Treatment of glaucoma with high intensity focused ultrasound

Figures & data

Figure 1. Two-point perspectives of the entire human eye (A) and of the anterior segment of the eye (B).

Figure 2. Optic nerve head photograph in a patient with glaucoma, showing visible cupping of the nerve (large central white part) (A). Optical coherence tomography scan of the optic nerve head, also showing the central cupping of the nerve (B). Visual field of the same patient, showing glaucomatous defects (grey and black points are locations of the space poorly or not seen by the patient, white points are locations of the space normally seen by the patient (C).

Table 1. Efficacy of diode laser cyclophotocoagulation procedures.

References	Number of patients	Method	Follow-up (month)	Efficacy/success rate
Al-Ghamdi et al. [21]	47	Trans-scleral	13 ± 8	79% (IOP <25 mmHg)
Hawkins & Stewart [22]	30	Trans-scleral	12	Preoperative IOP 20.8 ± 15.6 mmHg vs. 32.5 ± 10.9 mmHg post-operative
Brancato et al. [23]	48	Trans-scleral	20.7 ± 8	70.8% (IOP <21 mmHg)
Kosoko et al. [8]	27	Trans-scleral	19	84% (IOP reduction > 20% at 1 year), 62% (IOP reduction >20% at 2 years)
Bloom et al. [24]	210	Trans-scleral	10	66% (IOP <22 mmHg)
Chen et al. [25]	68	Endoscopic	12.9	90% (IOP <21 mmHg)
Hamard et al. [20]	50	Trans-scleral	19.4 ± 9.1	66% (IOP <20 mmHg)
Yap-Veloso et al. [26]	43	Trans scleral	11.9 ± 5.3	64% (IOP <22 mmHg)
Plager & Neely [27]	10	Endoscopic	36	20% (IOP <20 mmHg)
Walland [28]	30	Trans-scleral	21	45% (IOP <22 mmHg)
Egbert et al. [29]	79	Trans-scleral	13.2 ± 5.3	47% (IOP reduction >20%) 48% (IOP <22 mmHg)
Pueyo et al. [30]	13	Trans-scleral	22.2 ± 9.9	76.9% (IOP <22 mmHg)
Schlote et al. [31]	100	Trans-scleral	12	68.3% (IOP <21 mmHg)
Kramp et al. [32]	193	Trans-scleral	13.9	76.4% (IOP <22 mmHg)
Lima et al. [33]	68	Endoscopic	24	Post-operative IOP 14.1 ± 7.2 mmHg vs. preoperative IOP 41.6 ± 3.4 mmHg
Lai et al. [34]	13	Trans-scleral	26.5 ± 4.2	92.3% (IOP <21 mmHg with medical treatment) 0% (IOP <21 mmHg without medical treatment)
Vernon et al. [11]	42	Trans-scleral	65.7	88.1% (IOP <22 mmHg)
Yu et al. [35]	47	Endoscopic	10.8	51% (IOP <21 mmHg with medical treatment 25.5% (IOP <21 mmHg without medical treatment)
Iliev & Gerber [36]	131	Trans-scleral	30.1	69.5% (IOP <21 mm Hg)
Murthy et al. [37]	50	Endoscopic	12.2	88.1% (IOP <22 mm Hg)

IOP, intraocular pressure.

Table 2. Complications of diode laser cyclophotocoagulation procedures.

Complications	References	Complications rate (%)
Visual acuity decrease	Al-Ghamdi et al. [21]	8.5
	Yap-Veloso et al. [26]	22
	Egbert et al. [29]	23
	Hamard et al. [20]	34
	Pueyo et al. [30]	38
	Walland [28]	41
	Vernon et al. [11]	64.3
	Chen et al. [25]	6
	Goldenberg-Cohen et al. [38]	37.5
	Kosoko et al. [8]	30
	Lai et al. [34]	38.5
	Bloom et al. [24]	29
	Yildirim et al. [39]	24
Ocular phthisis	Yap-Veloso et al. [26]	2
	Goldenberg-Cohen et al. [38]	37.5
	Bloom et al. [24]	0.5
	Hamard et al. [20]	5
	Kramp et al. [32]	1.6.
Hypotony (IOP<5 mmHg)	Al-Ghamdi et al. [21]	14.8
	Bloom et al. [24]	1
	Yildirim et al. [39]	15
	Iliev and Gerber [36]	17.6
Chronic uveitis	Al-Ghamdi et al. [21]	27
	Yildirim et al. [39]	20
	Hamard et al. [20]	25
	Pueyo et al. [30]	15
	Kramp et al. [32]	12.4
Ocular hypertension	Al-Ghamdi et al. [21]	10
Corneal dystrophy	Yap-Veloso et al. [26]	2
	Hamard et al. [20]	6
Atonic pupil	Egbert et al. [29]	28
Hyphaema	Lima et al. [33]	17.6
Cataract	Hamard [20]	10
Neurotropic keratitis	Yildirim et al. [39]	8

IOP, intraocular pressure.

Figure 3. Schematic cross-section of the HIFU device to treat glaucoma (top left) and pictures of the device on a human eye (top right and bottom).

Figure 4. (A) Photomicrographs showing an entire lesion, with coagulation necrosis, loss of the bilayered ciliary epithelium and distension of the stromal collagen fibres (black arrows, magnification ×40). (B) Scanning electron microscopy of a treated ciliary process (left) and an untreated ciliary process (right) (×1000). (C) Photomicrographs showing an entire lesion, with also a fluid space between the sclera and the choroid (black arrows, magnification ×50). (D) Ultrasound biomicroscopy of a human eye 1 month after treatment, showing a hypoechoic fluid space between the sclera and the choroid (white arrows).

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