OSLI Retina

January 2020

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January 2020 · Vol. 51, No. 1 63 partial ciliochoroidal detachment, and absence of hy- potonic maculopathy. At 30-month follow-up, IOP was between 8 mm Hg and 10 mm Hg OD. RESULTS Patient preoperative and postoperative data are shown in Table 1. In this series, four patients with an- nular CCD with CC underwent scleral buckling surgery to treat persistent hypotony that did not respond to medical treatment. Before surgery, the mean IOP was 2.5 mm Hg ± 0.5 mm Hg. After surgery, mean IOP sig- nificantly improved to 10.75 mm Hg ± 1.1 mm Hg (P = .0129). Mean preoperative BCVA was +0.50 ± 0.16 logMAR, with significant improvement to +0.15 ± 0.17 logMAR (P = .0123) (Figure 6). In one case (patient No. 4), a significant improve- ment was observed in IOP and visual acuity; however, this improvement was counteracted by a posterior sub- capsular cataract 2+ development. Ciliochoroidal detachment and cyclodialysis cleft persisted in all patients after surgery. DISCUSSION Cyclodialysis clefts are usually associated with chronic ocular hypotony. The main goal of treatment is to close the cleft to restore IOP as not only the duration of hypotony, but also the extent of cyclodialysis leads to irreversible visual loss. Surgical management is in- dicated when medical treatment of hypotony fails. The scleral buckling procedure is a widely used technique for repair of retinal detachment as well as proliferative vitreoretinopathy, and it has also been used to treat lo- calized clefts with good results. Portney et al. used a sectorial and anterior buckle to abute the ciliary body detachment from 6.30-o'clock to 11-o'clock position with previous cryotherapy in the area where the buckle was going to be placed. 11 Mandava et al. utilized a secto- rial, separate and anterior buckle to abute the cyclodi- alysis cleft at 8.30-o'clock and 9.30-o'clock, 2 mm away from the limbus. After cleft closure the scleral buckle was removed. 2 In this study, we found that IOP and BCVA signifi- cantly improved after the scleral buckle surgery with encircling band. The technique was the same as the accepted method for the treatment of rhegmatogenous retinal detachment with peripheral breaks except for drainage placement or gas bubble injection. Further- more, normalization of IOP and complete resolution of hypotonic maculopathy was observed in all patients. In a previous published study, Inukai et al. also showed successful management of hypotonic maculopathy and peripheral retinal breaks using a 360° scleral buckling. 12 Interestingly, as reported in previous studies, our pa- tients showed clinical improvement even though per- sistence of CCD and cyclodialysis cleft. 13,14 It could be hypothesized that the encircling procedure stop poste- rior displacement of suprachoroidal fluid thus reducing uveoscleral outflow. So far, these results indicate that scleral buckling surgery with an encircling band appears to be an effec- tive approach to manage persistent ocular hypotony in patients with annular CCD and cyclodialysis cleft in order to prevent irreversible ocular sequelae. Further prospective and larger studies are needed to confirm these findings. REFERENCES 1. Brubaker RF, Pederson JE. Ciliochoroidal detachment. Surv Ophthal- mol. 1983;27(5):281-289. PubMed. https://doi.org/10.1016/0039- 6257(83)90228-X PMID:6407132 2. Mandava N, Kahook MY, Mackenzie DL, Olson JL. Anterior scleral buckling procedure for cyclodialysis cleft with chronic hypotony. Oph- thalmic Surg Lasers Imaging. 2006;37(2):151-153. PubMed. https://doi. org/10.3928/1542-8877-20060301-13 PMID:16583639 3. Agrawal P, Shah P. Long-term outcomes following the surgical repair of traumatic cyclodialysis clefts. Eye (Lond). 2013;27(12):1347-1352. https://doi.org/10.1038/eye.2013.183 PMID:23989121 4. Kuhn F. Ocular Traumatology. Heidelberg, Germany: Springer-Verlag Heidelberg; 2008:46. 5. Tang J, Du E, Wang J. Novel surgical management of cyclodialysis cleft via anterior chamber perfusion: Case report. Medicine (Baltimore). 2017;96(29):e7559. https://doi.org/10.1097/MD.0000000000007559 PMID: 28723783 6. Ioannidis AS, Bunce C, Barton K. The evaluation and surgical man- agement of cyclodialysis clefts that have failed to respond to conserva- tive management. Br J Ophthalmol. 2014;98(4):544-549. https://doi. org/10.1136/bjophthalmol-2013-303559 PMID:24457370 7. Wang M, Hu S, Zhao Z, Xiao T. A novel method for the localiza- tion and management of traumatic cyclodialysis cleft. J Ophthal- mol. 2014;2014:761851. https://doi.org/10.1155/2014/761851 PMID:24744915 8. Yang JG, Yao GM, Li SP, Xiao-Huawang, Ren BC. Surgical treatment for 42 patients with traumatic annular ciliochoroidal detachment. Int J Ophthalmol. 2011;4(1):81-84. https://doi.org/10.3980/j.issn.2222- 3959.2011.01.19 PMID:22553616 9. Medeiros MD, Postorino M, Pallás C, et al. Cyclodialysis induced per- sistent hypotony: surgical management with vitrectomy and endot- amponade. Retina. 2013;33(8):1540-1546. https://doi.org/10.1097/ IAE.0b013e3182877a41 PMID:23598794 10. Trikha S, Turnbull A, Agrawal S, Amerasinghe N, Kirwan J. Management challenges arising from a traumatic 360 degree cyclodialysis cleft. Clin Ophthalmol. 2012;6:257-260. https://doi.org/10.2147/OPTH.S29123 PMID:22368444 11. Portney GL, Purcell TW. Surgical repair of cyclodialysis induced hypoto- ny. Ophthalmic Surg. 1974;5(1):30-32. PubMed. PMID:4617845 12. Inukai A, Tanaka S, Hirose A, Tomimitsu S, Mochizuki M. [Three cases of hypotonic maculopathy due to blunt trauma, treated by 360-degree scleral buckling]. Nippon Ganka Gakkai Zasshi. 2003;107(6):337-342. PubMed. https://doi.org/10.1016/j.jjo.2003.09.015 PMID:12854505 13. Xu W-W, Huang Y-F, Wang L-Q, Zhang M-N. Cyclopexy versus vit- rectomy combined with intraocular tamponade for treatment of cyclo- dialysis. Int J Ophthalmol. 2013;6(2):187-192. https://doi.org/10.3980/j. issn.2222-3959.2013.02.16 PMID:23638422 14. Murta F, Mitne S, Allemann N, Paranhos Junior A. Direct cyclopexy sur- gery for post-traumatic cyclodialysis with persistent hypotony: ultrasound biomicroscopic evaluation. Arq Bras Oftalmol. 2014;77(1):50-53. https:// doi.org/10.5935/0004-2749.20140013 PMID:25076374

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