The presence of cornea verticillata is a useful aid in the diagnosis of Fabry's disease, as it is often present at the time of diagnosis. Vessel tortuosity may have some predictive value for systemic involvement.

The management of cyclodialysis clefts requires a step-wise approach. Initially, it is of particular importance to identify the full extent and location of the cleft as in some cases more than one cleft may be present requiring a variety of nonsurgical and surgical interventions. Nonincisional interventions include the application of various lasers and cryotherapy in the vicinity of the cleft. The traditional approach of direct cyclopexy has more recently been complemented by recent reports of employing modified external plombage procedures, vitrectomy and gas assisted endotamponade. There are insufficient studies formally evaluating these techniques to be able to assess their safety and efficacy.

PurposeTo 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.DesignRetrospective interventional case series.MethodsInterventional case series of consecutive patients with cyclodialysis clefts and hypotony treated surgically after failure of conservative treatment.ResultsEighteen 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.ConclusionsMost 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.

A significant number of patients who attend ophthalmic A&E departments have non-urgent conditions that could be managed satisfactorily in a primary care setting by specialist trained GPs or optometrists outside the hospital casualty department. Improvement in education of patients, the provision of specialist ophthalmic training for GPs and optometrists, and expansion of outpatient services are needed so that casualty remains a genuine emergency service.

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