ABSTRACT
BACKGROUND: To evaluate the risk factors associated with failure to correct hypotony using direct cyclopexy in patients with traumatic cyclodialysis cleft. METHODS: In a series of 116 patients with traumatic cyclodialysis who underwent direct cyclopexy at Zhongshan Ophthalmic Center from January 2008 to August 2018, the clinical correlation between the risk factors and failure of the operation were retrospectively studied, after adjusting for other potential confounders. RESULTS: The curative ratio after one procedure was 82.76%, whereas 20 (17.24%) eyes experienced treatment failure after the first surgery. The degree of anterior chamber angle closure was significantly wider in patients with a failed first surgery than in patients for whom one procedure was a success (p = .046). The risk of failure to achieve closure increased as the angle-closure exceeded 5 clock hour (odds ratio, 10.39; 95% confidence interval, 1.75-61.72; p = .010). An analysis of the recurrent position indicated that an angle closure exceeding 5 clock hour may impede accurate cleft location and is thus associated with an increased risk of failure to correct hypotony. CONCLUSION: Exceeding the threshold of 5 clock hour in anterior chamber angle closure may impede accurate cleft location and, thus, present a higher risk of failure to correct hypotony using direct cyclopexy. These patients may need injection of a viscoelastic agent into the anterior chamber by paracentesis to deepen the anterior chamber and to delineate the clefts using gonioscopy pre- or intraoperatively.
Subject(s)
Cyclodialysis Clefts/surgery , Ophthalmologic Surgical Procedures , Adult , Case-Control Studies , Cyclodialysis Clefts/diagnostic imaging , Cyclodialysis Clefts/etiology , Cyclodialysis Clefts/physiopathology , Eye Injuries/complications , Female , Gonioscopy , Humans , Intraocular Pressure/physiology , Male , Microscopy, Acoustic , Middle Aged , Ocular Hypotension/physiopathology , Retrospective Studies , Risk Factors , Suture Techniques , Treatment Failure , Visual Acuity/physiologyABSTRACT
IMPORTANCE: A new method to help diagnose suspected cyclodialysis clefts. BACKGROUND: To study the use of trypan blue stained aqueous flow patterns in diagnosing causes of hypotony where cyclodialysis clefts were suspected. DESIGN: A case series in a tertiary care centre. PARTICIPANTS: Ten subjects presenting with persistent hypotony and retinal changes. METHODS: Trypan blue was injected into the anterior chamber. MAIN OUTCOME MEASURES: The pattern of dye flow in the anterior chamber was categorized. Intraocular pressure prior to surgery was recorded. RESULTS: All seven subjects with cyclodialysis clefts had a preferential flow to the cleft region. Two hypotonous subjects post trabeculectomy had rapid (5 seconds) and extensive lymphatic staining (6 o'clock hours extent) without visible bleb formation. CONCLUSIONS AND RELEVANCE: Preferential flow of dye to the limbus is a reliable sign of cyclodialysis cleft and helps localize cleft extent. A new cause of hypotony, "lymphatic overdrain," is identified.
Subject(s)
Aqueous Humor/physiology , Coloring Agents/administration & dosage , Cyclodialysis Clefts/diagnosis , Ocular Hypotension/diagnosis , Trypan Blue/administration & dosage , Aged , Aged, 80 and over , Anterior Chamber/drug effects , Cyclodialysis Clefts/physiopathology , Female , Gonioscopy , Humans , Injections, Intraocular , Intraocular Pressure/physiology , Male , Ocular Hypotension/physiopathology , Prospective Studies , Tertiary Care Centers , Tonometry, Ocular , Visual Acuity/physiologyABSTRACT
IMPORTANCE: There is a paucity of evidence analysing the treatment of cyclodialysis clefts. BACKGROUND: We describe outcomes following the treatment of this rare condition at six centres internationally. DESIGN: Retrospective case series. PARTICIPANTS: Thirty-six patients with a cyclodialysis cleft from 2003 to 2017 were recruited. METHODS: Clefts were treated with cycloplegic agents, laser therapy and/or surgery. MAIN OUTCOME MEASURES: Postoperative best recorded visual acuity (BRVA), intraocular pressure (IOP) and the rate of cleft closure. RESULTS: The mean age was 45 ± 17 years and 29 (80.6%) patients were male. One eye (2.8%) received only medical therapy, 5 (13.9%) received laser, 14 (38.9%) underwent surgery after laser failure and 16 (44.4%) eyes received exclusively surgery. Over 80% of eyes had a BRVA improvement of more than two lines. Closure was attained in 30 eyes (93.8%; n = 32), with postoperative stabilized IOP ≥ 12 mmHg in 29 eyes (80.6%; n = 36) and postoperative BRVA ≤20/50 in 20 eyes (58.8%; n = 34). Improved postoperative BRVA was related to better preoperative BRVA (P = 0.006) and preoperative IOP ≥ 4 mmHg (P = 0.03). There was no significant difference between treatment approach for IOP ≥ 12 mmHg (P = 0.85) or postoperative BRVA ≤20/50 (P = 0.80). Only two eyes at last follow-up required IOP lowering medication. CONCLUSIONS AND RELEVANCE: There was a high closure rate with most eyes eventually requiring surgery. Clinically significant improvements in BRVA were found in most eyes. Improved postoperative BRVA was significantly related to better preoperative BRVA and IOP.
