Cyclodialysis Cleft following Intravitreal Injection; Case Report

To report an uncommon complication arising from an intravitreal injection (IVI).

This case describes ocular hypotony secondary to a cyclodialysis cleft following an IVI, including its management.

A 68-year-old male presented with a 5-month history of persistent hypotony and vision loss in the left eye following an intravitreal antivascular endothelial growth factor (anti-VEGF) injection. His history included rhegmatogenous retinal detachment in the right eye and chronic central serous chorioretinopathy with macular neovascularization in the left eye, treated with intravitreal anti-VEGF injections for 5 years. Clinical findings included best-corrected visual acuity (BCVA) of 20/1600 (right) and 20/150 (left), with intraocular pressure (IOP) of 16 mmHg (right) and 4 mmHg (left). Slit-lamp exam of the left eye revealed a deep pseudophakic anterior chamber, resolving vitreous hemorrhage, and chorioretinal folds without retinal breaks. Gonioscopy identified a suspected cyclodialysis cleft inferotemporally, which was confirmed by 50 MHz ultrasound biomicroscopy (UBM). The patient was treated with intraoperative argon laser photocoagulation (120 shots, 300 mW), targeting the cleft through a corneal incision. UBM, the next day, confirmed cleft closure and ciliary body reattachment. A transient IOP spike to 42 mmHg was medically controlled. Over the following weeks, IOP stabilized between 10 and 15 mmHg without medications, and optical coherence tomography showed resolution of chorioretinal folds and subretinal fluid. Final BCVA improved to 20/70 (left eye) and 20/800 (right eye postcataract surgery).

This report underscores a rare complication of IVIs and highlights the critical role of UBM in achieving accurate diagnostic assessment.