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• W2080121933 abstract "It is correct that traumatic cyclodialysis causes various signs and symptoms similar to those seen in the “ciliochoroidal effusion syndrome”, a new disease entity that we proposed.1Ikeda N. Ikeda T. Nagata M. Mimura O. Pathogenesis of transient high myopia after blunt eye trauma.Ophthalmology. 2002; 109: 501-507Abstract Full Text Full Text PDF PubMed Scopus (46) Google Scholar Küchle and Naumann2Küchle M. Naumann G.O. Direct cyclopexy for traumatic cyclodialysis with persisting hypotony. Report in 29 consecutive patients.Ophthalmology. 1995; 102: 322-333Abstract Full Text PDF PubMed Scopus (116) Google Scholar have interpreted the mechanism by which traumatic cyclodialysis leads to the characteristic signs and symptoms as follows: “cyclodialysis leads to ciliary body detachment, loosened zonules, anterior displacement of the lens, and shallowing of the anterior chamber. The anteriorly displaced lens has greater dioptric power and thus leads to a myopic shift.”Nevertheless, a different explanation is also possible. When such a serious blunt eye trauma leading to cyclodialysis occurs, it is highly likely that diffuse edema of the ciliary body and ciliochoroidal effusion will also occur through the mechanism that then progresses to the ciliochoroidal effusion syndrome as described in our paper.1Ikeda N. Ikeda T. Nagata M. Mimura O. Pathogenesis of transient high myopia after blunt eye trauma.Ophthalmology. 2002; 109: 501-507Abstract Full Text Full Text PDF PubMed Scopus (46) Google Scholar Thus, traumatic cyclodialysis and the ciliochoroidal effusion syndrome may often occur together, and it may be difficult to clearly distinguish particular signs and symptoms of cyclodialysis origin from other features of the disorder.Küchle and Naumann stated in their letter that: “We feel that traumatic cyclodialysis with possible subsequent spontaneous closure was present as the underlying cause for the clinical findings in patient 2 and possibly also in patient 1.” As we described in our original article, patient 2 had had a traumatic cyclodialysis which closed spontaneously. Until then, however, his cyclodialysis showed no detectable changes while ocular hypotony persisted, but the myopic changes were gradually reversed. This suggests that cyclodialysis was not the only cause of the myopic changes. In fact, patient 1 did not show ocular hypotony or cyclodialysis during the course of his disease process. We cannot totally exclude the possibility that the cyclodialysis was closed spontaneously before the anterior chamber angle became visible, but signs and symptoms of the ciliochoroidal effusion syndrome appeared at a stage when cyclodialysis was not detected at all.The ciliochoroidal effusion syndrome may also develop through non-traumatic mechanisms. Whether the primary cause is traumatic or non-traumatic, this syndrome is characterized by annular ciliochoroidal effusion with ciliary body edema, angle-closure glaucoma, myopic shift, lens thickening, and shallow anterior chamber. We have named this disease entity, “ciliochoroidal effusion syndrome”1Ikeda N. Ikeda T. Nagata M. Mimura O. Pathogenesis of transient high myopia after blunt eye trauma.Ophthalmology. 2002; 109: 501-507Abstract Full Text Full Text PDF PubMed Scopus (46) Google Scholar and listed the primary diseases that may cause this syndrome in Table 3 of our original article. These primary diseases induce ciliochoroidal effusion with ciliary body edema through different mechanisms. However, once this phenomenon is induced, the iris, ciliary body, and lens undergo identical changes irrespective of the primary disease, leading to the ciliochoroidal effusion syndrome.Unlike non-traumatic ciliochoroidal effusion syndrome, traumatic ones with cyclodialysis may show ocular hypotony. In such cases, a correct clinical diagnosis of traumatic hypotonous cyclodialysis is of importance as stressed by Küchle and Naumann because, as they have stated, long-standing ocular hypotony may cause progressive damage of the anterior and posterior segments. Thus, careful observation and timely surgical treatment are required in cases of cyclodialysis with ocular hypotony. It is correct that traumatic cyclodialysis causes various signs and symptoms similar to those seen in the “ciliochoroidal effusion syndrome”, a new disease entity that we proposed.1Ikeda N. Ikeda T. Nagata M. Mimura O. Pathogenesis of transient high myopia after blunt eye trauma.Ophthalmology. 