The evaluation and surgical management of cyclodialysis clefts that have failed to respond to conservative management.
OBJECTIVE
To investigate factors that may influence successful correction of hypotony in a consecutive series of patients with cyclodialysis clefts repaired surgically over a 10-year period.


METHODS
Retrospective interventional case series.


METHODS
Interventional case series of consecutive patients with cyclodialysis clefts and hypotony treated surgically after failure of conservative treatment.


RESULTS
Eighteen patients (18 eyes) of mean (SD) age 48.3 (15.8) years at the time of surgery were included (16 male, 2 female). All were diagnosed using gonioscopy, usually assisted with intracameral viscoelastic injection. Imaging used in three cases was not found to be sufficiently precise to plan surgical intervention, without prior gonioscopic cleft visualisation. The intraocular pressure (IOP) was restored in nine cases (50%) after one procedure with a postoperative IOP (mean ± SD) of 13.6 ± 4.5 mm Hg (6/11 who had cyclopexy as a first procedure and 3/6 who had cryopexy). 2-3 procedures were required in the remaining nine patients. There was a trend towards the use of cyclopexy for larger clefts and cryopexy for smaller clefts (NS). We observed a trend for a lower likelihood of successful closure of larger clefts after one intervention. Two eyes that had cyclopexy required later IOP-lowering surgery to achieve IOP control.


CONCLUSIONS
Most clefts were closed with one procedure. A trend towards larger cleft size as a preoperative risk factor for failure to achieve closure with one procedure was observed. In this series, imaging was not found to be sufficiently precise to replace viscoelastic-assisted gonioscopy in the diagnosis and evaluation of cyclodialysis clefts.
NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital, , London, UK.
Alexander S
AS
Ioannidis
Catey
C
Bunce
Keith
K
Barton
D002924:Ciliary Body / Q000293:injuries*; D003452:Cryosurgery; D005131:Eye Injuries / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006068:Gonioscopy; D006801:Humans; D007429:Intraocular Pressure / Q000502:physiology; D008297:Male; D033401:Microscopy, Acoustic; D008875:Middle Aged; D015814:Ocular Hypotension / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D012189:Retrospective Studies; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology; D014949:Wounds, Nonpenetrating / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*
Ciliary body; Glaucoma; Trauma; Treatment Surgery