Cyclodialysis Cleft Repair

This is Michael Lin sharing a case that most of us hope not to have to deal with very often. This is an intraoperative surgical video still that shows a large nasal cyclodialysis cleft of at least 2 clock hours that you're now tasked with repairing in order to prevent hypotony. Here, I introduce one of the straight needles of a double armed STC-6 10-0 polypropylene suture into the existing temporal clear corneal incision. Using intraocular forceps, I catch the peripheral iris with this needle and externalize the needle through the sclera. A nasal conjunctival peritomy had already been made.

I repeat this process with the other straight needle of the double armed suture, tacking the iris to the sclera, then externalizing the needle again through the sclera. After cutting off one of the needles to facilitate tying, a 3-1-1 knot is thrown and rotated. Now we're pretty close to finishing the repair of this microinvasive glaucoma surgery that had become not so microinvasive. The conjunctival peritomy was closed to coverthe suture. Repeat direct gonioscopy confirmed closure of the cleft. After using the irrigation/aspiration handpiece to evacuate viscoelastic and blood, the anterior chamber was deep, the eye was at physiologic pressure, and the case is complete after injecting intracameral antibiotics and subconjunctival dexamethasone. Thank you for watching! Hope this prepares you for the next time you have to deal with this, but hopefully you never will.

Michael M. Lin, MD, is an assistant professor of ophthalmology in the glaucoma service at Massachusetts Eye and Ear, Harvard Medical School Department of Ophthalmology in Boston. He reports no relevant disclosures.

Mary Qiu, MD, the editor of this series, is a glaucoma and cataract surgeon who completed her glaucoma fellowship at the Cole Eye Institute at Cleveland Clinic and her ophthalmology residency training at the Wilmer Eye Institute at Johns Hopkins. Her special interests include neovascular glaucoma; tube revisions and exchanges; optimizing technique and outcomes for nonvalved tubes, goniotomy, and canaloplasty; surgical education for trainees; and creating and sharing her surgical videos.