Anterior segment optical coherence tomography as a diagnostic tool for cyclodialysis clefts.

A nterior segment optical coherence tomography (OCT) is a noninvasive, painless, noncontact technique that provides accurate and reproducible images. This technique correlates well with ultrasound biomicroscopy, allows observation of iridocorneal angle abnormalities in the presence of opaque media, and is easier to perform than ultrasound biomicroscopy. A cyclodialysis cleft results from separation of the longitudinal ciliary muscle fibers from the scleral spur and establishes a new drainage pathway for aqueous humor between the anterior chamber and the suprachoroidal space. This new drainage channel increases uveoscleral outflow and may result in chronic ocular hypotonia; it is sometimes complicated by decreased visual acuity, a shallow anterior chamber, ciliochoroidal effusion, optic disc edema, retinal folds, hypotonus maculopathy, and engorgement and stasis of retinal veins. Slitlamp examination using a gonioscope has been the most common method used to confirm the existence of clefts. However, it cannot be used in patients with hyphema, corneal opacity, and excessive hypotonia after trauma or surgery. In these patients, ultrasound biomicroscopy (UBM) has been a useful tool for visualizing the anterior eye segment. We demonstrate the use of OCT as a new technique that provides anterior segment imaging and allows identification of cyclodialysis clefts in correlation with clinical examination and UBM.