Cyclodialysis Cleft After Intravitreal Injection

Introduction: A cyclodialysis cleft, separating the ciliary body muscle from the scleral spur, can cause ocular hypotony by creating an abnormal aqueous humor drainage pathway. Though rare, this can occur post-intravitreal injection. Case presentation: A 53-year-old man with diabetic retinopathy pre...

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Main Authors: Mohamed M. Khodeiry, Abdelrahman M. Elhusseiny, Christopher A. Dorizas, Richard K. Lee, Mohamed S. Sayed
Format: Article
Language:English
Published: Karger Publishers 2024-11-01
Series:Case Reports in Ophthalmology
Online Access:https://beta.karger.com/Article/FullText/542200
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author Mohamed M. Khodeiry
Abdelrahman M. Elhusseiny
Christopher A. Dorizas
Richard K. Lee
Mohamed S. Sayed
author_facet Mohamed M. Khodeiry
Abdelrahman M. Elhusseiny
Christopher A. Dorizas
Richard K. Lee
Mohamed S. Sayed
author_sort Mohamed M. Khodeiry
collection DOAJ
description Introduction: A cyclodialysis cleft, separating the ciliary body muscle from the scleral spur, can cause ocular hypotony by creating an abnormal aqueous humor drainage pathway. Though rare, this can occur post-intravitreal injection. Case presentation: A 53-year-old man with diabetic retinopathy presented with persistent hypotony in his right eye after receiving an aflibercept intravitreal injection. On presentation, his visual acuity was 20/200, and intraocular pressure (IOP) was 2 mmHg. Examination revealed a cyclodialysis cleft in the right eye. Despite initial treatment with steroids and atropine, the hypotony persisted, leading to surgical repair via ab-interno cyclopexy. Post-surgery, IOP normalized, and vision slightly improved. At three months post-operation, IOP was stable at 16 mmHg without glaucoma medication, and no signs of hypotony were present, with vision improving to 20/150. Conclusion: Misplaced intravitreal injections can lead to cyclodialysis cleft formation. Ophthalmologists should be aware of this possible complication. Meticulous gonioscopy and the adjunctive use of ocular imaging are crucial for the proper diagnosis of these cases. Ab-interno direct cyclopexy is an effective surgical approach for cyclodialysis clefts non- responsive to medical or laser treatment.
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spelling doaj-art-df43c777f1e24e0880a6d96392ba77ec2024-11-14T07:28:50ZengKarger PublishersCase Reports in Ophthalmology1663-26992024-11-011710.1159/000542200542200Cyclodialysis Cleft After Intravitreal InjectionMohamed M. KhodeiryAbdelrahman M. ElhusseinyChristopher A. DorizasRichard K. LeeMohamed S. SayedIntroduction: A cyclodialysis cleft, separating the ciliary body muscle from the scleral spur, can cause ocular hypotony by creating an abnormal aqueous humor drainage pathway. Though rare, this can occur post-intravitreal injection. Case presentation: A 53-year-old man with diabetic retinopathy presented with persistent hypotony in his right eye after receiving an aflibercept intravitreal injection. On presentation, his visual acuity was 20/200, and intraocular pressure (IOP) was 2 mmHg. Examination revealed a cyclodialysis cleft in the right eye. Despite initial treatment with steroids and atropine, the hypotony persisted, leading to surgical repair via ab-interno cyclopexy. Post-surgery, IOP normalized, and vision slightly improved. At three months post-operation, IOP was stable at 16 mmHg without glaucoma medication, and no signs of hypotony were present, with vision improving to 20/150. Conclusion: Misplaced intravitreal injections can lead to cyclodialysis cleft formation. Ophthalmologists should be aware of this possible complication. Meticulous gonioscopy and the adjunctive use of ocular imaging are crucial for the proper diagnosis of these cases. Ab-interno direct cyclopexy is an effective surgical approach for cyclodialysis clefts non- responsive to medical or laser treatment.https://beta.karger.com/Article/FullText/542200
spellingShingle Mohamed M. Khodeiry
Abdelrahman M. Elhusseiny
Christopher A. Dorizas
Richard K. Lee
Mohamed S. Sayed
Cyclodialysis Cleft After Intravitreal Injection
Case Reports in Ophthalmology
title Cyclodialysis Cleft After Intravitreal Injection
title_full Cyclodialysis Cleft After Intravitreal Injection
title_fullStr Cyclodialysis Cleft After Intravitreal Injection
title_full_unstemmed Cyclodialysis Cleft After Intravitreal Injection
title_short Cyclodialysis Cleft After Intravitreal Injection
title_sort cyclodialysis cleft after intravitreal injection
url https://beta.karger.com/Article/FullText/542200
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AT abdelrahmanmelhusseiny cyclodialysiscleftafterintravitrealinjection
AT christopheradorizas cyclodialysiscleftafterintravitrealinjection
AT richardklee cyclodialysiscleftafterintravitrealinjection
AT mohamedssayed cyclodialysiscleftafterintravitrealinjection