Management of Cyclodialysis Clefts and Associated Hypotony

Cyclodialysis clefts arise when the ciliary body detaches from the scleral spur, creating an abnormal channel for aqueous humour outflow and resulting in ocular hypotony. Persistent hypotony may lead to vision-threatening complications such as hypotony maculopathy, choroidal effusions and anterior chamber collapse. Management begins with accurate localisation using gonioscopy, ultrasound biomicroscopy or anterior segment optical coherence tomography. Small clefts may respond to medical therapies or argon laser photocoagulation, which promotes inflammatory adhesion. Larger or persistent clefts often require surgical intervention—ranging from external direct cyclopexy to internal cyclopexy with sutures. Vitrectomy with air or gas endotamponade, encircling scleral buckles and insertion of modified capsular tension rings into the ciliary sulcus have emerged as minimally invasive options that restore intraocular pressure while addressing concurrent lens or posterior segment pathology. Combined approaches increasingly integrate cataract extraction and posterior segment repair in a single session. Early intervention and tailored techniques aim to reduce hypotony duration, preserve visual acuity and minimise postoperative complications.

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Management of Cyclodialysis Clefts and Associated Hypotony publication trend

The graph below shows the total number of articles in management of cyclodialysis clefts and associated hypotony across all publications each year (not limited to Nature Index journals).

Technical terms

Cyclodialysis cleft: A separation between the ciliary body and scleral spur creating an abnormal outflow pathway for aqueous humour.

Ocular hypotony: Intraocular pressure below the normal physiological range, typically defined as <6 mmHg, risking structural and functional damage.

Direct cyclopexy: A surgical technique in which the detached ciliary body is resutured to the sclera through an external approach.

Ultrasound biomicroscopy (UBM): High-frequency ultrasound imaging used to visualise anterior segment structures and detect cyclodialysis clefts.

Capsular tension ring: A flexible ring inserted into the ciliary sulcus or lens capsule to provide internal tamponade and support closure of a cyclodialysis cleft.

References

1. A Modified Single-Armed Suture Technique for Traumatic Cyclodialysis Cleft with Vitreoretinal Injury. Journal of Clinical Medicine (2023).
2. Encircling Scleral Buckling Surgery for Severe Hypotony with Ciliary Body Detachment on Anterior Segment Swept-Source Optical Coherence Tomography: A Case Series. Journal of Clinical Medicine (2022).
3. Long-term outcomes of argon laser photocoagulation in small size cyclodialysis cleft. BMC Ophthalmology (2015).
4. A Novel Method for the Localization and Management of Traumatic Cyclodialysis Cleft. Journal of Ophthalmology (2014).
5. Vitrectomy with Air Endotamponade for Traumatic Cyclodialysis. Journal of Ophthalmology (2020).
6. Cyclodialysis cleft repair and cataract management by phacoemulsification combined with internal tamponade using modified capsular tension ring insertion. Graefe's Archive for Clinical and Experimental Ophthalmology (2018).
7. Concurrent Phacoemulsification and Encircling for Hypotony Maculopathy after Blunt Trauma. Case Reports in Medicine (2020).