Therapeutic Ultrasound in the Treatment of Glaucoma

Coleman, D. Jackson; Lizzi, Frederic L.; Driller, J.; Rosado, A.; Burgess, S. E. P.; Torpey, J H; Smith, Mary E.; Silverman, Ronald H.; Yablonski, Michael E.; Chang, Stanley; Rondeau, Mark J.

doi:10.1016/s0161-6420(85)34028-9

Cited by 151 publications

(40 citation statements)

References 9 publications

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“…Many physical methods have been proposed to partially destroy the ciliary body, resulting in coagulation necrosis of the ciliary body following heating (laser, ultrasounds) or freezing (cryotherapy). Ultrasonic coagulation of the ciliary body was extensively studied in the 1980s and 1990s (Coleman et al 1985;Burgess et al 1986;Polack et al 1991;Silverman et al 1991). The cyclodestructive methods have two major drawbacks which limit their use: they are non-selective for the target tissue to be treated, often resulting in damage to adjacent structures, and they have an unpredictable doseeffect relationship, which prevents accurate prediction of the treatment effect (De Roetth 1965;Maus & Katz 1990;Uram 1992;Al-Ghamdi et al 1993;Kosoko et al 1996;Hamard et al 1997;Sabri & Vernon 1999;Vernon et al 2006).…”

Section: Introductionmentioning

confidence: 99%

Multicenter clinical trial of high‐intensity focused ultrasound treatment in glaucoma patients without previous filtering surgery

Aptel

Denis

Rouland

et al. 2015

Acta Ophthalmologica

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ABSTRACT.Purpose: To evaluate the efficacy and safety of the ultrasonic circular cyclocoagulation procedure in patients with open-angle glaucoma na€ ıve of previous filtering surgery. Methods: Prospective non-comparative interventional clinical study conducted in five French University Hospitals. Thirty eyes of 30 patients with open-angle glaucoma, intra-ocular pressure (IOP) > 21 mmHg and with no previous filtering glaucoma surgeries were sonicated with a probe comprising six piezoelectric transducers. The six transducers were activated with a 6-s exposure time. Complete ophthalmic examinations were performed before the procedure and at 1 day, 1 week, 1, 2, 3, 6 and 12 months after the procedure. Primary outcomes were qualified surgical success (defined as IOP reduction from baseline ≥20% and IOP > 5 mmHg with possible re-intervention and without hypotensive medication adjunction) and complete surgical success (defined as IOP reduction from baseline ≥20%, IOP > 5 mmHg and IOP < 21 mmHg with possible re-intervention and without hypotensive medication adjunction) at the last follow-up visit and vision-threatening complications. Secondary outcomes were mean IOP at each follow-up visit compared with baseline, medication use, complications and re-interventions. Results: Intra-ocular pressure was significantly reduced (p < 0.05) from a mean pre-operative value of 28.2 AE 7.2 mmHg (n = 3.6 hypotensive medications) to 19.6 AE 7.9 mmHg at 12 months (n = 3.1 hypotensive medications and n = 1.1 procedures) (mean IOP reduction of 30%). Qualified success was achieved in 63% of eyes (19/30) (mean IOP reduction of 37% in these eyes) and complete success in 46.7% of eyes (14/30) (mean IOP reduction of 37% in these eyes) at the last follow-up. No major intra-or post-operative complications occurred. Conclusions: The UC 3 procedure seems to be an effective and well-tolerated method to reduce IOP in patients with open-angle glaucoma without previous filtering surgery.

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Section: Introductionmentioning

confidence: 99%

Multicenter clinical trial of high‐intensity focused ultrasound treatment in glaucoma patients without previous filtering surgery

Aptel

Denis

Rouland

et al. 2015

Acta Ophthalmologica

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“…Cyclodestructive procedures for intractable glaucoma unlikely to benefit from surgery, have evolved in the last 70 years: from penetrating cyclodiathermy, 1 to cyclocryotherapy, [2][3][4] to ultrasound for ciliary body ablation, 5,6 to laser cyclophotocoagulation. [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] The chief drawback of these procedures as a group is a narrow therapeutic window, which implies that there is a very small safety zone in which it is effective without causing significant complications.…”

Section: Introductionmentioning

confidence: 99%

Lower energy levels adequate for effective transcleral diode laser cyclophotocoagulation in Asian eyes with refractory glaucoma

