Treatment approaches for large traumatic cyclodialysis clefts in phakic eyes: A systematic review and proposal for...

Cyclodialysis cleft (CDC) is an uncommon but potentially vision-threatening condition characterized by separation of the ciliary body from the scleral spur, often causing hypotony and maculopathy. While small clefts may resolve with conservative or minor treatment, large traumatic CDCs in phakic eyes remain challenging due to limited evidence on optimal management. This systematic review aims to evaluate current surgical approaches for repairing large traumatic CDCs in phakic eyes, focusing on success rates, complication profiles, and the impact of treatment timing on outcomes.

A systematic search of three databases was conducted in November 2023, following PRISMA guidelines, to identify peer-reviewed studies and case reports published since 2000. Eligible cases included patients older than 14 years with phakic eyes who underwent treatment for traumatic CDCs involving ≥ 180°. The risk of bias was evaluated using the JBI Critical Appraisal Checklist for Case Reports. Cases were categorized based on primary repair method and compared according to outcomes and complications. Registration was not applicable.

We retrieved 284 publications, out of which 23 met the inclusion criteria, representing 43 eligible cases. No randomized controlled or interventional studies were identified. Mean age was 39 years, average baseline intraocular pressure (IOP) was 3.82 ± 2.31 mmHg, and mean cleft size was 8.6 ± 2.61 clock-hours. The two most common treatment approaches were direct cyclopexy and vitrectomy with or without additions. Successful cleft closure after a single intervention was achieved in 32 cases (74.4%). Vitrectomy-based procedures and direct cyclopexy produced similar postoperative IOP levels, although IOP spikes were more common after direct cyclopexy. Cataract alone did not influence treatment selection, whereas lens instability often necessitated an internal approach. Delayed intervention in eyes with intermediate baseline visual acuity did not appear to worsen outcomes, though late-treated eyes underwent more interventions.

Large traumatic CDCs in phakic eyes were usually managed either externally by cyclopexy or internally with vitrectomy-based procedures, with favorable outcomes in both approaches. The available evidence on treatment approaches is limited by publication bias and inconsistent reporting. Future standardized, structured case reporting is essential to improve comparative evaluation and guide future management strategies.