Risk Factors Associated with Failure of Direct Cyclopexy in the Treatment of Small to Moderate Tramatic Cyclodialysis Clefts

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.

KEYWORDS:

• Traumatic cyclodialysis
• hypotony
• direct cyclopexy
• angle closure

Acknowledgments

We would like to thank Qing Liu for his contribution to data statistical analysis guidance. We would like to appreciate Editage (www.editage.com) for English language editing.

Declarations of interest

The authors declare no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

Ethics approval

The study was conducted in compliance with the principles of the Declaration of Helsinki, and approved by the Institutional Ethics Committee of Zhongshan Ophthalmic Center (Guangzhou, China). Patient consent for inclusion was waived because of the retrospective nature of the study.

Additional information

Funding

This work was supported in part by funds from the Fundamental Research Funds of the State Key Laboratory of Ophthalmology (Guangzhou, China) [grant numbers 30306020240020130 and 3030902113030], and the Natural Science Foundation of Guangdong Province, China [grant numbers 2015A030313187 and 2018A030313585].