Gonioscopy-guided transscleral direct cyclopexy for traumatic cyclodialysis cleft ——eye injury vitrectomy study

PURPOSE: To evaluate the surgical efficacy and functional outcomes of gonioscopy-guided transscleral direct cyclopexy (GTS direct cyclopexy) for repairing traumatic cyclodialysis clefts. METHODS: This study included 20 eyes of 20 patients with traumatic cyclodialysis. GTS direct cyclopexy was performed using a curved needle with 10 - 0 polypropylene suture to close the cleft, with gonioscopy guidance for precise localization and closure confirmation. Additional procedures such as vitrectomy were performed as needed. Clinical data, including best-corrected visual acuity (BCVA), intraocular pressure (IOP), and ultrasound biomicroscopy (UBM) findings, were collected preoperatively and at regular follow-up visits. Statistical analyses were performed using the Wilcoxon matched-pairs signed-rank test. RESULTS: Cyclodialysis closure was achieved in 19 of 20 eyes (95%) after a single GTS direct cyclopexy. The median extent of cyclodialysis was 60° (IQR: 34°-113°). BCVA significantly improved from 1.74 ± 0.98 logMAR preoperatively to 0.90 ± 0.69 logMAR at 6 months postoperatively (p = 0.002). IOP increased from a mean of 6.1 ± 2.8 mmHg to 12.63 ± 3.60 mmHg at 6 months (p = 0.0007). Postoperative IOP spikes were observed in 4 patients (20%) but were managed successfully. No cataracts related to the surgery were reported. CONCLUSION: GTS direct cyclopexy is a safe, minimally invasive, and repeatable for repairing traumatic cyclodialysis clefts.