Successful direct cyclopexy for traumatic cyclodialysis cleft with persistent hypotony in a young patient

Introduction: A cyclodialysis cleft, a rare complication of ocular trauma, is characterised by the separation of the ciliary body from the scleral spur. This abnormal communication between the anterior chamber and the suprachoroidal space leads to ocular hypotony and visual impairment. While many cases respond to conservative management, persistent hypotony may require surgery. Direct cyclopexy effectively treats persistent cases when conservative methods fail. Patient presentation: A 20-year-old man presented 5 days after blunt trauma to the right eye with light perception vision, grade 2 hyphaema, afferent pupillary defect, and intraocular pressure (IOP) of 15 mmHg; the left eye was unremarkable. After 1 week of medical management, vision improved to hand motions and hyphaema improved, but IOP fell to 7 mmHg. Three weeks later, with IOP 6 mmHg, subluxated lens and vitreous haemorrhage, he underwent pars plana vitrectomy and lensectomy. Persistent hypotony (IOP ≈ 3 mmHg) and hypotony maculopathy developed. Management and outcome: Gonioscopy confirmed a traumatic cyclodialysis cleft spanning two clock hours. After 6 weeks of unsuccessful cycloplegia and topical steroids, direct cyclopexy was performed 3 months after trauma. A transient postoperative IOP spike to 58 mmHg was controlled medically. Moreover, IOP stabilised at 12–16 mmHg on topical medication, hypotony maculopathy resolved and final best-corrected acuity was counting fingers, limited by macular atrophy. Conclusion: Direct cyclopexy offers a safe, effective and durable surgical solution when conservative management fails, particularly in young patients with visually significant hypotony. Contribution: This case highlights the importance of considering cyclodialysis cleft in patients with persistent hypotony after ocular trauma and shows that timely direct cyclopexy can lead to successful anatomical and functional outcomes.