Treatment of hypotony maculopathy caused by traumatic cyclodialysis

A 29-year-old male experienced abrupt visual loss in the left eye following an elastic cord rebounding injury that resulted in ocular hypotony. He received topical atropine and prednisolone eye drops for more than one month without improvement. On examination, his visual acuity was 1.0 OD and counting fingers at 80 cm OS. Initial intraocular pressure (IOP) was 15 mmHg OD and 6 mmHg OS. Gonioscopic evaluation of his left eye revealed a cyclodialysis cleft positioned between 6 and 7 o'clock. A fundus photograph showed signs of hypotony maculopathy including optic disc edema, tortuous vessels, and chorioretinal folds. B-scan ultrasound displayed choroidal thickening and optical coherence tomography (OCT) demonstrated macular edema, subretinal fluid, retinal striae, and choroidal folds. Pars plana vitrectomy and sulfur hexafluoride (SF6) tamponade were performed. After gas absorption, IOP was 11 mmHg OS and remained steady during follow-up. One week after surgery, his visual acuity improved to 0.9. The present case highlights that pars plana vitrectomy with gas tamponade is worth considering for patients with cyclodialysis cleft associated with hypotony maculopathy. Early surgical intervention remains the treatment of choice when hypotony maculopathy and deteriorated vision are noted. Conservative management may be suitable in cases when visual function is not impaired.