Operation Indications Of Ciliary Body Detachment/cyclodialysis Caused By Eye Contusion

Eye contusion is defined by the blunt force of direct injury to the eye andrelated parts, resulting in ocular tissue pathological changes and dysfunction.With ocular hypotension after eye contusion, it is one of the most seriouscomplications after ocular contusion. The normal intraocular pressure rangesfrom10to21mmHg, but there is no standard and uniform definition of ocularhypotension in the domestic and foreign literature. Schubert suggestted thatthe definition of ocular hypotension should include the structure and functionof the eye, so he defined ocular hypotension as IOP≤5mmHg (transient orpersistent, acute or chronic) with visual impairments (symptomatic orasymptomatic) and structure damages (reversible or irreversible) since1920.With variable tolerance and duration of lower IOP, it is difficult to defineocular hypotension, but most scholars consider this diagnosis when IOP≤5mmHg, visual impairment or structure damage is present. The eye contusionof low intraocular pressure can be divided into temporary and persistent:temporary low intraocular pressure is considered if the intraocular pressurecan be restored in short-term (30days) after drug treatment, without obviousdamage of visual function; persistent ocular hypotension, also known aschronic intraocular pressure,,is considered when ocular hypotension lasts forlonger time after the injury, irresponsive to drug treatment, and we mustadopt operation or other treatment methods. Ciliary body detachment orcyclodialysis can decrease the secretion of aqueous humor, while thecyclodialysis will lead to aqueous humor drainage through the ciliary bodycavity, increasing the drainage of aqueous humor outflow. Reduced aqueoushumor secretion and excessive aqueous humor outflow are the causes ofocular hypotension. Persistent ocular hypotension can cause the loss of visualacuity, corneal edema/opacity and Descemet membrane folds, lens opacity, the atria or vitreous bleeding, retinal fold, macula cystoid edema, retinal vesseltortuosity, optic disc edema, eye volume diminution and shortened optical axis,which may eventually lead to the atrophy. In1991, Pavlin brought theultrasound biomicroscopy (UBM) into the clinical use. The UBM uses highfrequency probe40-100MHz to detect, which is5times higher than the eyeultrasonography, with tissue resolution up to50μ m, depth to4mm. UBMprovides great help in the diagnosis of ciliary body and surrounding regiondiseases. In recent years, it has been widely used as the main criteria for thediagnosis of ciliary body detachment and cyclodialysis, and to distinguisheach other. At present the medication and cyclodialysis reduction treatment aremost commonly used procedures in clinical treatment of ciliary bodydetachment and cyclodialysis. Medication is rather safe and reliable, but insome severe patients it cannot reverse the ocular hypotension, which requiresthe cyclodialysis reduction. There are operation risks and complicationsfollowing the cyclodialysis reduction, such as: bleeding, crystal damage,ciliary body injury and the high intraocular pressure after the operation. So theoperation indications of ciliary body detachment and cyclodialysis caused byeye contusion are very important.Purpose: Through the systematic study of patients with ciliary bodydetachment or cyclodialysis caused by eye contusion, we aim to illuminate therepair indications of ciliary body detachment or cyclodialysis caused by eyecontusion.Method: After searching the patients in the Second Hospital of HebeiMedical University from2012July to2013January,12eyes of12patientswith ciliary body detachment/cyclodialysis and ocular hypotension caused byeye contusion, received different treatment procedures. We followed up eachpatient and recorded visual acuity, intraocular pressure, optometry, conditionsof ciliary body detachment/cyclodialysis using UBM and optical coherencetomography (OCT). Finally, we analyzed the collected medical data andcompared the results with the literature data. Result:1Eleven eyes of11cases of ciliary body detachment or cyclodialysis withocular hypotension caused by eye contusion after medication:1.1Vision acuity：1.1.1Of10eyes in10cases the vision when admitted to hospital: manual/at the moment-0.1, the vision after1month:0.2-1.0;1.1.2Of1eye in1case the vision when admitted to hospital:0.4,the visionafter1month:1.0.1.2IOP：1.2.1Of3eyes in3cases the intraocular pressure when admitted to hospitalis less than5mmHg, up to5-10mmHg of which1eyes of1patients in1month;2cases2eyes improved to normal range (10-21mmHg) in1month;1.2.2Of8eyes in8cases the intraocular pressure when admitted to hospitalis5-10mmHg,4of which the intraocular pressure maintained at5-10mmHgthe follow-up period (1-18months);4of which intraocular pressure returnedto normal range (10-21mmHg) in1month.1.3Ciliary body：1.3.1Of2eyes in2cases with full of ciliary body detachment, only amodest part of ciliary body detachment after1month;1.3.2Of7eyes in7cases have full circular ciliary body detachment withcyclodialysisciliary in1quadrant, only a part of ciliary body detachmentwithout cyclodialysisciliary1month later;1.3.3Of1eye of1case have full circular ciliary body detachment withcyclodialysisciliary in1-2quadrant, only a part of ciliary body detachmentwith cyclodialysisciliary less than1quadrant1month later;1.3.4Of1eye in1case have full circular ciliary body detachment withcyclodialysisciliary in1-2quadrant, no obvious change in1and a half years.1.4Fundus oculi1.4.1Of the12eyes,10presented macular folds after injury, whichdisappeared after the recovery of intraocular pressure in3eyes;1.4.21eye underwent cyclodialysis reduction in2.5months after the injury,then the folds disappeared; choroidal folds appeared in1eye about1.5years after the injury.2Of12cases,1patient received cyclodialysis reduction1week after theinjury. The IOP rose to29~42mmHg for40days, which was irresponsive topharmaceutical treatments.Conclusion:1For patients of ocular hypotension with ciliary body detachment andcyclodialysis, the treatment decisions should be based on the IOP and whethera change of eyeball structure or visual function damage presents, caused byocular hypotension.2If the intraocular pressure higher than5mmHg, and no change ofeyeball structure or visual function damage, caused by ocular hypotension, isobserved, we can continue to watch;3If the intraocular pressure is less than5mmHg,the structure of eyeballchanges, or visual function is damaged, which is caused by ocular hypotension,such as cystoid macula edema, choroidal folds, we should do cyclodialysisreduction to prevent further damage.