multiple treatment options are available for this condition. Although medical treatment can be effective to close small clefts, surgery is needed in most patients to restore ocular pressure.

Report of case

We present the case of a 49-year-old patient who suffered ocular trauma to her right eye, caused by the impact of an airbag in a traffic accident. The patient presented a fracture of the orbital floor, vitreous prolapse in the anterior chamber, traumatic cataract with subluxation of the lens, in addition to extensive inferior cyclodialysis (from IV to VIII hours), giving rise to persistent hypotonia.

The patient was absent and eight months after the trauma, a cyclopexy of the inferior ciliary body could be performed. After making an extensive superficial scleral flap and an incision 3mm from the limbus, massive outflow of retained aqueous humor was observed and anteriorization of the detached ciliary body, which could be successfully sutured to the sclera. The intervention was monitored under gonioscopy. In the immediate postoperative period, the anatomical recovery of the structures of the chamber angle and ciliary body was verified, although the intraocular pressure was maintained at 6mmHg given the chronicity of the process.

After 8 months, phacoemulsification of the cataract was carried out with infusion in the anterior chamber to control hypotonia and with capsular retractor rings, a capsular tension ring and 2 Ahmed segments sutured with Goretex. In the immediate postoperative period the hypotonia persisted, although after two weeks and after the injection of triamcinolone in the subtenon space, the IOP rised to 16mmHg and has remained stable after three months.

Conclusion/Take home message

Cyclopexy is the essential first step for the successful treatment of large hypotonic clefts due to cyclodialysis. An adequate suture of the ciliary body constitutes the basis to facilitate subsequent surgical interventions that are usually necessary in patients with multiple complications after ocular trauma. The pressure exerted by the ahmed segments in combination with steroid treatment can help manage hypotonia.