Treatment for Persistent Hypotony due to Cyclodialysis

We assessed 14 eyes of 14 patients with persisting hypotony due to cyclodialysis by blunt trauma of after secondary intraocular lens implantation. All the 14 eyes showed persistent hypotony and no increment of intraocular pressure(IOP) nor the visual acuity during the follow up period of average 4.6 months before treatment, We treated these eyes with argon laser photocoagulation and/or direct cyclopexy. After treatment, the IOP changed from 3.7+/-1.5mmHg to 13.7+/-5.1mmHg, and posttreatment IOP was greater than 8mmHg in 12 eyes. All 14 eyes showed visual acuity under 0.3 before the treatment and after treatment, the visual acuity improved by 4.2+/-3.3 lines at the last follow up visit. The follow up period was 12.5 months on average. Before treatment, all the 12 eyes that had no medial opacity showed hypotony maculopathy, but after treatment only 4 eyes showed persisting hypotony maculopathy. A-scan axial length measurement was performed on 8 eyes before and after treatment, and the axial lengths were increased by 0.90+/-0.88mm after treatment in 7 eyes in which IOP were increased. The change in refractive errors before and after treatment was possible to be assessed in 9 eyes and among them, 7 eyes showed increment of IOP. Among those 7 eyes, 2 eyes had shallow chambers with anteriorly displaced lens before treatment and showed repositioning of lenses and hyperopic shift by +2.86 Dsph on average after treatment, but the remaining 4 eyes excluding one eye that received lensectomy at the time of surgery for taumatic cataract, showed myopic shift by -2.31 Dsph on average after treatment.

Surgical Repair of Traumatic Cyclodialysis with Persistent Hypotony

Cyclodialysis is characterized by a disruption of the circumferential attachment of the fibers of the meridional ciliary muscle to the scleral spur. Cyclodialysis can lead to a marked chronic hypotony. Prolonged periods of hypotony can result in corneal edema, Descemet`s folds, shallow anterior chamber, cataract formation, chorioretinal folds that can involve the macula, and optic disc edema. The authors experienced a case of traumatic cyclodialysis with a persistent hypotony. We have treated with refixation of the detached ciliary body, by direct cyclopexy. Postoperatively, hypotony was disappeared and visual improvement was achieved.