1/113. Management of traumatic cyclodialysis cleft associated with ocular hypotony. BACKGROUND AND OBJECTIVE: To evaluate the efficacy of direct cyclopexy for treatment of traumatic cyclodialysis cleft associated with ocular hypotony. patients AND methods: Eyes with traumatic cyclodialysis cleft were treated with direct cyclopexy or 1.0% atropine eyedrop. RESULTS: Five eyes with a large cyclodialysis cleft were treated with direct cyclopexy. Postoperatively, these eyes obtained normal intraocular pressure. Four of the 5 eyes had good visual acuity, and 1 eye that had preoperative subretinal hemorrhage in the macula had poor visual acuity. Of the 3 eyes treated with 1.0% atropine eyedrops, 1 had good visual acuity, and 2 with retinal folds had fairly good and poor visual acuity. CONCLUSION: The present study showed that direct cyclopexy is useful for the treatment of traumatic cyclodialysis cleft associated with ocular hypotony, and that the cyclodialysis should be surgically treated before irreversible retinal folds develop. ( info) |
2/113. Elastic cord-induced cyclodialysis cleft and hypotony maculopathy. We describe a case of hypotony maculopathy in which hypotony was due to a cyclodialysis cleft produced by an elastic cord injury. Sixteen months after being hit with an elastic cord, a 43-year-old white male presented with progressive loss of vision in the right eye. The visual acuity in the right eye was 1/200 due, in part, to a subluxated and cataractous lens. The intraocular pressure (IOP) was 4 mm Hg. gonioscopy revealed a cyclodialysis cleft at the 2 o'clock position, and fundus examination showed hypotony maculopathy. The patient underwent pars plana vitrectomy, pars plana lensectomy, repair of the cyclodialysis cleft, placement of an anterior chamber intraocular lens, and tightly sutured trabeculectomy without antimetabolite. Sixteen months following surgery, visual acuity was stable at 20/60 and IOP was 11 mm Hg but the chorioretinal folds persisted. ( info) |
3/113. ciliary body detachment caused by capsule contraction. A 74-year-old woman developed capsule contraction associated with hypotony and choroidal effusion 18 months after uneventful phacoemulsification with 3-piece poly(methyl methacrylate) intraocular lens implantation. Ultrasound biomicroscopy revealed ciliary body detachment and stretched zonules. A radial neodymium: YAG anterior capsulotomy was performed, resulting in the resolution of the ciliary body detachment and choroidal effusion as well as in normal intraocular pressure over 4 days. ( info) |
4/113. Treatment of hyperfiltering blebs with Nd:YAG laser-induced subconjunctival bleeding. PURPOSE: To assess the feasibility of a new technique to manage hyperfiltering blebs after penetrating glaucoma surgery. methods: neodymium:yttrium-aluminum-garnet (Nd:YAG) laser bursts were used to induce bleeding in conjunctival and episcleral vessels in the bleb area to achieve local delivery of autologous blood. RESULTS: In the three cases reported here in which this technique was used, the treatment was successful and safe, leading to resolution of hypotony and reduction of the bleb with no complications. CONCLUSION: Subconjunctival bleeding can be achieved using Nd:YAG laser, and can represent a valuable alternative to autologous blood injection in cases of hyperfiltration after glaucoma surgery. ( info) |
5/113. Combination of autologous blood injection and bleb compression sutures to treat hypotony maculopathy. PURPOSE: To report successful use of a combination of autologous blood injection and bleb compression sutures to treat overfiltration with hypotony maculopathy after trabeculectomy with mitomycin C. methods: Two patients underwent the combined procedure and were followed until visual acuity and intraocular pressure (IOP) were stable over three consecutive visits (4 to 9 months). RESULTS: Both patients experienced improvement in visual acuity both subjectively and objectively, and both patients had an elevation in IOP that persisted over three consecutive visits. CONCLUSIONS: Combination autologous blood injection and bleb compression suture placement may be an effective means of treating hypotony maculopathy after trabeculectomy with mitomycin C. ( info) |
