McCannel Suture Technique Resolves Persistent Dysphotopsia Following Laser Peripheral Iridotomy in Phakic Eyes.

A 57-year-old woman presented with photophobia and complaint of a persistent white light in the inferior field of her left eye for 18 months following laser peripheral iridotomy both eyes. In primary gaze, the upper lid margin was noted to bisect the iridotomy at 2 o'clock left eye (OS). She relates that the light moves with her eyelid OS only and resolves by lifting the lid. A 54-year-old male presented with complaint of seeing 2 horizontal lines in his field of vision immediately following laser iridotomy OS that have persisted for a duration of 7 years. He notes they are constant and resolve by lifting up the eyelid. In primary position, the left upper lid margin was noted to bisect the iridotomy at 12 o'clock OS. Given the presence of nonresolving symptomatic dysphotopsia, each patient underwent surgical repair of the iridotomy using a McCannel suture technique with complete resolution of their symptoms. Dysphotopsias are an uncommon complication that can occur following laser peripheral iridotomy. If they persist and conservative measures are ineffective, iris suture repair can provide a definitive intervention in resolving them. Laser iridotomies located in the far periphery pose a surgical challenge with respect to accessibility. A McCannel suture technique provides a feasible approach in suturing them with minimal iris manipulation. Furthermore, it is prudent to assess the upper lid position in primary gaze before creating an iridotomy in order to avoid interference with the lid margin tear film meniscus that can lead to the formation of symptomatic dysphotopsia.

Cyclodialysis cleft repair: A multi-centred, retrospective case series.

IMPORTANCE: There is a paucity of evidence analysing the treatment of cyclodialysis clefts. BACKGROUND: We describe outcomes following the treatment of this rare condition at six centres internationally. DESIGN: Retrospective case series. PARTICIPANTS: Thirty-six patients with a cyclodialysis cleft from 2003 to 2017 were recruited. METHODS: Clefts were treated with cycloplegic agents, laser therapy and/or surgery. MAIN OUTCOME MEASURES: Postoperative best recorded visual acuity (BRVA), intraocular pressure (IOP) and the rate of cleft closure. RESULTS: The mean age was 45 ± 17 years and 29 (80.6%) patients were male. One eye (2.8%) received only medical therapy, 5 (13.9%) received laser, 14 (38.9%) underwent surgery after laser failure and 16 (44.4%) eyes received exclusively surgery. Over 80% of eyes had a BRVA improvement of more than two lines. Closure was attained in 30 eyes (93.8%; n = 32), with postoperative stabilized IOP ≥ 12 mmHg in 29 eyes (80.6%; n = 36) and postoperative BRVA ≤20/50 in 20 eyes (58.8%; n = 34). Improved postoperative BRVA was related to better preoperative BRVA (P = 0.006) and preoperative IOP ≥ 4 mmHg (P = 0.03). There was no significant difference between treatment approach for IOP ≥ 12 mmHg (P = 0.85) or postoperative BRVA ≤20/50 (P = 0.80). Only two eyes at last follow-up required IOP lowering medication. CONCLUSIONS AND RELEVANCE: There was a high closure rate with most eyes eventually requiring surgery. Clinically significant improvements in BRVA were found in most eyes. Improved postoperative BRVA was significantly related to better preoperative BRVA and IOP.