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R. Margolis, C. Sonnie, J. E. Sears; Ultrasound Biomicroscopy-Guided Surgical Intervention for Cyclodialysis Clefts. Invest. Ophthalmol. Vis. Sci. 2008;49(13):5995.
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To report the treatment of cyclodialysis clefts (CDC) by ultrasound biomicroscopy (UBM)-directed external cycloplexy using radial sutures.
A retrospective chart review of all patients with hypotony who underwent UBM at our institution between January 2002 and January 2008 was conducted. The following data was recorded from each medical record: patient age, presumed etiology of hypotony, duration of hypotony, surgical procedure performed, pre- and post-operative UBM findings, complications, intraocular pressure (IOP) prior to surgery and at last follow up, and visual acuity pre-operatively and at last follow up. Direct cyclopexy was performed using interrupted radial 9-0 polyproylene sutures were placed starting approximately 2 to 3 mm posterior to the surgical limbus and extending up to the limbus. The suture needle was passed through full thickness sclera, through ciliary body, and out through sclera.
38% (6/16) of patients with hypotony were diagnosed with a CDC. Two additional patients were judged to have a questionable cleft. Mean age for patients who underwent cyclopexy was 52 years (range 12-80 years). Mean duration of hypotony prior to cyclopexy was 7.5 months (range 1-24 months). 50% (4/8) of patients that underwent cyclopexy experienced an increase in intraocular pressure by an average of 16 mmHg (range 14-28 mmHg). Mean follow-up was 20 months (range 10-36 months). Characteristics of successful outcomes included definite identification of cleft and hypotony duration of less than 3 months. Characteristics of unfavorable outcomes were history of infectious uveitis.
UBM-guided external cyclopexy is an effective treatment option for eyes with severe hypotony due to CDC. Only definite identification of cleft by UBM warrants surgery. Patients with hypotony for greater than 3 months duration and/or history of infectious uveitis may not respond to cyclopexy.
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