Short-Term Observation of Ultrasonic Cyclocoagulation in Chinese Patients with End-Stage Refractory Glaucoma: A Retrospective Study

Abstract

Purpose To assess the efficacy and safety of HIFU-based ultrasonic cyclocoagulation in Chinese patients with end-stage refractory glaucoma. Method Patients were recruited consecutively from May 2016 to May 2017 in the Zhongshan Ophthalmic Center. Ultrasonic cyclocoagulation was performed on every patient, using the EyeOP1 ultrasound emitting device. Return visits were set at 1 day, 7 days, 1 month, and 3 months after the treatment. An intraocular pressure (IOP) reduction of ≥20% while IOP ≥ 5 mmHg was deemed as success. Mean IOP change was assessed. Efficacy of two modes (6 sectors and 8 sectors) was also compared. Complications were recorded for safety evaluation. Results 61 eyes were treated in this study. The baseline IOP (mean ± SD) was 41.11 ± 10.65 mmHg. The percentage of IOP reduction after treatment was 29.2%, 43.2%, 34.8%, and 23.1% at 1 day, 7 days, 1 month, and 3 months, respectively. Overall success rate at 3 months was 50.0% (26/52). No significant difference was found between the 6 sectors group and the 8 sectors group in terms of the success rate (48.6% vs. 52.9%, p=0.768) as well as IOP reduction (p=0.417) at 3 months. Primary angle-closure glaucoma (PACG) had the highest success rate (80.0%, 12/15). Scleral thinning existed in 12 eyes, among which 2 developed hypotony (2 mmHg and 3 mmHg). Average pain score decreased massively compared with baseline data. Conclusion With high percentage of IOP reduction and a good safety profile observed in our study, HIFU-based ultrasonic cyclocoagulation might become a promising alternative to cyclodestructive methods. Long-term efficacy and safety need further assessment. The study was registered with Chinese Clinical Trial Registry (http://www.chictr.org.cn; Registration number: ChiCTR-OOC-17014028).

Ultrasound Cycloplasty in Chinese Glaucoma Patients: Results of a 6-Month Prospective Clinical Study

“…As expected, our results showed that operative complications such as conjunctival hyperemia disappeared within 1 month. Moreover, as previously reported by Hu et al [10], the decrease of IOP after UCP completely relieved the patients' ocular pain symptoms before operation.…”

“…Although the treatment of glaucoma continues to update, glaucoma is still the main cause of permanent visual impairment in adults. In recent years, UCP treatment using high-intensity focused ultrasound technology has been applied to partially coagulate the ciliary body as a novel noninvasive glaucoma procedure, accompanied with a more predictable and controlled IOP reduction when compared to traditional cyclodestructive surgeries [10, 11]. In our present study, UCP procedure achieved significant 34% IOP reduction at the 6-month follow-up visit, which was within the efficiency range from 20.1 to 40.8% published in previous studies [7].…”

“…In China, the incidence of PACG is the highest among glaucoma subtypes, followed by primary open-angle glaucoma and SG [2]. In a previous study of UCP in Chinese glaucoma patients [10], PACG responded much better than other types of glaucoma. Our results showed that patients with PACG and SG had achieved the greatest IOP reduction (41 and 50%, respectively) and therapeutic success rate but will have to be confirmed by other series on a larger population.…”

“…The following standard parameters of operation module were applied: operating frequency, 21 MHz; acoustic power, 2.45 W; ultrasound exposure time per sector, 8 s; and sequential sector activation interval, 20 s. There were 3 modes including 6 sectors, 8 sectors, and 10 sectors activated being applied for UCP treatment according to the preoperative IOP and vision status. After the first activation of the 6 transducers successively, the 8-or 10-sector modes were achieved by rotating the probe to the second position, and then 2 or 4 of the 6 transducers were activated again to complete the procedure [9,10] Postoperatively, patients were treated with anti-inflammatory eyedrops (TobraDex, tobramycin-dexamethasone suspension) 4 times a day for 1 month. If necessary, low concentration steroid eyedrops (0.1% fluorometholone ophthalmic suspension) were prescribed for another 1 month.…”

“…UCP decreases IOP by reducing aqueous humor production and by increasing uveoscleral outflow. Many published studies have reported positive and favorable results of UCP procedure regarding safety and efficacy in patients with refractory glaucoma or patients who were not surgically treated before [7][8][9][10][11][12][13][14][15][16][17][18]. In the present study, the objective was to evaluate, in Chinese patients with medically uncontrolled glaucoma with low or good vision, the efficacy and safety of UCP treatment and to explore the feasibility of multidose UCP.…”