Minimally Invasive Direct Internal Cyclopexy in the Management of Goniotomy-Related Cyclodialysis Cleft with Hypotony Maculopathy

Masato Matsuo,1,2 Sho Ichioka,1 Akiko Harano,1 Yuji Takayanagi,1 Masaki Tanito1 1Department of Ophthalmology, Shimane University Faculty of Medicine, Izumo, Japan; 2Department of Ophthalmology, Gifu University Graduate School of Medicine, Gifu, JapanCorrespondence: Masato Matsuo, Department of Ophthalmology, Shimane University Faculty of Medicine, Enya 89-1, Izumo, Shimane, 693-8501, Japan, Tel +81-853-20-2284, Fax +81-853-20-2278, Email [email protected]: Although ab-interno trabeculotomy-related (goniotomy-related) surgeries has a favorable safety profile, cyclodialysis cleft refractory to conservative management could occur, thereby requiring additional surgical treatment. External and, more recently, internal cycloplexy have been attempted to treat cyclodialysis clefts with hypotony maculopathy, however the traditional methods require conjunctival or scleral incisions and have been inappropriate for glaucoma patients who need to undergo future trabeculectomy. Therefore, we report two cases who underwent a novel reliable technique for suture fixation of the detached ciliary body onto the original scleral bed directly through the intraocular approach without conjunctival or scleral incision, minimally invasive direct internal cyclopexy, in the management of goniotomy-related cyclodialysis cleft with hypotony maculopathy.Case Description: Goniotomy-related cyclodialysis cleft exceeded 45° and vision-threatening hypotony maculopathy was observed in two eyes in two patients with normal tension glaucoma and myopia gravis without a prior history of trauma who had undergone Kahook Dual Blade goniotomy combined with cataract surgery. The patients were followed conservatively for a while, however the cyclodialysis clefts and hypotony maculopathies did not resolve. Therefore, a 72-year-old man underwent minimally invasive direct internal cyclopexy on postoperative day 65 after the goniotomy, and another 67-year-old man underwent minimally invasive direct internal cyclopexy on postoperative day 149. In both cases, topical antibiotic and steroid eye drops were prescribed postoperatively. The cyclodialysis clefts were repaired successfully; however, the latter patient developed delayed-onset acute transient ocular hypertension 33 days after minimally invasive direct internal cyclopexy and required glaucoma medications. The hypotony maculopathies resolved approximately 3 months after suturing, and eventually visual acuity improved from preoperative levels and good intraocular pressure control was achieved in both. No further postoperative complications have been observed to date.Conclusion: We successfully managed two cases of goniotomy-related cyclodialysis cleft with hypotony maculopathy using minimally invasive direct internal cyclopexy.Keywords: cyclopexy, cyclodialysis cleft, hypotony maculopathy, ab-interno trabeculotomy, surgical complicatio

On the Uniqueness of the effective Lagrangian for N= 2 SQCD

The low energy effective Lagrangian for N= 2 SU(2) supersymmetric Yang-Mills theory coupled to N_F<4 massless matter fields is derived from the BPS mass formula using asymptotic freedom and assuming that the number of strong coupling singularities is finite.Comment: 16 pages, LaTeX, 2 figures, title changed, sections on central charge and superconformal anomaly extende