J Korean Ophthalmol Soc.  2019 Apr;60(4):393-398. 10.3341/jkos.2019.60.4.393.

Transscleral Cyclopexy Using Partial-Thickness Scleral Flap for Repairing Cyclodialysis Cleft: a Case Report

• Park HS
• Choi SY
• Jang HJ
• Ahn JH

• KMID: 2443158
• DOI: http://doi.org/10.3341/jkos.2019.60.4.393

Abstract

PURPOSE
To report a case of a cyclodialysis cleft that was successfully managed with gonioscopically guided transscleral cyclopexy using partial-thickness scleral flap.
CASE SUMMARY
A 44-year-old man complaining of blurred vision in the left eye after blunt trauma was referred to our hospital. The intraocular pressure (IOP) was 4 mmHg and the visual acuity was counting finger. Gonioscopy examination revealed cyclodialysis cleft from 3 to 6 o'clock and fundus examination revealed macular folds. After the failure of conservative medical therapy and laser photocoagulation, gonioscopically guided transscleral cyclopexy using partial-thickness scleral flap was performed. Four months later, the IOP was 18 mmHg, the visual acuity was 0.8, and fundus examination showed the disappearance of the macular folds.
CONCLUSIONS
Transscleral cyclopexy using partial-thickness scleral flap is a safe and effective method to treat hypotony maculopathy due to cyclodialysis and to minimize pupil distortion.

Keyword

Cyclodialysis; Cyclopexy; Gonioscopy; Hypotonic maculopathy; Traumatic hypotony

MeSH Terms

Adult
Fingers
Gonioscopy
Humans
Intraocular Pressure
Light Coagulation
Methods
Pupil
Visual Acuity

Figure

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  Figure 1 Preoperative fundus photography and optical coherence tomography. (A) Fundus photograph showing chorioretinal folds at macular area. (B) Optical coherence tomography showing wrinkling of the retina and the choroid.

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  Figure 2 Surgical procedures of transscleral cyclopexy using partial-thickness scleral flap. (A) A partial thickness scleral flap was created at the site of the cleft. (B) Cyclodialysis cleft was observed using Zeiss 4-mirror (Carl Zeis Meditec AG) gonioprism. (C) Cleft was closed with 10-0 nylon suture passing through the sclera and the detached ciliary body. (D) The cleft was closed completely with interrupted 10-0 nylon sutures.

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  Figure 3 Postoperative anterior segment photography, fundus photography, and optical coherence tomography. (A) Cyclodialysis cleft was attached to the sclera and iris configure was well maintained. (B) No chorioretinal folds were observed in fundus photography and optical coherence tomography.

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