Treatment of refractory open-angle glaucoma using ultrasonic circular cyclocoagulation: a prospective case series

Abstract

Objective:

To evaluate the efficacy and safety of the ultrasonic circular cyclocoagulation (UC³) procedure in patients with refractory primary open-angle glaucoma.

Research design and methods:

Prospective non-comparative interventional case series performed in two French glaucoma centers. Twenty-eight eyes of 28 patients with primary open-angle glaucoma, intraocular pressure (IOP) >21 mmHg, an average of 1.4 failed previous surgeries and an average of 3.8 hypotensive medications were insonified with a therapy probe comprising six piezoelectric transducers. The six transducers were activated and all patients were treated with a 6 second exposure time. Complete ophthalmic examinations were performed before the procedure, and at 1 day, 1 week, 1, 2, 3, 6 and 12 months after.

Main outcome measures:

Primary outcomes were surgical success (defined as IOP reduction from baseline ≥20% and IOP >5 mmHg) at the last follow-up visit, and vision-threatening complications. Secondary outcomes were mean IOP at each follow-up visit compared to baseline, medication use, complications, and re-interventions.

Results:

IOP was significantly reduced (P < 0.05), from a mean preoperative value of 29.0 ± 7.2 mmHg (n = 3.8 hypotensive medications) to a mean value of 21.6 ± 9.4 mmHg at last follow-up (n = 3.8 hypotensive medications and n = 1.29 procedures) (mean IOP reduction of 26%). Complete success (IOP reduction >20% without re-intervention and without hypotensive medications adjunction) was achieved in 50% of eyes at last follow-up (mean IOP reduction of 45% in these same eyes) and qualified success (IOP reduction >20% with possible re-interventions) was achieved in 68% of eyes at last follow-up. No major intra- or post-operative complications occurred.

Conclusions:

UC³ procedure seems to be an effective and well tolerated method to reduce intraocular pressure in patients with primary open-angle glaucoma. Studies directly comparing the efficacy and safety of the UC³ procedure with that of trabeculectomy or diode laser are needed.

Keywords::

• Ciliary body
• Glaucoma
• Intraocular pressure
• Ultrasound

Transparency

Declaration of funding

The ultrasonic probes were provided by EyeTechCare SA (Rillieux-la-Pape, France). EyeTechCare SA had no role in the design of the study and preparation of the manuscript.

Declaration of financial/other relationships

F.A. and J.-F.R. have disclosed that they are consultants of EyeTechCare SA. C.D. has disclosed that she received sponsorship from EyeTechCare for her role in developing this study.

CMRO peer reviewers on this manuscript have received an honorarium from CMRO for their review work, but have no other relevant financial relationships to disclose.