Ultrasonic biomicroscopic evaluation of cyclodialysis before and after direct cyclopexy

Objectives: To investigate the clinical manifestations and surgical prognoses after direct cyclopexy in patients with traumatic cyclodialysis according to the cleft extent as determined by ultrasound biomicroscopy (UBM). Methods: A detailed ophthalmologic examination, which included gonioscopy and UBM, was performed before and after direct cyclopexy in 32 eyes of 31 patients with traumatic cyclodialysis clefts. Results: Cyclodialysis clefts were accurately diagnosed and delineated in all 32 eyes using UBM. Cyclodialysis resulted in hypotony with a mean intraocular pressure of 3.2 mm Hg irrespective of cleft size. On A-scan ultrasonography, mean (SD) preoperative and postoperative lens thicknesses were 4.4 (0.4) mm (range, 3.71-4.92mm) and 4.1 (0.4) mm (range, 3.42-4.57 mm), respectively, and mean (SD) preoperative and postoperative axial lengths were 23.2 (0.7) mm (range, 21.91-24.57 mm) and 23.6 (0.7) mm (range, 22.47-24.56 mm), respectively. The larger a cleft was, the longer it took for a postoperatively elevated intraocular pressure to normalize after direct cyclopexy. Postoperative visual acuities were significantly better than preoperative values, even when direct cyclopexy was performed 54 months after trauma. Conclusions: Even small clefts usually resulted in hypotony and visual prognosis was better after cyclopexy, even in cases with a protracted history. Larger clefts need longer postoperative follow-up to check for intraocular pressure normalization after direct cyclopexy.