ABSTRACT

Purpose:

Traumatic 360° or anular ciliochoroidal detachment (ACCD) asociated with cyclodialysis cleft (CC) produces ocular hypotony (OH). OH below 10 mmHg, reduces visual acuity due to hypotonic maculopathy (HM). Severe ocular hypotony (SH), below 5 mmHg, can progress to phthisis bulbis due to diffuse choroidal detachment. Treatments for ACCD asociated with CC have shown discouraging results on the literature opposite to when ciliochoroidal detachment with CC is localized in 1 or 2 quadrants We evaluated an encircling scleral buckling procedure for the treatment of ACCD asociated with CC and its devastating consequences.

Methods:

Retrospective case series. Four (4) male patients with ocular contusion trauma presented SH. Diagnosis of ACCD asociated with CC was confirmed by ultrabiomicroscopy (UBM). Three (3) patients were naive of treatment and 1 had history of a previous unsuccessful vitrectomy with direct ciclopexy. In the 4 cases an encircling scleral buckling procedure was performed by 3 different surgeons using the following explants: sponge Mira 503, E240, E40. Sutures with nylon 5-0 were done in the 4 quadrants, 2 mm back from muscles insertion and adjusted to produce a high indentation. Complete ophthalmic examination and UBM were done pre and postoperatively.

Results:

Demographic, LogMAR BCVA, IOP mmHg and UBM status pre and postoperative are shown in Table 1. All patients step out their SH or prephthisical status. In 3 patients IOP level returned to normal, HM dessapeared and BCVA improved to+0.10 or +0.00. In the 4 th patient, improvement was registered in IOP (from 2 to 8 mm Hg), in HM and visual acuity was observed; although BCVA improvement was contrarrested by a posterior subcapsular 2+ development. The LogMAR BCVA average improved from of +0,50 at baseline to +0.15 at last visit. The difference was statistically significant P=0,0123. The IOP average improve from 2,5 mmHg at baseline to 11 mmHg. It was also statistically significant P=0,0129. However, none had complete resolution of ACCD. There was no complication registered secondary to the circular escleral buckling procedure.

Conclusions:

All patients step out their SH status, therefore living the possibility of phthisis bulbis behind. Normal IOP level was achieved in 3 cases with complete HM resolution and BCVA improvement. The 4th patient registered notoriuos improvement. In this retrospective case series, this easy, safe, and worldwide known technique appears to be a therapeutic option with encouraging results. Statistically significant improvement in IOP and BCVA force the authors to strongly suggest considere the encircling scleral buckling as the last option when in a stepwise treatment approach the rest of the option have failed. And mostly for the ACCD asociated with cyclodialisis cleft that are the most difficult to treat with succes with the actual therapeutics techniques. Further studies are needed to guarantee this new therapeutic indication and its possible mechanisms.


CONTACT DETAILS

 

Eleonora Beatriz LAVAQUE*, Mariano IROS, Alberto ZAMBRANO
Hospital Oftalmológico Santa Lucía
Buenos Aires, Argentina
Email: eblavaque@hotmail.com
Cell Phone: +5491156458302
Work Phone: +541148124494