Cryotherapy for the management of refractory hypotony secondary to post-goniotomy cyclodialysis cleft

PURPOSE: To report on the management of an unusual case of post-goniotomy hypotony. OBSERVATION: A 41-year-old female with pigmentary glaucoma presented with a post-goniotomy cyclodialysis cleft and signs of hypotony maculopathy. Indirect cyclopexy closed the visible cleft but did not resolve her hypotony, despite neither ultrasonographic nor gonioscopic evidence of an open cleft or communication channel. Cryotherapy-induced cyclopexy and subsequent viscoelastic agent fill increased the intraocular pressure back to baseline. CONCLUSIONS: This is the first reported case of cryotherapy correcting hypotony in a patient with no gonioscopic or ultrasonographic evidence of a cyclodialysis cleft. It demonstrates the utility of cryotherapy in the management of persistent ocular hypotony despite no detectable channel of aqueous outlet.