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Abstract #103821 Published in IGR 23-2
VITRECTOMY + TRANSSCLERAL DIODE LASER CYCLOPEXY TREATMENT FOR 360° TRAUMATIC CYCLODIALYSIS AND HYPOTONY MACULOPATHY: CASE REPORT
Rios-Nequis G; Flores-Villalobos EO; Ramirez-Estudillo A; Gonzalez-Saldivar G; Diez-Cattini GFRetinal cases & brief reports 2022; 16: 625-630
BACKGROUND/PURPOSE: To report a surgical approach of combined vitrectomy, gas endotamponade, and transscleral diode laser cyclopexy treatment for hypotony maculopathy induced by traumatic cyclodialysis. METHODS: A case of a 37-year-old male patient with decreased vision in his right eye because of hypotony maculopathy and 360° traumatic cyclodialysis is reported. Patient was initially treated conservatively with topical steroid + cycloplegic eye drops and repeated periocular corticosteroid injections with no improvement in the intraocular pressure and the anatomical defect. The patient underwent 23 G pars plana vitrectomy with 20% SF 6 gas endotamponade and supine position. Transscleral 810-nm laser burns were applied at 1.5 mm from the scleral limbus around the cornea in two confluent rows avoiding the horizontal meridians. Parameters used were 700-1,000 mW of power with a 2-second exposure in a continuous wave mode, and postoperative supine positioning of the head was indicated. RESULTS: Preoperative intraocular pressure improved from 2 mmHg to 10 mmHg at one week after surgical treatment and achieved 16 mmHg at one month to remain stable during a 6 months follow-up period. Presenting visual acuity was 1.0 logMAR (20/200 Snellen) and improved to 0.3 logMAR (20/40 Snellen) at Month 1 and achieved 0.1 logMAR (20/20 Snellen) at the third month. Complete closure of the cyclodialysis cleft and peripheral anterior synechiae formation were also observed at 3 months after treatment, with complete reattachment of the ciliary body demonstrated by ultrasound biomicroscopy and significant improvement of the macular anatomy demonstrated by spectral-domain optical coherence tomography. CONCLUSION: The combination of pars plana vitrectomy, supine positioning with gas endotamponade, and transscleral laser cyclopexy can successfully improve the visual and anatomical outcomes in patients with hypotony maculopathy and 360° traumatic cyclodialysis.
Retina and Vitreous Department, Fundación Hospital Nuestra Señora de la Luz, Mexico City, México.
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