2002; 109: 501-507Abstract Full Text Full Text PDF PubMed Scopus (46) Google Scholar Küchle and Naumann2Küchle M. Naumann G.O. Direct cyclopexy for traumatic cyclodialysis with persisting hypotony. Report in 29 consecutive patients.Ophthalmology. 1995; 102: 322-333Abstract Full Text PDF PubMed Scopus (116) Google Scholar have interpreted the mechanism by which traumatic cyclodialysis leads to the characteristic signs and symptoms as follows: “cyclodialysis leads to ciliary body detachment, loosened zonules, anterior displacement of the lens, and shallowing of the anterior chamber. The anteriorly displaced lens has greater dioptric power and thus leads to a myopic shift.” Nevertheless, a different explanation is also possible. When such a serious blunt eye trauma leading to cyclodialysis occurs, it is highly likely that diffuse edema of the ciliary body and ciliochoroidal effusion will also occur through the mechanism that then progresses to the ciliochoroidal effusion syndrome as described in our paper.1Ikeda N. Ikeda T. Nagata M. Mimura O. Pathogenesis of transient high myopia after blunt eye trauma.Ophthalmology. 2002; 109: 501-507Abstract Full Text Full Text PDF PubMed Scopus (46) Google Scholar Thus, traumatic cyclodialysis and the ciliochoroidal effusion syndrome may often occur together, and it may be difficult to clearly distinguish particular signs and symptoms of cyclodialysis origin from other features of the disorder. Küchle and Naumann stated in their letter that: “We feel that traumatic cyclodialysis with possible subsequent spontaneous closure was present as the underlying cause for the clinical findings in patient 2 and possibly also in patient 1.” As we described in our original article, patient 2 had had a traumatic cyclodialysis which closed spontaneously. Until then, however, his cyclodialysis showed no detectable changes while ocular hypotony persisted, but the myopic changes were gradually reversed. This suggests that cyclodialysis was not the only cause of the myopic changes. In fact, patient 1 did not show ocular hypotony or cyclodialysis during the course of his disease process. We cannot totally exclude the possibility that the cyclodialysis was closed spontaneously before the anterior chamber angle became visible, but signs and symptoms of the ciliochoroidal effusion syndrome appeared at a stage when cyclodialysis was not detected at all. The ciliochoroidal effusion syndrome may also develop through non-traumatic mechanisms. Whether the primary cause is traumatic or non-traumatic, this syndrome is characterized by annular ciliochoroidal effusion with ciliary body edema, angle-closure glaucoma, myopic shift, lens thickening, and shallow anterior chamber. We have named this disease entity, “ciliochoroidal effusion syndrome”1Ikeda N. Ikeda T. Nagata M. Mimura O. Pathogenesis of transient high myopia after blunt eye trauma.Ophthalmology. 2002; 109: 501-507Abstract Full Text Full Text PDF PubMed Scopus (46) Google Scholar and listed the primary diseases that may cause this syndrome in Table 3 of our original article. These primary diseases induce ciliochoroidal effusion with ciliary body edema through different mechanisms. However, once this phenomenon is induced, the iris, ciliary body, and lens undergo identical changes irrespective of the primary disease, leading to the ciliochoroidal effusion syndrome. Unlike non-traumatic ciliochoroidal effusion syndrome, traumatic ones with cyclodialysis may show ocular hypotony. In such cases, a correct clinical diagnosis of traumatic hypotonous cyclodialysis is of importance as stressed by Küchle and Naumann because, as they have stated, long-standing ocular hypotony may cause progressive damage of the anterior and posterior segments. Thus, careful observation and timely surgical treatment are required in cases of cyclodialysis with ocular hypotony." @default.
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• W2080121933 date "2003-07-01" @default.
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• W2080121933 title "Author reply: Transient myopia, anterior chamber shallowing, and ciliary body detachment after blunt eye trauma" @default.
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