Direct cyclopexy for traumatic cyclodialysis with persisting hypotony. Report in 29 consecutive patients.

Abstract

Traumatic or postoperative cyclodialysis frequently is associated with persisting ocular hypotony, causing morphologic changes and visual loss. The authors retrospectively analyzed the data of 29 eyes of 29 patients who underwent consecutive direct surgical cyclopexy for hypotonus cyclodialysis between 1980 and 1993 at the authors' institution. Cyclopexy was performed by directly suturing the ciliary body to the scleral spur under a scleral flap. The cyclodialysis clefts were posttraumatic (26 eyes) or postsurgical (3 eyes), extended for 3.6 +/- 1.7 clock hours (range, 1.5-9.5 clock hours), and were most frequently located superiorly. In eight eyes, argon laser photocoagulation of the cyclodialysis cleft (1-11 sessions) was performed before surgical cyclopexy but failed to permanently close the clefts. Preoperatively, all eyes showed persisting ocular hypotony with intraocular pressure of 3.1 +/- 2.3 mmHg (range, 0-8 mm Hg), macular edema, and disc swelling. Postoperatively, intraocular pressure was 14.0 +/- 3.7 mmHg (range, 6-20 mmHg), and visual acuity improved in 25 eyes (86%) and remained unchanged in 4 (14%) because of posttraumatic posterior segment problems. In 14 eyes, painful reversible pressure spikes of up to 58 mmHg developed during the first postoperative days, but no persisting secondary glaucoma was observed during further follow-up of 37.7 +/- 35.9 months (range, 2-134 months). All ten phakic eyes that were refracted preoperatively and postoperatively showed hyperopic shifts of more than 1 diopter after cyclopexy. Direct surgical cyclopexy is a successful treatment for large hypotonus cyclodialysis clefts that are unresponsive to or too large for laser photocoagulation. Painful early postoperative pressure spikes are frequent, but the development of glaucoma seems to be very uncommon. Postoperative visual acuity may be compromised due to posterior segment sequelae of preceding ocular trauma.