Cyclopexy versus vitrectomy combined with intraocular tamponade for treatment of cyclodialysis

Abstract

Aim: To compare the effects and complications of direct cyclopexy (DC) versus vitrectomy, endophotocoagulation, and gas/silicone oil endotamponade (VEE) treatment in patients with cyclodialysis and persistent hypotony.

Methods: This is a prospective, comparative, nonrandomized clinical trial which includes 52 patients with cyclodialysis and persisting hypotony. Fifty-two patients suffering from cyclodialysis and persistent hypotony in one eye were divided into 2 groups (groups DC and VEE) and treated, respectively, with direct cyclopexy or vitrectomy, endophotocoagulation, and gas/silicone oil endotamponade. The patients were followed up for 12 months. Assessments included best corrected visual acuity (BCVA), intraocular pressure (IOP), anterior chamber depth (ACD), anterior chamber volume (ACV) and subjective rating of the pain caused by the treatments.

Results: After a follow-up of 12 months, significant improvement was seen in postoperative mean BCVA, IOP, ACD and ACV in both treatment groups (which were not significantly different from each other). The success rates for the treatments were not significantly different (DC: 50.0% vs VEE: 62.5%, P=0.383). Postoperative morbidity of cataract and subjective pain rating were significantly higher in the VEE group vs the DC group (P= 0.003 and P<0.001 respectively).

Conclusion: DC and VEE were effective surgical procedures in treating patients with cyclodialysis and persistent hypotony. Patients had better tolerance to DC treatment and VEE was more likely lead to cataract complications. Taking into consideration the ease of the operation, success rate, and patient comfort, DC treatment seems preferable to VEE treatment in patients with simple cyclodialysis. While VEE has the advantage of treating patients with cyclodialysis combined with vitreous hemorrhage.

Keywords: cyclodialysis; cyclopexy; ocular hypotony; vitrectomy.

Figure 1. Pre- and postoperative ulrtasound biomicroscopy (UBM), images of direct cyclopexy (DC) and gas/silicone oil endotamponade (VEE)

A: Before DC surgery UBM showed a cyclodialysis cleft at 2 o'clock (yellow arrow), with the cleft extension from 12 o'clock to 4 o'clock (anterior chamber is to the right); B: Two months after DC surgery the cyclodialysis cleft was closed. The yellow arrows show the location of sutures in the cleft. The red arrow indicates the position of small residual cleft at 1 o'clock; C: Prior to surgery there was a cyclodialysis cleft at 3 o'clock extending from 2 o'clock to 5 o'clock (yellow arrow; anterior chamber is to the right); D: Two months after VEE surgery the cyclodialysis cleft was closed and the gas endotamponade had been completely absorbed.