Department of Ophthalmology, China Medical University Hospital, China Medical University, 2 Yuh-Der Road, Taichung City, 40447, Taiwan.
Stanford University School of Medicine, Stanford, CA, USA.
BMC Ophthalmol. 2020 Mar 23;20(1):117. doi: 10.1186/s12886-020-01375-3.
A cyclodialysis cleft often leads to direct communication between the anterior chamber and the suprachoroidal space. It is a rare condition that is encountered with blunt trauma, and less commonly, after surgery. Hypotony is the major sequelae that may lead to hypotonous maculopathy, optic disc edema, corneal folds, and astigmatism. These may cumulatively lead to visual loss. We describe how endoscopy in a cyclodialysis repair allowed us to accurately locate the cleft and guided its appropriate management avoiding unnecessary cryopexy.
A 41-year-old male experienced a traumatic cyclodialysis cleft, which resulted in persistent hypotony. Pars plana vitrectomy was performed to treat vitreous hemorrhage. Scleral indentation was attempted to visualize the cyclodialysis cleft. However, the depression distorted the visualization. Intraocular endoscopy was therefore used to evaluate the cleft. Guided by this assessment, only intraocular gas tamponade was used to reposition the ciliary body. The patient's intraocular pressure was restored to 13 mmHg 3 days after the operation, and OCT confirmed cleft closure 1 month after the operation.
Endoscopy-assisted repair of cyclodialysis is an approach that enhances visualization and can guard against common causes of persistent cleft and hypotony, as well as reveal the causes of recurrent failure. Hence, it can eliminate unnecessary cryopexy that might worsen the hypotonous state. In our case, intraocular endoscopy was effective for the evaluation of a cyclodialysis cleft and the subsequent selection of an appropriate management technique, gas tamponade, that was more conservative than other approaches initially considered.
睫状体分离裂缝常导致前房和脉络膜上腔之间直接相通。这是一种罕见的情况，通常发生在钝性创伤后，较少见于手术后。低眼压是主要的后遗症，可能导致低眼压性黄斑病变、视盘水肿、角膜皱褶和散光。这些可能会累积导致视力丧失。我们描述了在睫状体分离修复中使用内窥镜如何准确定位裂缝，并指导适当的管理，避免不必要的冷冻治疗。
一名 41 岁男性因创伤性睫状体分离裂缝导致持续性低眼压。行玻璃体切割术治疗玻璃体积血。试图进行巩膜压陷以观察睫状体分离裂缝，但凹陷会扭曲视野。因此，使用眼内内窥镜评估裂缝。根据这一评估，仅使用眼内气体填充来重新定位睫状体。术后 3 天，患者眼内压恢复至 13mmHg，术后 1 个月 OCT 证实裂缝闭合。
内窥镜辅助修复睫状体分离是一种增强可视化的方法，可以防止常见的持续性裂缝和低眼压的原因，并揭示复发性失败的原因。因此，它可以消除可能使低眼压状态恶化的不必要的冷冻治疗。在我们的病例中，眼内内窥镜对于评估睫状体分离裂缝和随后选择适当的治疗技术（气体填充）非常有效，这种方法比最初考虑的其他方法更保守。
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