Journal of Current Glaucoma Practice

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VOLUME 11 , ISSUE 1 ( January-April, 2017 ) > List of Articles

CASE REPORT

Gonioscopically Guided Nonpenetrating Cyclodialysis Cleft Repair: A Novel Surgical Technique

Ian AS Rodrigues, Brinda Shah, Saurabh Goyal, Kin Sheng Lim

Keywords : Cyclodialysis cleft, Direct gonioscope, Hypotony, Ocular trauma

Citation Information : Rodrigues IA, Shah B, Goyal S, Lim KS. Gonioscopically Guided Nonpenetrating Cyclodialysis Cleft Repair: A Novel Surgical Technique. J Curr Glaucoma Pract 2017; 11 (1):31-34.

DOI: 10.5005/jp-journals-10008-1218

License: CC BY-NC 4.0

Published Online: 01-08-2019

Copyright Statement:  Copyright © 2017; The Author(s).


Abstract

Aim: We present a novel surgical technique for repair of persistent and symptomatic cyclodialysis clefts refractory to conservative or minimally invasive treatment. Background: Numerous surgical techniques have been described to close cyclodialysis clefts. The current standard approach involves intraocular repair of cyclodialysis clefts underneath a full-thickness scleral flap. Technique: Our technique employs intraoperative use of a direct gonioscope to guide a nonpenetrating surgical repair. Subsequently, a significantly less invasive, nonpenetrating technique utilizing a partial-thickness scleral flap can be performed that reduces potential risks associated with intraocular surgery. The direct gonioscope is also used for confirmation of adequate surgical closure of the cyclodialysis cleft prior to completion of surgery. This technique has been successfully carried out to repair traumatic chronic cyclodialysis clefts associated with hypotony in two patients. There were no significant adverse events as a result of using this technique. Conclusion: The novel technique described increases the likelihood of successful and permanent repair of cyclodialysis clefts with resolution of symptoms associated with hypotony, through direct intraoperative visualization of the cleft. Clinical significance: Gonioscopically guided nonpenetrating cyclodialysis cleft repair offers significant benefits over previously described techniques. Advantages of our technique include gonioscopic cleft visualization, enabling accurate localization of the area requiring repair, and subsequent confirmation of adequate closure of the cleft. Using a partial-thickness scleral flap is also less invasive and reduces risks associated with treatment of this potentially challenging complication of ocular trauma. How to cite this article: Rodrigues IAS, Shah B, Goyal S, Lim S. Gonioscopically Guided Nonpenetrating Cyclodialysis Cleft Repair: A Novel Surgical Technique. J Curr Glaucoma Pract 2017;11(1):31-34.


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  1. Fuchs E. Ablosung der Aderhaut nach Staaroperation. Graefes Arch Clin Exp Ophthalmol 1900;51(2):199-224.
  2. Malandrini A, Balestrazzi A, Martone G, Tosi GM, Caporossi A. Diagnosis and management of traumatic cyclodialysis cleft. J Cataract Refract Surg 2008 Jul; 34(7):1213-1216.
  3. Küchle M, Naumann GO. Direct cyclopexy for traumatic cyclodialysis with persisting hypotony: report in 29 consecutive patients. Ophthalmology 1995 Feb;102(2):322-333.
  4. Ormerod LD, Baerveldt G, Sunalp MA, Riekhof FT. Management of the hypotonous cyclodialysis cleft. Ophthalmology 1991 Sep;98(9):1384-1393.
  5. Joondeph HC. Management of postoperative and posttraumatic cyclodialysis clefts with argon laser photocoagulation. Ophthalmic Surg 1980 Mar;11(3):186-188.
  6. Harbin TS Jr. Treatment of cyclodialysis clefts with argon laser photocoagulation. Ophthalmology 1982 Sep;89(9): 1082-1083.
  7. Barasch K, Galin MA, Baras I. Postcyclodialysis hypotony. Am J Ophthalmol 1969 Oct;68(4):644-645.
  8. Maumenee AE, Stark WJ. Management of persistent hypotony after planned or inadvertent cyclodialysis. Am J Ophthalmol 1971 Jan; 71(1 Part 2):320-327.
  9. Krohn J. Cryotherapy in the treatment of cyclodialysis cleft induced hypotony. Acta Ophthalmol Scand 1997 Feb;75(1): 96-98.
  10. Vannas M, Bjorkenheim B. On hypotony following cyclodialysis and its treatment. Acta Ophthalmol (Copenh) 1952;30(1):63-64.
  11. Kato T, Hayasaka S, Nagaki Y, Matsumoto M. Management of traumatic cyclodialysis cleft associated with ocular hypotony. Ophthalmic Surg Lasers 1999 Jun;30(6):469-472.
  12. Parikh RS, Parikh SR, Thomas R. Surgical repair of cyclodialysis cleft. J Curr Glaucoma Pract 2008 May-Aug;2(2):41-44.
  13. Agrawal P, Shah P. Long-term outcomes following the surgical repair of traumatic cyclodialysis clefts. Eye 2013 Dec;27(12):1347-1352.
  14. Ormerod LD, Baerveldt G, Green RL. Cyclodialysis clefts: natural history, assessment and management. In: Weinstein GW, editor. Open angle glaucoma. New York (NY): Churchill Livingstone; 1986. p. 201-225.
  15. Brooks AM, Troski M, Gillies WE. Noninvasive closure of a persistent cyclodialysis cleft. Ophthalmology 1996 Nov;103(11):1943-1945.
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