Retina-sparing suprachoroidal intraocular foreign body resulting in cyclodialysis cleft

Suprachoroidal intraocular foreign bodies (IOFBs) are an exceedingly rare manifestation of ocular trauma. Here we present a unique case of a metallic wire tracking from the cornea through the suprachoroidal space, and remarkably sparing the retina and lens. The patient attained an excellent visual outcome after management of resultant cyclodialysis cleft.

A 34-year-old male experienced a penetrating IOFB while operating a rotary wire brush. He presented to the emergency department where posterior involvement of the IOFB was confirmed on CT scan. He underwent emergent pars plana vitrectomy, during which the IOFB was found to be located underneath intact retina and choroid on scleral depression. The wire was removed through the entry wound, which was self-sealing. At follow up, intraocular pressure was 3 mmHg with findings of hypotony. A cyclodialysis cleft was confirmed with ultrasound biomicroscopy. Cycloplegic and photocoagulation treatments were attempted, but ultimately direct cyclopexy was performed to successfully repair the cleft. One year after the initial incident, visual acuity is 20/25 and IOP is 17 mmHg.

Cyclodialysis cleft is a rare sequela of penetrating ocular injury. Clinicians should consider the presence of a cyclodialysis cleft in the setting of postoperative hypotony and confirm either with gonioscopy or other anterior segment imaging methods. Despite failure of conservative therapies, our patient had an excellent visual outcome following surgical closure of the cleft.