Surgical reconstruction of traumatic ciliary body dialysis: a case report

BACKGROUND: A cyclodialysis cleft is a gap resulting from disruption of the longitudinal fibers constituting the ciliary body attachment to the scleral spur. The cyclodialysis cleft can be of traumatic or iatrogenic origin, and it may occur during intraocular surgery or as a result of a glaucoma operation. In this report we present a surgical technique to treat cyclodialysis: cyclopexy combined with phacoemulsification subluxation lens, transscleral suturing of Cionni ring, and intraocular lens implantation with iris cerclage suture. CASE PRESENTATION: A 44-year-old Polish woman experienced a traumatic cyclodialysis cleft in her left eye, complicated by persistent hypotony, maculopathy, lens subluxation, and pupillary sphincter injury. Her corrected distance visual acuity was 0.1 (Snellen chart) and intraocular pressure 3.0 mmHg. We performed direct cyclopexy, anterior vitrectomy, removal of the subluxated lens by phacoemulsification, followed by an insertion of a capsular tension ring with 1-point scleral suture fixation with implantation of intraocular lens in the capsular bag and suturing around the pupil. Anterior segment optical coherence tomography revealed closure of the cleft by reattachment of the ciliary body to the sclera spur. Her corrected distance visual acuity was 0.8 and intraocular pressure 18 mmHg. CONCLUSIONS: The choice of operating technique depends on the area of the ciliary body dialysis, the number of clefts and their location, the presence of other abnormalities of the ocular structures, and the surgical skills of the operator. Cyclopexy combined with phacoemulsification and transscleral suturing of Cionni ring and intraocular lens implantation with iris cerclage suture can be a good solution in cases of this type. The applied surgical technique proved to be effective.