Cyclodialysis cleft formation following Yamane secondary intraocular lens implantation

To report two cases of hypotony with maculopathy related to cyclodialysis cleft after Yamane intraocular lens (IOL) implantation, and the use of localized transscleral cyclophotocoagulation (TSCPC) to successfully treat this condition.

1. 37 year-old man with childhood BB-gun related injury in the left eye (OS) and traumatic iridodialysis and angle recession underwent pars plana vitrectomy and Yamane IOL placement for subluxed traumatic cataract OS. Postoperative hypotony [intraocular pressure (IOP) 5-6 mmHg] and maculopathy with best corrected vision acuity (BCVA) of 20/200 at 1 month postoperative prompted referral, and localized TSCPC was performed. Nine days later sudden elevation of IOP occurred, responsive to treatment, and the hypotony and maculopathy resolved. 2. 87 year-old man with prior OS retinal detachments treated with scleral buckling, pars plana vitrectomy x 2, and cataract extraction with sulcus IOL ranging from 8 to 37 years prior presented with temporal sulcus IOL haptic penetration through the iris and dense vitreous hemorrhage. He underwent pars plana vitrectomy, IOL explantation and Yamane IOL placement OS. Postoperative hypotony (IOP 1-4 mmHg) and maculopathy with evidence of cyclodialysis cleft on ultrasonography at 1 month postoperative prompted referral. The patient underwent 2 rounds of localized TSCPC; after his second treatment, IOP ranged from 9 to 14 mmHg over the next 8 months and maculopathy resolved.

We highlight the risk of development of cyclodialysis cleft after Yamane IOL placement in highly traumatized eyes, and the benefit of localized TSCPC in such cases for cleft closure.