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We are in the process of analyzing 17 years worth of data and hope to be bringing some papers to the mainstream peer review literature. There is definately an incidence of late cleft closure and abrupt extreme IOP elevation.We will detail our incidence once the data is analyzed. Interestingly, often the event of cleft closure usually responds well to medical therapy and in the end the patient ends up with a better IOP than preop with less medications, but a definate increase in meds and higher IOP prior to anatomic cleft closure. This is my clinical impression. The papers will have the real results

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Interesting video. But the cyclodialysis done in the past would close with an abrupt and acute IOP elevation? Do you have any published long-term data, Dr. Baum?

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Anaesthesia must be retrobulbar. This is not a topical procedure.

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Hi, good video. What type of anesthesia you usually use?

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Sushil, Managing over-functioning procedure in cyclodialysis is more difficult than trabeculectomy but in my experience more infrequent. My first steps are to apply argon laser into cleft, long exposure (0.5 sec), large spot (500 microns), 300-400 mW power. Apply through gonio lens into cleft in a "bank shot" approach (aim at sclera to reflect beam to ciliary body/choroid). Titrate with several treatments. If hypotony is persistent rarely have had to resuture iris root to sclera through a scleral incision parallel to limbus 0.5 mm posterior to Schlemm's canal. Use 10-0 prolene. Expect a 24 hour IOP spike if closure was successful.

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GHTANAKA, you are correct nothing major changed. Doing the procedure in minor OR with no viscoelastic is however technically more difficult so would do a number of procedures under viscoelastic first. Not sure which oloder technique you ae referring to. Classic cyclodialysis is performed from a scleral approach with peritomy, scleraotomy etc. This is very different. UBM is a great idea. I do not have one but I will try to pick a few patients with well formed clefts and send them for UBMs and see what I find. I think you are right in that it may predict efficacy of the procedure. I am not claiming superiority to trabeculectomy bu it is a great alternative to have in the toolbox. The three year followup that I had in the initial study is much longer than most trabectomy studies. As I am at Kaiser I can access followup back to 1994 so I will try to get to culling 16 years of data. Wish I could find a fellow or an interested med student.

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Interesting revisitation of an older procedure. Correct me if I'm wrong, but it seems nothing has changed: same instrument and no viscoelastic when done separate from phaco. Any refinements on the older technique? How about UBM to better delineate the depth and extent of the cleft? Sounds like a good pilot study, but with glaucoma surgery we need longer follow up to know long term success rate and whether or not its truly superior to trabeculectomy, although its certainly much much faster.

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Fantastic procedure Dr Baum..I'm going to try it next week and hope to get some tips form you...

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