Cryotherapy for Treatment of Cyclodialysis Cleft Refractory to Argon Laser Treatment

Abstract

Abstract: : Purpose: This presentation demonstrates the role of cryotherapy as an effective treatment for hypotony secondary to traumatic cyclodialysis clefts. Method: We describe the clinical course of a 54 year-old man treated with a one year history of hypotony (4mmHg) and decreased vision secondary to a traumatic cylcodialysis cleft. Presence of the cleft 1 clock hour and choroidal folds were noted after removal of a dense traumatic cataract. Conventional argon green laser photocoagulation closure of the cleft was attempted over three separate sessions separated by one month. A total of 122 laser applications to the internal and external walls of the cleft were performed with ascending powers from 0.5-1.1 watts, duration 0.1-0.5 seconds using a Goldman 3 mirror speculum. A second line therapy was then instituted one month after the failed last laser treatment utilizing cryotherapy. A single treatment using a cryotherapy probe applied to the external sclera, 1mm posterior to the limbus over the area of the cleft. End point for cryotherapy application was freezing of the vitreous overlying the ciliary body seen on direct transpupillary visualization. The patient was followed for 1.5 years. Results: Hypotony and visual acuity failed to improve after three sessions with conventional argon green laser photocoagulation of the cleft. Cryotherapy was then used to treat the cleft externally. Within 2 weeks after treatment, intraocular pressure increased to 19mm Hg and has persisted at approximately 20 mmHg for 1.5 years after the therapy. Final visual acuity was 20/200. Conclusion: Cryotherapy appears to be a more effective treatment for hypotony and choroidal folds secondary to traumatic cyclodialysis clefts than argon laser treatment. Cryotherapy may be an appropriate first line therapy for this condition. Further studies will be needed to elucidate the efficacy and potential complications of cyrotherapy for cyclodialysis clefts.

Keywords: 318 anterior segment • 609 treatment outcomes of cataract surgery • 345 choroid