Management of the hypotonous cyclodialysis cleft

Authoritative experience in the management of hypotonous cyclodialysis clefts is difficult to obtain because of their rarity. In this study, the authors describe nine patients with hypotonous cyclodialyses clefts: six patients were treated successfully with argon laser photocoagulation to the cleft surfaces; in one patient, cleft diathermy was used to seal an incompletely closed cleft after a single argon laser treatment; one patient responded to conservative management; another patient did not require treatment. Four cases followed ocular trauma and five occurred after extracapsular cataract extraction and posterior chamber intraocular lens implantation. In three patients, the anterior chamber was too shallow to permit gonioscopy; sodium hyaluronate (Healon) was used to reform the anterior chamber, to delineate the extent of the cyclodialysis cleft, and to provide maximal access for the argon laser treatment. In another patient, laser cleft consolidation was successful only after fully opening the cleft with sodium hyaluronate. The evolution of the laser photocoagulation technique used by the authors is described. Laser cyclodialysis cleft consolidation can be repeated easily and safely. The authors recommend argon laser photocoagulation as the primary management approach. Intracameral viscoelastic agents are useful adjuncts. The complications of cleft lasering are minor, although a hypertensive episode commonly occurs in the early postoperative period as the cleft closes. Major intraocular surgeries usually can be avoided.