Skip to main content

Advertisement

SpringerLink
Log in

Safety and efficacy of multiple cyclocoagulation of ciliary bodies by high-intensity focused ultrasound in patients with glaucoma

  • Glaucoma
  • Published:
Graefe's Archive for Clinical and Experimental Ophthalmology Aims and scope Submit manuscript

Abstract

Purpose

To evaluate long-term efficacy and safety of repeated ultrasonic circular cyclocoagulation (UCCC) in patients with uncontrolled glaucoma.

Methods

Forty eyes of 40 patients affected by primary or secondary uncontrolled glaucoma under maximal tolerated medical therapy were enrolled in this prospective non-comparative case series study. A complete ophthalmic examination was performed before and after each month for 1 year. The UCCC treatment was repeated at 4 months if the intraocular pressure (IOP) was > 21 mmHg without major complications. Complete success was defined as a final IOP > 5 mmHg and ≤ 21 mmHg without hypotensive medication adjunction and no major or vision-threatening complications.

Results

The mean preoperative IOP was 32.5 ± 9.9 mmHg. Four months after the first UCCC treatment the overall IOP reduction was 27.8%. Twenty-two of the treated eyes did not achieve the complete success and a second treatment was performed in 20 of these eyes. Four months after the second UCCC procedure, the IOP reduction was 20.3% from preoperative values and 34.7% from baseline. Twelve of the retreated eyes needed a third treatment. Four months after the third UCCC treatment, the overall IOP reduction was 34% and 52.6% from baseline. No major complications occurred during or after any of the procedures. At 12 months, complete success was achieved in 85% (34/40) of treated eyes, with a maximum of three procedures and a significant medication reduction.

Conclusions

Multiple UCCC treatments are safe, and additional treatments increase the overall procedure efficacy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7

Similar content being viewed by others

References

  1. Abdelrahman AM (2015) Noninvasive glaucoma procedures: current options and future innovations. Middle East Afr J Ophthalmol 22(1):2–9

    Article  PubMed  PubMed Central  Google Scholar 

  2. Kosoko O, Gaasterland DE, Pollack IP et al (1996) Long-term outcome of initial ciliary ablation with contact diode laser transscleral cyclophotocoagulation for severe glaucoma. The Diode Laser Ciliary Ablation Study Group. Ophtalmologie 103:1294–1302

    Article  CAS  Google Scholar 

  3. McKelvie PA, Walland MJ (2002) Pathology of cyclodiode laser: a series of nine enucleated eyes. Br J Ophtalmol 86:381–386

    Article  CAS  Google Scholar 

  4. Coleman DJ, Lizzi FL, Driller J et al (1985) Therapeutic ultrasound in the treatment of glaucoma, I. Experimental model. Ophthalmology 92(3):339–346

    Article  CAS  PubMed  Google Scholar 

  5. Coleman DJ, Lizzi F, Driller J et al (1985) Therapeutic ultrasound in the treatment of glaucoma, II: clinical applications. Ophthalmology 92:347–352

    Article  CAS  PubMed  Google Scholar 

  6. Burgess SEP, Silverman RH, Coleman DJ et al (1986) Treatment of glaucoma with high-intensity focused ultrasound. Ophthalmology 93(6):831–838

    Article  CAS  PubMed  Google Scholar 

  7. Charrel T, Aptel F, Birer A et al (2011) Development of a miniaturized HIFU device for glaucoma treatment with conformal coagulation of the ciliary bodies. Ultrasound Med Biol 37:742–754

    Article  PubMed  Google Scholar 

  8. Aptel F, Charrel T, Palazzi X et al (2010) Histologic effects of a new device for high-intensity focused ultrasound cyclocoagulation. Invest Ophthalmol Vis Sci 51(10):5092–5098

    Article  PubMed  Google Scholar 

  9. Aptel F, Charrel T, Lafon C et al (2011) Miniaturized high-intensity focused ultrasound device in patients with glaucoma: a clinical pilot study. Invest Ophthalmol Vis Sci 52(12):8747–8753

    Article  PubMed  Google Scholar 

  10. Mastopasqua R, Agnifili L, Fasanella V et al (2016) Uveo-scleral outflow pathways after ultrasonic cyclocoagulation in refractory glaucoma: an anterior segment optical coherence tomography and in vivo confocal study. Br J Ophtalmol 100(12):1668–1675

    Article  Google Scholar 

  11. Aptel F, Dupuy C, Rouland JF (2014) Treatment of refractory open-angle glaucoma using ultrasonic circular cyclocoagulation: a prospective case series. Curr Med Res Opin 30(8):1599–1605

    Article  CAS  PubMed  Google Scholar 

  12. Aptel F, Béglé A, Razavi A et al (2014) Short- and long-term effects on the ciliary body and the aqueous outflow pathways of high-intensity focused ultrasound cyclocoagulation. Ultrasound Med Biol 40(9):2096–2106

    Article  PubMed  Google Scholar 

  13. Denis P, Aptel F, Rouland J-F et al (2015) Cyclocoagulation of the ciliary bodies by high-intensity focused ultrasound: a 12-month multicenter study. Invest Ophthalmol Vis Sci 56:1089–1096

    Article  PubMed  Google Scholar 

  14. Shaarawy T, Sherwood MB, Grehn F (2009) Guidelines on design and reporting of glaucoma surgical trials. Kugler Publications, Amsterdam

    Google Scholar 

Download references

Funding

No funding was received for this research.

Author information

Authors and Affiliations

  1. Ophthalmic Unit, San Bassiano Hospital, Via dei Lotti 40, Bassano del Grappa, 36061, Vicenza, Italy

    Alessandra De Gregorio, Giulia Stevan, Margherita Montali & Simonetta Morselli

  2. Eye Clinic, Department of Neuroscience, Biomedicine and Mouvement, University of Verona, Verona, Italy

    Emilio Pedrotti

Authors
  1. Alessandra De Gregorio
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Emilio Pedrotti
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Giulia Stevan
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Margherita Montali
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Simonetta Morselli
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Alessandra De Gregorio.

Ethics declarations

Conflict of interest

All authors certify that they have no affiliations with or involvements in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge, or beliefs) in the subject matter or materials discussed in this manuscript.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

De Gregorio, A., Pedrotti, E., Stevan, G. et al. Safety and efficacy of multiple cyclocoagulation of ciliary bodies by high-intensity focused ultrasound in patients with glaucoma. Graefes Arch Clin Exp Ophthalmol 255, 2429–2435 (2017). https://doi.org/10.1007/s00417-017-3817-4

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00417-017-3817-4

Keywords

Search

Navigation