Cyclodialysis Cleft Closure Following Suprachoroidal Spacer Implantation

PURPOSE: To report a case of cyclodialysis cleft closure following ab interno suprachoroidal spacer implantation (AlloFlo) resulting in a severe postoperative intraocular pressure (IOP) spike. OBSERVATIONS: An 80-year-old woman with uncontrolled open-angle glaucoma in the right eye and intolerance to multiple medications declined incisional glaucoma surgery due to scarring risk and eyelid anatomy limiting bleb management. She underwent ab interno cyclodialysis creation and placement of 2 suprachoroidal spacers composed of donor scleral tissue [AlloFlo, White Plains, NY]. On postoperative day 1, IOP decreased from 34 to 10 mm Hg with a quiet anterior segment and visible spacers on gonioscopy. The early postoperative course was unremarkable. At postoperative week 3, she presented with ocular pain and an IOP of 60 mm Hg despite anterior visualization of the spacers. Serial anterior chamber paracenteses and maximal medical therapy provided only transient pressure reduction. Ultrasound biomicroscopy ultimately demonstrated posterior closure of the cyclodialysis cleft without a posterior fluid lake. The patient subsequently underwent urgent tube shunt implantation. At 9 months postoperatively, vision was preserved, and IOP was controlled on 2 topical agents. CONCLUSIONS AND IMPORTANCE: Cyclodialysis cleft closure is a potential failure mechanism following suprachoroidal spacer implantation and may result in abrupt and marked IOP elevation. Careful patient selection, vigilant postoperative monitoring, and early imaging with ultrasound biomicroscopy are essential to guide timely management.