Cyclodialysis Cleft

A patient with no significant PMHx presented to BPEI one day after being hit with a giant rubber band in his left eye. Visual acuity of the left eye was hand motion and IOP was 21 mmHg. Examination revealed a hyphema, vitreous hemorrhage, and shallow choroidal detachments. The patient was started on topical steroids and atropine. By three weeks the hyphema, and by two months the vitreous hemorrhage had resolved, however, the patient still had poor VA and the IOP was 7 mmHg. The patient was subsequently diagnosed with a cyclodialysis cleft, supported by gonioscopy and high res UBM. The patient failed argon laser photocoagulation and underwent direct cyclopexy three months after the initial injury. The patient did not experience a post-operative IOP spike and at post-op month 2, his BCVA had improved to 20/60 and IOP was 17 mmHg. Cyclodialysis clefts are rare, though are a well-recognized cause of hypotony. Clefts are important to recognize as most do not spontaneously resolve and treatment may be multifactorial, encompassing medical, laser, and surgical therapies to allow for best visual outcomes.

Presentation Date: 02/25/2021

Issue Date: 03/12/2021