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CYCLODIALYSIS INDUCED PERSISTENT HYPOTONY: Surgical Management With Vitrectomy and Endotamponade

Dutra Medeiros, M. MD; Postorino, Maurizio MD; Pallás, Carolina MD; Salinas, Cecilia MD; Mateo, Carlos MD; Garcia-Arumí, J. MD, PhD; Corcóstegui, Borja MD, PhD

doi: 10.1097/IAE.0b013e3182877a41
Original Study

Purpose: To report novel surgical approaches to the management of persistent hypotony after cyclodialysis.

Methods: Retrospective review of the medical records of six eyes of six patients with persistent hypotony after traumatic cyclodialysis. The diagnosis accuracy of cyclodialysis was documented by ultrasound biomicroscopy in five patients. The other one underwent an anterior segment optical coherence tomography. The authors performed pars plana vitrectomy and silicone oil–assisted endotamponade in four patients. The remaining eyes underwent a gas tamponade after pars plana vitrectomy.

Results: Preoperative visual acuity (Snellen scale) ranged from count fingers to 20/50. The patients' visual acuity improved after the surgery. The intraocular pressure ranged from 2 mmHg to 6 mmHg (mean, 3.33 mmHg) before surgery. The authors did achieve an intraocular pressure normalization postoperatively. After surgery, the ciliary body was completely reattached in all cases. A slight angle recession was documented in one eye.

Conclusion: The management of cyclodialysis clefts requires a stepwise approach. In cases where conservative management fails, wide ranges of options have been reported. Based on our results, we consider that silicone oil–assisted or gas-assisted endotamponade, after pars plana vitrectomy, can be an effective alternative approach to the cyclodialysis.

The authors' results suggest that vitrectomy with ocular endotamponade, namely, silicone oil, provides an effective approach in stabilizing eyes with chronic macular hypotony because of cyclodialysis. Given the absence of a consistently effective treatment for this challenging group of eyes, the described procedure may prove particularly helpful for selected patients, with long-standing multiple ocular comorbidities. To the authors' knowledge, this is the first study addressing the use of silicone oil as a tamponade on cyclodialysis cleft closure.

Instituto de Microcirugia Ocular, Barcelona, Spain.

Reprint requests: M. Dutra Medeiros, MD, Instituto de Microcirurgia Ocular, Calle Josep María Lladó, n° 308035, Barcelona, Spain; e-mail: marcodutramedeiros@gmail.com

All the listed authors agree with the submission of this manuscript and none of them have any conflicting financial interest related to it.

© 2013 by Ophthalmic Communications Society, Inc.