case_images: PMC11743908_01
case_images: PMC11743908_02
case_images: Slit lamp (A) and fundus optical coherence tomography (OCT) findings (B, C) 14 months after Tanito microhook trabeculotomy (TMH) (left eye).. (A) Mild shallow anterior chamber and pupillary deformation are observed (arrow). (B, C) Vertical (B) and horizontal (C) scans of the macula by fundus OCT (RS-3000 Advance 2, Nidek, Gamagori, Japan) reveal the formation of macular retinal-choroidal folds (arrowheads).
case_images: cureus-0017-00000077516-i01.jpg
case_images: PMC11743908_03_cureus-0017-00000077516-i01.jpg
case_images: FIG1
case_images: Cataract surgery combined with direct internal cyclopexy was performed (Figures 5A-5I, Video 1).
case_images: Gonioscopic findings (A) and 360  gonio-photography (B) of the nasal angle 14 months after Tanito microhook trabeculotomy (TMH) (left eye).. (A) Gonioscopy shows no evidence of cyclodialysis cleft in the nasal angle, where goniotomy was performed. (B) 360  gonio-photography with GS-1 (Nidek, Gamagori, Japan) also reveals no cyclodialysis cleft. I, inferior; N, nasal; S, superior; T, temporal.
case_images: cureus-0017-00000077516-i02.jpg
case_images: PMC11743908_02_cureus-0017-00000077516-i02.jpg
case_images: FIG2
case_images: Gamagori, Japan) showed retinal-choroidal folds in the macula of the left eye (Figures 1B-1C). Gonioscopy (Figure 2A) and 360  gonio-photography (GS-1, Nidek, Gamagori, Japan) (Figure 2B) revealed no apparent cyclodialysis cleft.
case_images: Findings of angle observation by anterior segment optical coherence tomography (OCT).. (A-I) Using the default angle observation mode (STAR360) of Casia 2 (Tomey Corporation, Nagoya, Japan), a 45  interval scan detects ciliary body detachment (arrows) but no cyclodialysis cleft.
case_images: cureus-0017-00000077516-i03.jpg
case_images: PMC11743908_02_cureus-0017-00000077516-i03.jpg
case_images: FIG3
case_images: Using the angle observation mode (STAR360) of AS-OCT (Casia 2, Tomey Corporation, Nagoya, Japan), 45  interval scans showed ciliary body detachment throughout the angle but no communication between the anterior chamber and the suprachoroidal space (Figures 3A-3I).
case_images: Anterior segment optical coherence tomography (AS-OCT) findings using a manually adjusted scanning axis.. AS-OCT in the 23 -203  direction reveals an angle detachment cleft in the inferonasal quadrant (203 ) (arrow) and irido-trabecular contact due to anterior iris rotation (arrowhead). The inset in the upper left shows the scanning direction.
case_images: cureus-0017-00000077516-i04.jpg
case_images: PMC11743908_02_cureus-0017-00000077516-i04.jpg
case_images: FIG4
case_images: In manual AS-OCT scans, angle detachment at 203  and irido-trabecular contact due to anterior iris rotation were observed (Figure 4).
case_images: PMC11743908_03
case_images: Slit lamp (A) and fundus optical coherence tomography (OCT) findings (B, C) 14 months after Tanito microhook trabeculotomy (TMH) (left eye).. (A) Mild shallow anterior chamber and pupillary deformation are observed (arrow). (B, C) Vertical (B) and horizontal (C) scans of the macula by fundus OCT (RS-3000 Advance 2, Nidek, Gamagori, Japan) reveal the formation of macular retinal-choroidal folds (arrowheads).
case_images: cureus-0017-00000077516-i01.jpg
case_images: PMC11743908_03_cureus-0017-00000077516-i01.jpg
case_images: FIG1
case_images: Cataract surgery combined with direct internal cyclopexy was performed (Figures 5A-5I, Video 1).
case_images: Repair of cyclodialysis cleft using direct internal cyclopexy combined with micro-incision cataract surgery.. (A) Gonioscopic observation of the nasal angle. (B) Cyclodialysis cleft is observed (arrow) after injecting viscoelastic material into the anterior chamber. (C) The extent of the cyclodialysis cleft is marked using a marker pen. (D) Micro-incision cataract surgery is performed through a nasal corneal incision, followed by intraocular lens implantation. The ciliary sulcus is expanded with viscoelastic material. (E, F) Two needles of a 10-0 polypropylene suture (PC-9, Alcon Laboratories, Fort Worth, TX) are prepared. The suture is passed through the sclera and ciliary sulcus at locations covering the cyclodialysis cleft. (G) The suture is tied and rotated to bury the knot beneath the sclera without conjunctival incision. (H) Additional viscoelastic material is injected into the anterior chamber. (I) Successful repair of the cyclodialysis cleft is confirmed (arrow).
case_images: cureus-0017-00000077516-i05.jpg
case_images: PMC11743908_03_cureus-0017-00000077516-i05.jpg
case_images: FIG5
case_images: Cataract surgery combined with direct internal cyclopexy was performed (Figures 5A-5I, Video 1). TX) was injected into the anterior chamber to reposition the anteriorly rotated iris, exposing the cyclodialysis cleft (Figures 5A-5B). The extent of the cleft was marked at the corneal limbus (Figure 5C). After IOL implantation into the capsular bag, the ciliary sulcus was expanded with viscoelastic material (Figure 5D). TX) was tied, and the needle was used to pass through the ciliary sulcus and sclera at two points covering the cyclodialysis cleft (Figures 5E-5F). Without conjunctival incision, the suture was tied and buried beneath the sclera by rotating the knot (Figure 5G). The viscoelastic material was re-injected to confirm cleft closure (Figures 5H-5I).
case_images: Direct internal cyclopexy.
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case_images: PMC11743908_03_.jpg
case_images: VID1
case_images: Ax110 ), and IOP was 44 mmHg with four IOP-lowering medications. At 14 days, IOP was 35 mmHg, the anterior chamber depth remained improved without significant inflammation (Figure 6A), and the suture had naturally buried itself under the conjunctiva (Figure 6B). Gonioscopy revealed the suture sites (Figure 6C), and AS-OCT confirmed the successful repair of the cyclodialysis cleft (Figure 6D).
case_images: Findings 14 days after direct internal cyclopexy.. (A) Slit lamp observation shows a deeper anterior chamber. Intraocular pressure (IOP) is 35 mmHg (under four glaucoma medications). (B) The suture tied on the conjunctiva has naturally buried itself into the subconjunctival space. (C) Gonioscopic observation shows the suture insertion site (arrows). (D) Anterior segment OCT shows that the iris root is pulled into the anterior chamber (arrow), confirming the repair of the cyclodialysis cleft.
case_images: cureus-0017-00000077516-i06.jpg
case_images: PMC11743908_03_cureus-0017-00000077516-i06.jpg
case_images: FIG6
case_images: Retinal-choroidal folds significantly resolved (Figure 7).
case_images: Fundus optical coherence tomography (OCT) findings 14 days after direct internal cyclopexy.. Retinal-choroidal folds have significantly improved.
case_images: cureus-0017-00000077516-i07.jpg
case_images: PMC11743908_03_cureus-0017-00000077516-i07.jpg
case_images: FIG7
case_images: At 14 days post-AGV insertion (28 days post-cyclopexy), the anterior chamber remained deep without inflammation (Figure 8), and hypotony maculopathy did not recur.