Cyclodialysis Cleft after Intravitreal Injection

Introduction: A cyclodialysis cleft, separating the ciliary body muscle from the scleral spur, can cause ocular hypotony by creating an abnormal aqueous humor drainage pathway. Though rare, this can occur post-intravitreal injection. Case Presentation: A 53-year-old man with diabetic retinopathy presented with persistent hypotony in his right eye after receiving an aflibercept intravitreal injection. On presentation, his visual acuity was 20/200, and intraocular pressure (IOP) was 2 mm Hg. Examination revealed a cyclodialysis cleft in the right eye. Despite initial treatment with steroids and atropine, the hypotony persisted, leading to surgical repair via ab-interno cyclopexy. Post-surgery, IOP normalized, and vision slightly improved. At 3 months post-operation, IOP was stable at 16 mm Hg without glaucoma medication, and no signs of hypotony were present, with vision improving to 20/150. Conclusion: Misplaced intravitreal injections can lead to cyclodialysis cleft formation. Ophthalmologists should be aware of this possible complication. Meticulous gonioscopy and the adjunctive use of ocular imaging are crucial for the proper diagnosis of these cases. Ab-interno direct cyclopexy is an effective surgical approach for cyclodialysis clefts non-responsive to medical or laser treatment.