[Treatment of post-traumatic cyclodialysis using by direct cyclopexy]

We report 2 cases of posttraumatic cyclodialysis treated by direct cyclopexy. We decided to operate because of the presence of a macular and disc oedema after an ocular chronic hypotony.

The case was a blunt ocular trauma and the other case a perforating injury. For the latter, a cycloplegic treatment was ineffective. The ocular hypotony persisted 2 months in the first case and 2 and a half years in the second. In both cases, the hypotony was major (0mmHg) and the cyclodialysis cleft was extended to 90 degrees (in the superior temporal quadrant and the inferior nasal quadrant). A direct cyclopexy was performed with cilioscleral sutures with 10-0 monofilament.

One patient presented a moderate and temporary postoperative hypertony. The maximal follow-up was 9 months: ocular tonus was normalized (10 and 11mmHg), the fundus aspect was improved, and visual acuity was either the same (hand movement perception) or increased from 0.1, 14 to 1.0, 2 on the Parinaud scale.

The direct cyclopexy was effective in both cases. It precisely defined the cyclodialysis limits, it allowed the suprachoroïdal fluid to drain and restored the anatomic features. Moreover, it allowed treating larger cyclodialysis for which a simple laser treatment would be incomplete. On the other hand, it was invasive intraocular surgery which presented risks of hemorrhage, infection and retinal detachment.

The direct cyclopexy is an advisable method in the treatment of cyclodialysis. It normalized an ocular tonus and improved of hypotonus retinopathy. However, vision remained sometimes limited because of the posttraumatic sequels are or ocular hypotony that was too lengthy.