A Modified Single-Armed Suture Technique for Traumatic Cyclodialysis Cleft with Vitreoretinal Injury

Abstract

Our aim was to assess the therapeutic efficacy of a modified single-arm suture technique on traumatic cyclodialysis cleft with vitreoretinal injury. The procedure involved fixing a detached ciliary body using a single-armed 10-0 polypropylene suture under the assistance of a 29-gauge needle. Patients with a traumatic cyclodialysis cleft combined with an anterior and posterior segment injury who underwent modified internal cyclopexy together with vitreoretinal surgery were enrolled in this study. Ultrasound biomicroscopy (UBM) was used to diagnose and evaluate the cyclodialysis and anterior segment injury. B-scan ultrasonography was performed to assess the condition of the vitreous, retina and choroid. The surgical time and successful rate for repairing the cyclodialysis cleft were recorded. Preoperative and postoperative best-corrected visual acuity (BCVA), and intraocular pressure (IOP) were documented for assessment. The study included 20 eyes. The extent of the cyclodialysis cleft was from 30° to 360°. Besides a traumatic cyclodialysis cleft, the included cases also combined this with vitreous hemorrhages, retinal detachment, macular holes, choroid avulsion, and suprachoroidal hemorrhage. All the clefts were anatomically closed in one surgery. The average surgical time for fixing the cyclodialysis cleft was 2.68 ± 0.54 min/30° cleft. A significant improvement in LogMAR BCVA was observed from 2.94 ± 0.93 preoperatively to 1.81 ± 1.11 at the 6-month follow-up. IOP was elevated from 10.90 ± 6.18 mmHg preoperatively to 14.45 ± 2.35 mmHg at the 6-month follow-up. The modified single-armed suture technique was proved to be an effective method to fix the traumatic cyclodialysis cleft, which could facilitate the use of the procedure to repair chorioretinal disorders. It improved the BCVA and maintained the IOP with less postoperative complications.

Keywords: cyclodialysis cleft; internal cyclopexy; ocular trauma; ultrasound biomicroscopy; vitreoretinal surgery.

Figure 1

Surgical procedures of modified single-suture technique. (A) A needle with a 10-0 polypropylene thread was pierced into the eye at the site of the cyclodialysis cleft. (B) A 29-gauge needle guided the long straight needle to the outside through a corneal limbus incision. (C,D) The needle returned into the anterior chamber, and pierced the other site of the cyclodialysis cleft to the outside with the assistance of the 29-gauge needle. (E) The 10-0 polypropylene thread was tied onto the surface of the sclera and the suture knot was rotated into the eye. (F) Another suture was overlapped with the previous one by approximately 0.5 mm to avoid the residual cleft. (G–J) The suturing maneuver was repeated to attach the ciliary body to the sclera.

Figure 2

Modified single-suture technique was performed on the patient with traumatic cyclodialysis due to zone-3 ruptured-globe injury. (A) Preoperative UBM analysis indicated traumatic cyclodialysis combined with hyphema (white arrow). (B) Postoperative UBM analysis demonstrated cyclodialysis cleft was closed 3 months after silicone-oil removal. (C) On the first postoperative day, the retina attached with silicone oil tamponed. Retinectomy was performed from 8-1 clock in order to separate incarcerated retina from the scleral rupture. (D) Retina remained attached 3 months after silicone-oil extraction with LogMAR BCVA 1.0 and 14 mmHg for IOP.

Figure 3

Modified single-suture technique was performed on the patient with cyclodialysis due to blunt trauma. (A) Traumatic cyclodialysis (white arrow) was found according to preoperative UBM analysis. (B) Cyclodialysis cleft was repaired 4 months after surgery. (C) Preoperative fundus photography indicated dislocation of lens. (D) Postoperative fundus photography at 2 months.

Figure 4

BCVA significantly improved at day 1, day 7, month 1, month 3, and month 6 compared with preoperative BCVA (n = 20). IOP significantly increased at day 1, day 7, month 1, month 3, and month 6 compared with preoperative IOP (n = 20). Abbreviation: Preop: pre-operation; D1: 1 day after cyclopexy; D7: 1 week after cyclopexy; M1: 1 month after cyclopexy; M3: 3 months after cyclopexy; M6: 6 months after cyclopexy. (* p < 0.05, ** p < 0.01, *** p < 0.001).