Ultrasonic Circular Cyclocoagulation

Aptel, Florent; Denis, Philippe

doi:10.1007/978-1-4614-8348-9_11

Cited by 3 publications

(6 citation statements)

References 20 publications

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“…Investigators from France were the first to report on the efficacy and safety of ultrasonic circular cyclocoagulation (UC3) treatment using HIFU in refractory glaucoma (16, 24, 25).…”

Section: Discussionmentioning

confidence: 99%

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High-Intensity Focused Ultrasound Treatment in Refractory Glaucoma Patients: Results at 1 Year of Prospective Clinical Study

Melamed

Goldenfeld

Cotlear

et al. 2015

European Journal of Ophthalmology

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Purpose To evaluate the safety and efficacy of the ultrasonic circular cyclo-coagulation procedure using high-intensity focused ultrasound by a miniaturized annular device containing 6 piezoceramic transducers in patients with refractory glaucoma. Methods This was a prospective interventional noncomparative study of 20 eyes of 20 patients with refractory glaucoma. All eyes were treated with 6 activated transducers operating at 21 MHz. Ultrasound biomicroscopy and a complete ophthalmic examination were performed before the procedure and at 1 day, 1 week, and 1, 3, 6, and 12 months after the procedure. Primary outcomes were surgical success (defined as intraocular pressure (IOP) reduction from baseline ≥20% and IOP >5 mm Hg) at the last follow-up visit. Secondary outcomes were mean IOP at each follow-up visit compared to baseline, medication use, complications, and re-interventions. Results Intraocular pressure was significantly reduced (p<0.01) from a mean preoperative value of 36.4 ± 5.7 mm Hg to a mean postoperative value of 22.5 ± 10.3 mm Hg at 12 months. Four patients needed to be re-treated. The mean IOP reduction achieved was 38%. Surgical success was achieved in 13 of 20 eyes (65%). No major intraoperative or postoperative complications occurred. Conclusions Ultrasonic circular cyclo-coagulation using high-intensity focused ultrasound delivered by a circular miniaturized device containing 6 piezoceramic transducers is an effective and well-tolerated method to reduce IOP in patients with refractory glaucoma.

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“…Investigators from France were the first to report on the efficacy and safety of ultrasonic circular cyclocoagulation (UC3) treatment using HIFU in refractory glaucoma (16, 24, 25).…”

Section: Discussionmentioning

confidence: 99%

“…Other cycloablative techniques like cryotherapy and laser cyclophotocoagulation are much less precise. Endoscopic cyclophotocoagulation (ECP) allows direct visualization of ciliary processes with better focusing, but requires invasive entry into the eye with all the related complications (23)(24)(25).…”

confidence: 99%

High-Intensity Focused Ultrasound Treatment in Refractory Glaucoma Patients: Results at 1 Year of Prospective Clinical Study

Melamed

Goldenfeld

Cotlear

et al. 2015

European Journal of Ophthalmology

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“…Ultrasound has been used for cyclodestruction since the 1980s [ 20 , 44 ]. Transscleral cyclodestruction by means of ultrasound has an important advantage over laser energy; because scleral tissue has significant light-scattering properties, a large amount of laser energy may be needed for clinically meaningful ciliary body ablation.…”

Section: Techniques and Evidence On Efficacymentioning

confidence: 99%

“…Transscleral cyclodestruction by means of ultrasound has an important advantage over laser energy; because scleral tissue has significant light-scattering properties, a large amount of laser energy may be needed for clinically meaningful ciliary body ablation. This excessive laser energy may produce significant damage to collateral tissues such as conjunctiva, sclera and crystalline lens [ 20 , 44 ].…”

