Traumatic cyclodialysis is always a challenging condition. Evidence is based on single case reports or small case series. Treatment is indicated in the presence of persistent ocular hypotony or disturbance of the posterior segment anatomy due to deformation of the globe caused by extremely low IOP. The first step in the management of a traumatic cyclodialysis should always include a conservative approach with cycloplegic drops and topical, periocular or oral corticosteroids. More invasive options should be reserved for refractory cases and for eyes with risk of irreversible visual loss. Many treatment options have been reported, ranging from internal or external laser cyclophotocoagulation [1–3], transscleral diathermy [1], cryotherapy [4] to surgical therapy and vitreoretinal procedures, such as suture-based techniques [5], vitrectomy, endotamponades or scleral buckling. All of the aforementioned approaches share the same purpose of closing the cyclodialysis cleft, reattach the ciliary body to the sclera and to normalize the IOP. Even when favourable results have been reported using any of these techniques, the evidence is insufficient to establish superiority over each other or an adequate management algorithm and choosing the right option must be based on the size, extension and location of the cleft as well as the duration of the ocular hypotony. We report four cases of 360° traumatic cyclodialisis with favourable results after vitrectomy+ transscleral laser cyclophotocoagulation+ supine positioning (Table 1). We highlight the role of the transscleral laser cyclopexy in achieving such early favourable results, with good anatomic and visual results (Fig. 1). Amini and Razeghinejad first described the use of transscleral laser to close a sectorial small cyclodialysis in a post-traumatic patient and one post-trabeculectomy patient by applying laser burns over the cleft with the following parameters: 2500MW of power with a 2 s exposure time in two consecutive rows around the cornea. We aimed for a controlled thermal laser burn to induce cyclopexy with a laser power of 700–1000MW with an exposure time of 2 s. By performing a pars plana vitrectomy and while the vitreous cavity was completely filled with air, we achieved a rise of the IOP and a transient apposition of the ciliary body to the sclera facilitating transscleral laser application. After this, air-SF6 or air–silicon oil exchange was performed and supine positioning of the head was indicated following the same principles of pneumatic retinopexy. The combination of these techniques had never been reported elsewhere. Transscleral cryotherapy combined with pars plana vitrectomy has been successfully used to treat traumatic cyclodialysis but it is frequently accompanied by postoperative complications. Comparing our combined treatment with this cryotherapy technique, we believe that transscleral laser application is a better option than the latter because of possible standardization in laser parameters, faster effects, less inflammation, no hypertensive spikes and a greater cyclopexy adherence. In conclusion, pars plana vitrectomy+ application of 360° transscleral diode laser technique can be useful to treat patients with 360° cyclodialysis in the presence of hypotonic maculopathy secondary to ocular trauma.

中文翻译：

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玻璃体切除术 + 360° 睫状体固定术与经巩膜 810 nm 激光应用：一种治疗低渗性黄斑病变的新型手术技术

创伤性环透析始终是一个具有挑战性的条件。证据基于单个病例报告或小病例系列。治疗适用于因极低眼压引起的眼球变形而导致持续性眼压低或后段解剖结构紊乱的情况。治疗外伤性睫状体透析的第一步应始终包括使用睫状肌麻痹滴剂和局部、眼周或口服皮质类固醇的保守方法。对于难治性病例和有不可逆视力丧失风险的眼睛，应保留更具侵入性的选择。已经报道了许多治疗选择，从内部或外部激光睫状体光凝术 [1-3]、经巩膜透热疗法 [1]、冷冻疗法 [4] 到手术疗法和玻璃体视网膜手术，例如基于缝合的技术 [5]、玻璃体切除术、内填塞或巩膜扣带。所有上述方法都有相同的目的，即关闭环透析裂隙，将睫状体重新连接到巩膜，并使眼压正常化。即使使用这些技术中的任何一种报告了有利的结果，证据也不足以确定彼此之间的优越性或适当的管理算法，选择正确的选项必须基于裂隙的大小、延伸和位置以及眼压低的持续时间。我们报告了 4 例 360° 外伤性睫状体散瞳术，在玻璃体切除术 + 经巩膜激光睫状体光凝术 + 仰卧位后取得了良好的结果（表 1）。我们强调了经巩膜激光睫状体固定术在获得这种早期有利结果中的作用，并具有良好的解剖和视觉效果（图 1）。Amini 和 Razeghinejad 首先描述了使用经巩膜激光通过以下参数在裂隙上应用激光灼伤来关闭一个创伤后患者和一名小梁切除术后患者的扇形小循环透析：2500MW 功率，2 秒暴露时间角膜周围连续两行。我们的目标是控制热激光燃烧，以 700-1000 MW 的激光功率和 2 秒的曝光时间诱导环固定术。通过执行平部玻璃体切除术，当玻璃体腔完全充满空气时，我们实现了眼压升高和睫状体与巩膜的短暂并置，促进了经巩膜激光应用。此后，进行空气-SF6 或空气-硅油交换，并遵循气动视网膜固定术的相同原则指示头部仰卧位。这些技术的组合从未在其他地方报道过。经巩膜冷冻联合玻璃体切除术已成功用于治疗外伤性睫状体透析，但常伴有术后并发症。将我们的联合治疗与这种冷冻疗法技术进行比较，我们认为经巩膜激光应用是比后者更好的选择，因为激光参数可能标准化、效果更快、炎症更少、没有高血压峰值和更大的睫状体附着力。总之，平部玻璃体切除术+应用 360° 经巩膜二极管激光技术可用于治疗存在继发于眼外伤的低渗黄斑病变的 360° 睫状体透析患者。经巩膜冷冻联合玻璃体切除术已成功用于治疗外伤性睫状体透析，但常伴有术后并发症。将我们的联合治疗与这种冷冻疗法技术进行比较，我们认为经巩膜激光应用是比后者更好的选择，因为激光参数可能标准化、效果更快、炎症更少、没有高血压峰值和更大的睫状体附着力。总之，平部玻璃体切除术+应用 360° 经巩膜二极管激光技术可用于治疗存在继发于眼外伤的低渗黄斑病变的 360° 睫状体透析患者。经巩膜冷冻联合玻璃体切除术已成功用于治疗外伤性睫状体透析，但常伴有术后并发症。将我们的联合治疗与这种冷冻疗法技术进行比较，我们认为经巩膜激光应用是比后者更好的选择，因为激光参数可能标准化、效果更快、炎症更少、没有高血压峰值和更大的睫状体附着力。总之，平部玻璃体切除术+应用 360° 经巩膜二极管激光技术可用于治疗存在继发于眼外伤的低渗黄斑病变的 360° 睫状体透析患者。