Kaushik

Pandav

Jain

et al. 2006

Eye

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Purpose To study the treatment parameters for diode laser cyclophotocoagulation (DLCP) in Asian Indian eyes using laser energy titrated to clinical response. Methods This prospective interventional longitudinal study included 66 eyes of 66 patients with varied aetiology refractory glaucoma, no previous cycloablation, and minimum 1 year follow-up. DLCP was performed using the Oculight s Diode laser system (IRIS & Medical Instruments Inc., CA, USA). Power used per spot was titrated according to the audible 'pops' indicating tissue microexplosion. The mean laser energy delivered, post-laser intraocular pressure (IOP) reduction, complications, and requirement of re-treatment in various subgroups were analyzed. Differences in energy delivered in each subgroup were assessed by analysis of variance with post hoc Bonferroni corrections. Linear regression analysis was used to identify possible predictive factors for failure of cyclodiode therapy. Results The mean total energy delivered per eye was 87.80731.8 J (range 105.4736.8 J in neovascular glaucoma (NVG) to 61.578.8 J in uveitic glaucoma (P ¼ 0.134)). Mean pre treatment IOP was 36.4710.7 mmHg, which reduced to 19.479.8 mmHg (Po0.001) at 1 week, and 15.676.6 mmHg at 1 year. At 1 year, 58 of 66 patients had IOPo22.0 mmHg (response rate 87.8%), and six patients had hypotony (success rate 78.8%). The uveitic glaucoma group had 100% success rate. NVG group required maximum re-treatments. Conclusions DLCP with a titrated energy protocol needs resulted in lower energy in Asian Indian eyes compared to that reported in literature, and different energy levels are needed for different diseases. 'Standard treatment parameters' for DLCP may be inappropriate for all diseases and all races.

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“…Clinical applications include treatment of renal tumors (Wu et al 2003b;Marberger et al 2005;Kohrmann et al 2002), prostate cancer Thuroff et al 2003;Blana et al 2004), liver cancer (ter Haar et al 1989;Yang et al 1993;Kennedy et al 2004) and breast cancer (Wu et al 2003aGianfelice et al 2004), among others. In the 1980's our research group used HIFU for treatment of glaucoma (Coleman et al 1985;Burgess et al 1986;Silverman et al 1991) and ocular tumors Coleman et al 1986). The first FDA approved commercial HIFU instrument (for glaucoma treatment), manufactured by Sonocare, Inc., was an outgrowth of this program.…”

Section: Introductionmentioning

confidence: 99%

Improved visualization of high-intensity focused ultrasound lesions

Silverman

Muratore

Ketterling

et al. 2006

Ultrasound in Medicine & Biology

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Spectral parameter imaging in both the fundamental and harmonic of backscattered radiofrequency (RF) data was used for immediate visualization of high-intensity focused ultrasound (HIFU) lesion sites. A focused 5-MHz HIFU transducer with a coaxial 9-MHz focused single-element diagnostic transducer was used to create and scan lesions in chicken breast and freshly excised rabbit liver. Bmode images derived from the backscattered RF signal envelope were compared with midband fit (MBF) spectral parameter images in the fundamental (9-MHz) and harmonic (18-MHz) bands of the diagnostic probe. Images of HIFU-induced lesions derived from the MBF to the calibrated spectrum showed improved contrast (~ 3 dB) of tumor margins versus surround compared to images produced from the conventional signal envelope. MBF parameter images produced from the harmonic band showed higher contrast in attenuated structures (core, shadow) compared to either the conventional envelope (3.3 dB core; 11.6 dB shadow) or MBF images of the fundamental band (4.4 dB core; 7.4 dB shadow). The gradient between the lesion and surround was 3.4 dB/mm, 6.9 dB/mm and 17.2 dB/mm for B-mode, MBF-fundamental mode and MBF-harmonic mode respectively. Images of threshold and 'popcorn' lesions produced in freshly excised rabbit liver were most easily visualized and boundaries best defined using MBF-harmonic mode.

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Therapeutic Ultrasound in the Treatment of Glaucoma

Cited by 151 publications

References 9 publications

Multicenter clinical trial of high‐intensity focused ultrasound treatment in glaucoma patients without previous filtering surgery

Multicenter clinical trial of high‐intensity focused ultrasound treatment in glaucoma patients without previous filtering surgery

Lower energy levels adequate for effective transcleral diode laser cyclophotocoagulation in Asian eyes with refractory glaucoma

Improved visualization of high-intensity focused ultrasound lesions

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