Direct cyclopexy surgery for post-traumatic cyclodialysis with persistent hypotony: ultrasound biomicroscopic evaluation / Ciclopexia direta em ciclodiálise pós-traumática com hipotonia ocular persistente -acompanhamento por biomicroscopia ultrassônica (UBM)

Cyclodialysis is a relatively rare condition usually caused by ocular injury; however, it can also be caused iatrogenically during intraocular surgery. Hypotony maculopathy is the most important complication and the primary reason for visual loss. Clinical diagnosis using gonioscopy may be difficult, and ultrasound biomicroscopy (UBM) can be an alternative. There are different kinds of treatments, and the optimal one remains controversial. Here we describe a case of traumatic cyclodialysis with persistent ocular hypotony treated by direct cyclopexy, as illustrated by UBM performed before and after surgery.

Ciclodiálise é uma condição relativamente rara, geralmente devido a um trauma ocular, mas também pode ser causada iatrogenicamente como consequência de cirurgia intraocular. A maculopatia hipotônica é a complicação mais importante e a principal razão para a perda visual nessa situação. O diagnóstico clínico por gonioscopia pode ser difícil e a biomicroscopia ultrassônica (UBM) pode ser uma alternativa. Existem diferentes tipos de tratamentos e algumas controvérsias sobre a melhor opção. Neste relato, nós descrevemos um caso de ciclodiálise traumática com hipotonia ocular persistente tratado por cyclopexia direta avaliado por UBM antes e depois da cirurgia.

Introduction of Lens-angle Reconstruction Surgery in Rabbit Eyes

PURPOSE: In this study, we examined the stability of the lens-angle supporter (LAS) for accommodation restoration by comparing intraocular lens (IOL) location, after-cataract and ciliary body damage after cataract surgery in rabbits. METHODS: Eight rabbits were divided into experimental and control groups of four rabbits each. Phacoemulsification and irrigation and aspiration were performed in all rabbits. This was followed by an LAS and IOL insertion in the four experimental rabbits. In the four control rabbits, only an IOL insertion was performed. Six months after the surgery, the location of the IOL, the conditions of the lens capsule and ciliary body were evaluated using a slitl-amp examination and Miyake-Apple view. RESULTS: For the experimental group, the ultrasound biomicroscope results showed normal LAS and IOL positioning in all four cases. According to the slitlamp examination and Miyake-Apple view, the IOL was positioned at the center, with less after-cataract and damage to the ciliary body. For the control group, ultrasound biomicroscope results indicated a higher IOL position than normal, as well as a single case of IOL decentering. According to the slit-lamp examination and Miyake-Apple view, the IOL was decentered with more severe after-cataract and ciliary body damage. CONCLUSIONS: The LAS has the potential to maintain a stable IOL position while producing less after-cataract when used in lens-angle reconstruction for correction of presbyopia. Moreover, LAS implantation incurs less damage to the ciliary body.

A Case Report on the Change of the Refractive Power After a Blunt Trauma

PURPOSE: To determine the pathogenesis of transient myopia after blunt eye trauma. METHODS: In one patient, the refraction of both eyes (the left eye was injured, but the right eye was not) was measured with an autorefractometer. The cycloplegic refraction was measured at the early stage of trauma and again 3 months after the blunt eye injury. The angle and depth of the anterior chamber, the ciliary body, and the choroids were examined by ultrasound biomicroscopy (UBM) over 3 months. The depth of the anterior chamber, the thickness of the lens, and the axial length were measured by A-scan ultrasonography in both eyes. During the 3 months after the injury, we made comparisons between the menifest and the cycloplegic refractions, the depths of anterior chambers, the thickness of the lenses, the axial lengths, and the UBM-determined appearances of the angles and depths of the anterior chambers, the ciliary bodies, and the choroids in both eyes. RESULTS: We suspect that the depth reduction in the anterior chamber, the increase in anterior to posterior lens diameter, and the edema in the ciliary body are all related to the change in the refractive power following the blunt trauma. CONCLUSIONS: Ultrasound biomicroscopy (UBM) and ultrasonography of the anterior segment in the eye may be helpful to diagnose and confirm changes in the refractive power that occur after trauma.

A Case Report on the Change of the Refractive Power After a Blunt Trauma

PURPOSE: To determine the pathogenesis of transient myopia after blunt eye trauma. METHODS: In one patient, the refraction of both eyes (the left eye was injured, but the right eye was not) was measured with an autorefractometer. The cycloplegic refraction was measured at the early stage of trauma and again 3 months after the blunt eye injury. The angle and depth of the anterior chamber, the ciliary body, and the choroids were examined by ultrasound biomicroscopy (UBM) over 3 months. The depth of the anterior chamber, the thickness of the lens, and the axial length were measured by A-scan ultrasonography in both eyes. During the 3 months after the injury, we made comparisons between the menifest and the cycloplegic refractions, the depths of anterior chambers, the thickness of the lenses, the axial lengths, and the UBM-determined appearances of the angles and depths of the anterior chambers, the ciliary bodies, and the choroids in both eyes. RESULTS: We suspect that the depth reduction in the anterior chamber, the increase in anterior to posterior lens diameter, and the edema in the ciliary body are all related to the change in the refractive power following the blunt trauma. CONCLUSIONS: Ultrasound biomicroscopy (UBM) and ultrasonography of the anterior segment in the eye may be helpful to diagnose and confirm changes in the refractive power that occur after trauma.

Ultrasound Biomiscroscopy in the diagnosis and management of cyclodialysis clefts.

PURPOSE: To report the role of Ultrasound Biomicroscopy (UBM) as a tool in the diagnosis and management of cyclodialysis clefts. METHODS: Six eyes of 6 patients with hypotony and suspected or diagnosed cyclodialysis clefts underwent UBM evaluation. Post-treatment UBM was performed in four eyes to assess the effect of the treatment. RESULTS: Cyclodialysis clefts were accurately diagnosed and delineated in 6 eyes by UBM. Complete closure was documented after treatment in 3 eyes, and a residual cleft in one eye. These findings were compared to gonioscopic findings. CONCLUSIONS: UBM is a safe, accurate and noninvasive diagnostic tool in the diagnosis of cyclodialysis clefts and is of particular use when other conventional methods of diagnosis are inconclusive.