Cyclodialysis cleft repair with scleral band-buckle encircla
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A 51-year-old male presented with reduced vision in the left eye for two months, which occurred immediately following blunt trauma to the eye. The patient had sought medical care elsewhere, where he was diagnosed with hyphema in the left eye and was treated with cycloplegics and oral and topical steroids. The patient was a known hypertensive but had no history of any other systemic illness. On ocular examination, BCVA was 20/20 in the right eye (OD) and 20/200 OS with no improvement on pinhole. Intraocular pressure (IOP) was 6 mm of Hg (left eye) and 16 mm of Hg right eye. Central corneal thickness was slightly elevated at 572 ?m indicating corneal edema in the left eye.

Slit-lamp examination revealed no abnormal findings in the right eye. There was a traumatic posterior subcapsular rosette cataract in left eye. Slit-lamp retro-illumination showed sectoral iridodialysis of 1.5 clock hours from 6:30 to 8 o'clock in the left eye. Fundus examination (left eye) and color fundus photography showed vascular tortuosity. Increased choroidal thickness was documented on USG B-scan which was suggestive of generalized choroidal effusion. The posterior pole and disc appeared blurry due to the presence of a traumatic cataract; the retina was attached.

Ultrasound biomicroscopy of the left eye revealed a cyclodialysis cleft. Gonioscopy of the right eye was normal. Gonioscopy of left eye revealed the presence of iris root detachment corresponding to the iridodialysis seen on anterior segment examination and the presence of ciliary body detachment from the scleral spur. A diagnosis of traumatic persistent cyclodialysis cleft with hypotony maculopathy and traumatic posterior subcapsular rosette cataract left eye was made. Since the IOP had not improved, even after two months of medical management, surgical options were considered.

Relative to the equatorial plane, anterior placement of a scleral band-buckle encirclage was performed in OS. A 360° conjunctival peritomy was performed under local peribulbar anesthesia. All four rectus muscles were bridled, and the scleral surface was examined in all four quadrants after clearing away Tenon's capsule. A 240-style silicone band (Labtician®) was used, whose posterior edge was placed at 9 mm from the limbus (to support the ciliary body in its posterior extent) and anteriorly hugging the insertion of all four rectus muscles along the ‘spiral of Tillaux’. The band was secured using 5-0 braided polypropylene (Dacron®) mattress sutures in each quadrant. The band was tied end-to-end in the lower-nasal quadrant; care was taken not to over-tighten the band inadvertently since the eye was already in the state of hypotony. Intraocular pressure was digitally assessed, and the conjunctiva was closed using 7–0 coated polyglactin (Vicryl®) sutures. The postoperative course showed closure of the cleft with an IOP of 20 mm Hg on day 4. The patient underwent cataract extraction with intraocular lens implantation at two months and improved to 20/40 at the last follow up visit with a normal IOP.

An encircling silicone band could be considered a safe and effective alternative surgical treatment modality for traumatic, non-resolving cyclodialysis cleft with persistent hypotony. This technique may form the first line of surgical management after unsuccessful medical management. Invasive intraocular surgery may be undertaken in recalcitrant cases that fail to respond to extraocular procedures. However, larger comparative studies need to be undertaken in the future in order to confirm these findings.