Cyclodialysis Cleft After Atent Implantation

Patient with history of primary open angle glaucoma presented with persistent hyphema and hypotony after combined cataract surgery and implantation of a stent. Vision on presentation was hand motion with an intraocular pressure of 6. Exam was notable for 80% hyphema. B-scan showed vitreous hemorrhage with choroidal detachment and thickening. Ultrasound bio-microscopy showed a cyclodialysis cleft. Surgery was initiated with an anterior chamber washout that revealed a stent implanted in the peripheral iris with a large cyclodialysis cleft extending from 7 to 11 o'clock. The device was carefully removed using a side-port blade and retina grasping forceps. Next, repair of the cyclodialysis cleft was performed using endolaser set at 450mW on continuous wave setting applied directly to the cleft and overlying trabecular meshwork/sclera. Additionally, a pars plana vitrectomy was performed and the eye was filled with 24% SF6 gas. At post-operative week 16, VA had improved to 20/50 with an intraocular pressure of 3. B-scan showed resolution of vitreous hemorrhage and choroidal detachments. Gonioscopy shows a closed cleft with PAS however ultrasound bio-microscopy shows an area of persistent separation of uvea. Considerations for further treatment include observation vs. Sub-tenon's steroid injection vs. Additional pars plana vitrectomy with injection of silicone oil for further tamponade.

Presentation Date: 12/21/2023

Issue Date: 01/05/2024