Marko Popovic1, Shakeel Shareef2, Juan J Mura3, Felipe Valenzuela4, Julio González Martín-Moro5, Matthew B Schlenker6, Keith Barton7, Francisco Muñoz-Negrete8, Mohammad Reza Razeghinejad9,10, Iqbal Ike K Ahmed6. 1. Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. 2. Flaum Eye Institute, University of Rochester School of Medicine and Dentistry, Rochester, New York. 3. Centro de la Visión, Hospital Del Salvador, Universidad de Chile, Santiago, Chile. 4. Clinica Universidad de Los Andes, Santiago, Chile. 5. Department of Ophthalmology, Hospital Universitario del Henares, Madrid, Spain. 6. Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada. 7. Glaucoma Service, Moorfields Eye Hospital, London, UK. 8. Department of Ophthalmology, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain. 9. Glaucoma Service, Wills Eye Institute, Philadelphia, Pennsylvania. 10. Poostchi Eye Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
Abstract
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.
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.
Authors: Samuel M Dresner; Yasmin Florence Khodeja Islam; Thomas A Lazzarini; Jorge Fortun; Arindel S R Maharaj Journal: Am J Ophthalmol Case Rep Date: 2022-07-01