Gonioscopically Guided Nonpenetrating Cyclodialysis Cleft Repair: A Novel Surgical Technique

Abstract

Aim: We present a novel surgical technique for repair of persistent and symptomatic cyclodialysis clefts refractory to conservative or minimally invasive treatment.

Background: Numerous surgical techniques have been described to close cyclodialysis clefts. The current standard approach involves intraocular repair of cyclodialysis clefts underneath a full-thickness scleral flap.

Technique: Our technique employs intraoperative use of a direct gonioscope to guide a nonpenetrating surgical repair. Subsequently, a significantly less invasive, nonpenetrating technique utilizing a partial-thickness scleral flap can be performed that reduces potential risks associated with intraocular surgery. The direct gonioscope is also used for confirmation of adequate surgical closure of the cyclodialysis cleft prior to completion of surgery. This technique has been successfully carried out to repair traumatic chronic cyclodialysis clefts associated with hypotony in two patients. There were no significant adverse events as a result of using this technique.

Conclusion: The novel technique described increases the likelihood of successful and permanent repair of cyclodialysis clefts with resolution of symptoms associated with hypotony, through direct intraoperative visualization of the cleft.

Clinical significance: Gonioscopically guided nonpenetrating cyclodialysis cleft repair offers significant benefits over previously described techniques. Advantages of our technique include gonioscopic cleft visualization, enabling accurate localization of the area requiring repair, and subsequent confirmation of adequate closure of the cleft. Using a partial-thickness scleral flap is also less invasive and reduces risks associated with treatment of this potentially challenging complication of ocular trauma.

How to cite this article: Rodrigues IAS, Shah B, Goyal S, Lim S. Gonioscopically Guided Nonpenetrating Cyclodialysis Cleft Repair: A Novel Surgical Technique. J Curr Glaucoma Pract 2017;11(1):31-34.

Keywords: Cyclodialysis cleft; Direct gonioscope; Hypotony; Ocular trauma..

Figs 1A to C:

(A) Intraoperative view with direct gonioscope of cyclodialysis cleft (black arrow) with scars from previous thermal laser visible on the iris; (B) partial-thickness scleral flap is created overlying the cyclodialysis cleft; and (C) center of the cyclodialysis cleft is identified using a direct gonioscope with indentation of the sclera (white arrow) and marked with pen

Figs 2A to C:

(A) Full-thickness 8/0 nylon suture is inserted through the sclera parallel to the limbus across the marked central point of the cyclodialysis cleft; (B) additional full-thickness 8/0 nylon sutures are added parallel to the limbus in order to fully close the cyclodialysis cleft; and (C) complete closure of the cyclodialysis cleft is confirmed intraoperatively with a direct gonioscope prior to closure of the scleral flap and conjunctiva