Outcomes and Predictors of Failure of Ultrasound Cyclo Plasty for Primary Open-Angle Glaucoma

Abstract

Aims: To evaluate the outcomes of ultrasound cyclo plasty (UCP) for primary open-angle glaucoma (POAG) and identify the predictors of failure. Methods: This retrospective cohort study included patients with POAG who underwent UCP at King Abdul Aziz University Hospital, Riyadh, Saudi Arabia, between 2016 and 2021. The main outcome measures were the intraocular pressure (IOP), the number of antiglaucoma medications, and the presence of vision-threatening complications. The surgical outcome of each eye was based on the main outcome measures. Cox proportional hazard regression analysis was performed to identify the possible predictors of UCP failure. Results: Sixty-six eyes of fifty-five patients were included herein. The mean follow-up period was 28.95 (±16.9) months. The mean IOP decreased significantly from 23.02 (±6.1) to 18.22 (±7.0) and 16.44 (±5.3) mm Hg on the 12th and 24th months, respectively; the mean number of antiglaucoma medications decreased significantly from 3.23 (±0.9) to 2.15 (±1.5) and 2.09 (±1.6), respectively. The cumulative probabilities of overall success were 71.2 ± 5.6% and 40.9 ± 6.1% on the 12th and 24th months, respectively. High baseline IOP and the number of antiglaucoma medications were associated with a higher risk of failure (hazard ratio = 1.10 and 3.01, p = 0.04 and p < 0.01, respectively). The most common complications were cataract development or progression (30.8%) and prolonged or rebound anterior chamber reaction (10.6%). Conclusions: UCP reasonably controls the IOP and reduces the antiglaucoma medication burden in eyes with POAG. Nevertheless, the success rate is modest, with a high baseline IOP and number of medications.

Comparison of the efficacy and safety of ultrasonic cycloplasty vs valve implantation and anti-VEGF for the treatment of fundus disease-related neovascular glaucoma

“…Starting from the 1980s, ultrasound began to be used for the treatment of glaucoma [24] . High-intensity focused ultrasound was applied non-invasively to the ciliary processes that produce aqueous humor, for precise, controlled, and gentle thermal coagulation, melting the epithelial cell layer of the ciliary body while preserving the blood-aqueous humor barrier, reducing aqueous humor production, opening the uveoscleral pathway, increasing aqueous humor outflow, and achieving a dual reduction in IOP [12,[25][26][27] . The precise focusing causes no damage to non-treatment areas, does not cause eye shrinkage, is not affected by pigment absorption, and the degree of pressure reduction is controllable, without causing low eye pressure.…”

“…It does not require incisions, has a fast recovery, and allows for quick subsequent anti-VEGF or PRP treatment. The procedure is simple and the treatment time is short, only a few minutes, which improves the efficiency of clinical treatment [13][14][15]25,28] . The results of this study showed that the IOP of both groups of patients with NVG significantly decreased at each postoperative time point compared to preoperative levels.…”

Outcomes of Ultrasound Cyclo Plasty in Primary Angle Closure Glaucoma

“…Several studies have reported encouraging short-term results regarding the safety and efficacy of UCP. [8][9][10][11][12][13][14] However, little is known about its outcomes in PACG. Therefore, our study aimed to report the intermediate-term outcomes of UCP in eyes with PACG.…”

“…Both the miniaturized transducers and the circular-shaped probe matching the 3-dimensional anatomy of the ciliary body allow correct focusing of ultrasound beams on the target tissue through optically opaque ocular media with controlled energy absorption. Several studies have reported encouraging short-term results regarding the safety and efficacy of UCP 8–14. However, little is known about its outcomes in PACG.…”