[Surgical treatment of cyclodialysis].
OBJECTIVE
Cyclodialysis is a rare complication following blunt traumatic bulb injuries or surgical interventions. When treatment with cycloplegics or steroids is ineffective in attaching the ciliary body, cyclodialysis should be surgically treated. However, for reliable diagnosis and surgical therapy, an exact identification (size and extent) of the cyclodialysis cleft is imperative. Ultrasound biomicroscopy (UBM) provides the appropriate information.


METHODS
Four patients (19 to 65 years old, mean 45 years) with a detached ciliary body are described. Three patients had suffered an injury, and one patient presented with a prior trabeculotomy. The diagnosis was established with UBM. The location of the cyclodialysis cleft ranged between 2 and 3 o'clock (mean 2.4 o'clock). In spite of an intense treatment with cycloplegics and steroids no reattachment of the cyclodialysis took place. Therefore, a surgical intervention was performed. The span between the injury and trabeculotomy, respectively, and the cyclodialysis operation ranged from 3 to 30 months (mean 12 months). On average, visual acuity was increased from 0.3 preoperatively to 0.6 postoperatively, and the intraocular pressure was 6 mm Hg before and 15 mm Hg after operation. Symptoms preoperatively found without exception (choroidal detachment, papilledema "e vacuo", macular edema) had a complete recovery after operation.


CONCLUSIONS
In cases where drug therapies are unsuccessful in attaching the ciliary body, an operative fixation is recommended. UBM is a very useful tool for making an exact diagnosis and defining the location of cyclodialysis as well as for follow-up of surgical treatment.
Universitätsaugenklinik der Friedrich-Schiller-Universität Jena. Regine.Augsten@med.uni-jena.de
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Augsten
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Königsdörffer
D000328:Adult; D000368:Aged; D002924:Ciliary Body / Q000000981:diagnostic imaging / Q000187:drug effects / Q000293:injuries* / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D033401:Microscopy, Acoustic; D008875:Middle Aged; D009184:Mydriatics / Q000008:administration & dosage; D013508:Ophthalmologic Surgical Procedures / Q000379:methods*; D013256:Steroids / Q000008:administration & dosage; D016896:Treatment Outcome
D009184:Mydriatics; D013256:Steroids