Objective To explore the surgical techniques, efficacy and the management of complicated ocular trauma with anteriorposterior segment complications such as cyclodialysis.Methods Fifty-five patients (55 eyes) with complicated ocular trauma were enrolled in this study. Among them, there were 35 cases with eyeball contusion and 20 cases of eyeball rupture. Preoperative visual acuity was from no light perception to 0.15, intraocular pressure (IOP) ranged from one to 10 mm Hg(1 mm Hg=0.133 kPa）.Cyclodialysis, vitreous hemorrhage or retinal detachment were revealed by B-ultrasound and ultrasound biomicroscopy (UBM). Cyclodialysis clefts ranged from one to 12 clockhours. All patients underwent 3-port pars plana vitrectomy with gas/silicone oil tamponade and ciliary body reattachment by cryotherapy (cyclodialysis cleftsle;three clock-hours) or suture fixation (cyclodialysis clefts＞three clockhours). Healing after surgical trauma, visual acuity, intraocular pressure, intraocular hemorrhage, ciliary body and retinal reattachment were followed up.Results In one month after surgery, UBM showed 54 patients out of 55 patients had good ciliary body reattachment. Gonioscopy revealed cyclodialysis still existed in one patient, and this was cured by a second surgical suture fixation. In three months after surgery, ocular trauma healed in all 55 patients, the visual acuity ranged from no light perception to 0.15, with a best corrected visual acuity of 0.8. The ciliary body and retina had good reattachment. IOP of 52 patients was normal; IOP of three patients was still lower than 10 mm Hg. Three patients had secondary glaucoma which was treated by glaucoma surgery. Conclusions Complicated ocular trauma with cyclodialysis can be treated with vitrectomy and cryotherapy or transscleral sutures. The procedure is safe and effective.
The cyclodialysis cleft is a rare disease characterized by ocular hypotony and vision loss. Gonioscopy, ultrasound biomicroscopy and anterior segment optical coherence tomography are used to evaluate the cleft before treatment. The evaluation of cyclodialysis clefts provide a basis for the selection of treatment and the evaluation of effect. Current popular therapeutic approaches for cyclodialysis clefts include medical management, laser photocoagulation, transscleral diathermy, cryotherapy, cyclopexy and so on. Medical treatment is effective in small-size cyclodialysis cleft. But the indications and course of medical treatment remains controversial. Although laser photocoagulation, transscleral diathermy and cryotherapy are effective to treat cyclodialysis clefts in some cases, there are some risks, such as ocular damage, uncertainty about the effect and so on. Cyclopexy is the principal method for cyclodialysis clefts that failed to respond to conservative management, including extraocular cyclopexy, intraocular cyclopexy and cyclopexy under endoscopic. The modified cyclopexy is effective which reduces the surgical risk. For keeping the lens, intraocular cyclopexy and cyclopexy under endoscopic are not suitable. Vitrectomy combined with other method for cyclodialysis is effective for cyclodialysis clefts which combined with serious posterior segment damage.