Effect of Different Preoperative Intraocular Pressures on the Prognosis of Traumatic Cyclodialysis Cleft Associated with Lens Subluxation

Purpose: To evaluate the prognosis of patients with blunt trauma-mediated cyclodialysis cleft and lens subluxation treated by dual capsular tension rings (CTRs) with different preoperative intraocular pressures (IOPs).

Methods: Twenty-five patients with cyclodialysis cleft and lens subluxation after blunt trauma were recruited in this study. They were categorized into the low IOP group (IOP < 10 mmHg) and normal IOP group (between 10 mm and 21 mmHg). A modified CTR (MCTR) or CTR was sutured into the ciliary sulcus, and another MCTR or CTR was implanted in the capsular bag. The prognosis outcome measurements, including BCVA (LogMAR), IOP, UBM, and macular character on OCT, were collected during the regular outpatient follow-up after surgery until the recovery of cyclodialysis cleft was found. Measures of cyclodialysis cleft recovery included successful IOP control (defined as an IOP within 10-21 mmHg), confirmation of cleft closure on UBM, and confirmation of IOL centration under slit-lamp examination. Follow-up period or recovery time was regarded as the duration between discharge from the hospital after the operation and the recovery of cyclodialysis cleft. The longest follow-up period was 1 year.

Results: Cyclodialysis cleft was successfully treated in 21/25 eyes, whereas lens subluxation was treated effectively in all 25 eyes. CTRs and IOLs were stable in all eyes. BCVA (P < 0.001) and IOP (P < 0.001) were significantly improved after surgery. The primary surgical complication included reversible IOP spike in seven eyes. Postoperative BCVA was found to have correlation with the preoperative IOP (P = 0.016), maculopathy (P = 0.002,), and trauma duration (P = 0.046). Worse BCVA (P = 0.037) and more severe grade of maculopathy (P = 0.030) were observed in the low IOP group (14 eyes). In contrast, a better prognosis and greater probability of IOP spike (P = 0.021) were observed in the normal IOP group (11 eyes).

Conclusion: Timely and proper intervention for traumatic cyclodialysis cleft associated with lens subluxation is essential. Lower preoperative IOP is associated with worse prognosis and prolonged recovery time, while caution should be taken in IOP spike monitoring in patients with normal preoperative IOP.