Medical, laser, and surgical management of inadvertent cyclodialysis cleft with hypotony.

Cyclodialysis cleft is the result of separation of the meridonal ciliary muscle fibers from the scleral spur, thereby providing a new drainage pathway of aqueous humor into the suprachoroidal space. Cyclodialysis has been used as a surgical option for aphakic glaucoma but more often occurs inadvertently during anterior segment surgery or because of blunt ocular trauma. The new drainage channel increases uveoscleral outflow and may result in chronic ocular hypotony. Choroidal effusion, cystoid macular edema, optic nerve edema, engorgement and stasis of retinal veins, retinal folds, shallow anterior chamber, and cataract are recognized complications of chronic ocular hypotony. Medical management of inadvertent cyclodialysis cleft is a trial of topical 1% atropine sulfate for 6 to 8 weeks. Topical or systemic corticosteroid therapy is not indicated. If medical management is ineffective, noninvasive methods of cleft closure, such as argon laser photocoagulation to the cleft, should be attempted. Should conservative therapy fail, then surgical closure of the cleft is the final option. We describe 7 patients who had an inadvertent cyclodialysis cleft that occurred following uneventful extracapsular cataract extraction with posterior chamber intraocular lens implantation in 5 patients, blunt trauma in 1 patient, and trabeculotomy in 1 patient (Table). Their ocular hypotony was successfully treated with topical 1% atropine in 4 patients, argon laser photocoagulation in 2 patients, and surgical closure in 1 pediatric patient.