Section: Techniques and Evidence On Efficacymentioning

confidence: 99%

Cyclodestructive Procedures in Glaucoma: A Review of Current and Emerging Options

et al. 2018

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The first surgical modalities to reduce aqueous humor production by damaging the ciliary body date back to the early twentieth century. Until recently, however, cyclodestructive procedures (e.g., cyclocryotherapy and transscleral diode laser photocoagulation) have been reserved as last option procedures in refractory glaucoma patients with poor visual potential. Emerging technologic innovation has led to the development of promising, safer and less destructive techniques, such as micropulse diode cyclophotocoagulation, endoscopic cyclophotocoagulation and ultrasound cyclodestruction. Consequently, an emerging paradigm shift is under way with the selection of these surgical options in eyes with less severe glaucoma and good visual potential. Although existing evidence has not, as yet, adequately defined the role and value of these procedures, their emergence is a welcome expansion of available options for patients with moderate-to-severe glaucoma. This article reviews the pertinent evidence on both established and evolving cyclodestructive techniques and describes their growing role in the management of glaucoma.

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“…Unlike reduced aqueous production, an increase in the aqueous outflow via the uveoscleral pathway is perhaps a less expected mechanism of action of UCP that nonetheless has been hypothesised on multiple occasions. 11,12,[21][22][23] Aptel observed in 2014 that a fluid space could be seen between the sclera and the ciliary body, and between the sclera and the choroid adjacent to treated areas, 21,24 and hypothesised that this corresponds to an area where the opening of the space should lead to an increase of the aqueous outflow via the uveoscleral pathway. A more recent prospective, observational monocentric study from Rouland and Aptel, using three-dimensional ultrasound biomicroscopy (UBM) that included 24 eyes from 19 patients, demonstrated that, in addition to reduction in aqueous humour production, UCP treatment caused an increase in aqueous humour outflow due to uveoscleral pathway opening.…”

Section: A: Control; B: Having Undergone Treatment With the Ultrasounmentioning

confidence: 99%

Ultrasound Cycloplasty in Glaucoma – Mechanisms of Action and their Possible Impact on Intraocular Pressure

Lim¹

2017

European Ophthalmic Review

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U ltrasound cycloplasty (UCP) is a procedure based on high-intensity focused ultrasound (HIFU) for refractory and non-refractory glaucoma in cases for which surgery is not suitable. UCP may bring about a reduction in intraocular pressure (IOP) via multiple mechanisms of action that result in a decrease in aqueous humour production and increase in aqueous humour evacuation. UCP appears to have a favourable safety profile compared with cyclo-destructive methods, with no phthisis bulbi, no induced cataract, and no persistent hypotony. In 103 patients with refractory and non-refractory glaucoma who underwent UCP, 94 (91%) achieved an initial reduction in IOP, and in 65 patients (63.1%), treatment success was achieved whereby the IOP remained low. However, in 22 patients (21.4%), at 3 months, the IOP rose to near the original level, indicating treatment failure: 'early failure'. In the remaining 7 patients (6.8%), a slow rise in IOP occurred over 6 months following the procedure: 'late failure'. The differences in IOP changes in these 94 patients may be in part explained by: (i) a reduction in the uveoscleral-transscleral openings in some patients, leading to an eventual rise in the initially decreased IOP; (ii) a possible re-epithelialisation of the ciliary processes taking place in some cases; and/or (iii) that the circumference of 160° UCP treatment might not be sufficient for all patients. The first 3 months following the UCP procedure are therefore critical since treatment success or failure is determined within this timeframe. KeywordsIntraocular pressure (IOP), glaucoma, ciliary body, ultrasound cycloplasty (UCP), mechanism of action, high-intensity focused ultrasound (HIFU)

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Ultrasonic Circular Cyclocoagulation

Cited by 3 publications

References 20 publications

High-Intensity Focused Ultrasound Treatment in Refractory Glaucoma Patients: Results at 1 Year of Prospective Clinical Study

High-Intensity Focused Ultrasound Treatment in Refractory Glaucoma Patients: Results at 1 Year of Prospective Clinical Study

Cyclodestructive Procedures in Glaucoma: A Review of Current and Emerging Options

Ultrasound Cycloplasty in Glaucoma – Mechanisms of Action and their Possible Impact on Intraocular Pressure

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