6/113. Treatment of a cyclodialysis cleft by means of ophthalmic laser microendoscope endophotocoagulation. PURPOSE: To report on the repair of a cyclodialysis cleft by means of endolaser photocoagulation. METHOD: Case report. We describe treatment of a cyclodialysis cleft by means of endolaser photocoagulation with a diode laser. RESULTS: In a 8-year-old boy with pseudophakia and secondary glaucoma in the right eye, combined trabeculectomy/trabeculotomy was performed. Ten months later, the patient was seen with persistent hypotony with a flat filtration bleb. The hypotony was unresponsive to all forms of medical therapy. Reformation of the anterior chamber along with synechialysis revealed a 2.5 clock-hour cyclodialysis cleft by means of gonioscopy. A laser microendoscope probe was used and laser was applied to both the internal scleral and external ciliary body surfaces within the depths of the cleft. Within 3 weeks after treatment, intraocular pressure increased to 15 mm Hg and has remained at that level as of 9 months after the endolaser photocoagulation procedure. CONCLUSION: Endolaser photocoagulation with the ophthalmic laser microendoscope may be an appropriate procedure, after failure of medical therapy, for the diagnosis and repair of a cyclodialysis cleft, especially in the pediatric population. ( info) |
7/113. Choroidal effusions and hypotony caused by severe anterior lens capsule contraction after cataract surgery. PURPOSE: To report the clinical features and management of two patients with pseudophakic anterior capsule contraction with secondary tractional ciliary body detachments and hypotonous choroidal effusions. methods: case reports. RESULTS: In two eyes of two patients with pseudophakia, severe anterior lens capsule contraction and tractional ciliary body detachments, anterior capsulotomy (one Nd:YAG laser, one surgical), was followed by resolution of the ocular hypotony and resolution/nonrecurrence of the choroidal effusions. In both cases, continuous curvilinear capsulorhexis was used during cataract surgery. CONCLUSION: Anterior capsule contraction following pseudophakia may result in tractional ciliary detachment and secondary ocular hypotony. Radial anterior capsulotomy appeared to be effective in both cases. ( info) |
| This case report describes an unusual complication of descemet membrane detachment after anterior chamber reformation to treat a flat anterior chamber and hypotony from a trabeculectomy. This large descemet membrane detachment was unexpectedly associated with a clear cornea. Treatment was conservative, and the descemet membrane detachment spontaneously resolved in 6 months. ( info) |
9/113. indocyanine green angiographic findings in 3 patients with traumatic hypotony maculopathy. PURPOSE: Little is known about the choroidal circulation in human eyes with ocular hypotony. Recently, indocyanine green angiography (IA) became a useful method for examining choroidal circulation. The present study using IA was designed to determine choroidal circulatory disturbances in patients with traumatic hypotony maculopathy. methods: indocyanine green angiography was performed on 3 consecutive patients (3 eyes) with traumatic hypotony. One patient underwent IA using an infrared fundus camera only during the hypotony stage. The other 2 patients underwent IA using a scanning laser ophthalmoscope before and after recovery of intraocular pressure (IOP). RESULTS: During the hypotony stage, IA revealed multiple hypofluorescent spots in many parts of the fundus, sector hypofluorescent areas, dilatation, and tortuosity of the choroidal vessels in the posterior pole. These findings had not been detected by fluorescein angiography. After surgical treatment, IOP returned to the normal range and visual acuity improved. indocyanine green angiography showed improvement of the sector hypofluorescent areas, and dilatation and tortuosity of choroidal vessels in the posterior pole. However, most of the hypofluorescent spots and regional delay of choroidal filling remained. CONCLUSIONS: indocyanine green angiography revealed that choroidal circulatory disturbances occurred during the hypotony stage and that some remained during the recovery stage. ( info) |
10/113. Cyclodialysis cleft diagnosed by conventional ultrasonography. This case report describes the diagnosis and management of a traumatic cyclodialysis cleft, in the absence of newer investigating modalities like ultrasonic biomicroscopy (UBM). This entity is frequently difficult to recognize clinically owing to the extreme hypotony and media haze that these patients usually present with, which makes gonioscopy particularly taxing. Adding to the diagnostic dilemma is the difficulty in delineating the lesion ultrasonically due to the extreme anterior location of the cleft. In these situations, high frequency ultrasound has been found to be extremely helpful, but the availability of such sophistication is difficult. Presented here is demonstration of the cleft with a microconvex ultrasound probe of 9 MHz frequency. The patient was successfully managed conservatively. This modality could prove to be a valuable adjunct to the diagnosis of such cases even in the situations of nonavailability of high frequency ultrasonography. ( info) |