High-Intensity Focused Ultrasound Circular Cyclocoagulation in Glaucoma: A Step Forward for Cyclodestruction?

Abstract

The ciliary body ablation is still considered as a last resort treatment to reduce the intraocular pressure (IOP) in uncontrolled glaucoma. Several ablation techniques have been proposed over the years, all presenting a high rate of complications, nonselectivity for the target organ, and unpredictable dose-effect relationship. These drawbacks limited the application of cyclodestructive procedures almost exclusively to refractory glaucoma. High-intensity focused ultrasound (HIFU), proposed in the early 1980s and later abandoned because of the complexity and side effects of the procedure, was recently reconsidered in a new approach to destroy the ciliary body. Ultrasound circular cyclocoagulation (UC3), by using miniaturized transducers embedded in a dedicated circular-shaped device, permits to selectively treat the ciliary body in a one-step, computer-assisted, and non-operator-dependent procedure. UC3 shows a high level of safety along with a predictable and sustained IOP reduction in patients with refractory glaucoma. Because of this, the indication of UC3 was recently extended also to naïve-to-surgery patients, thus reconsidering the role and timing of ciliary body ablation in the surgical management of glaucoma. This article provides a review of the most used cycloablative techniques with particular attention to UC3, summarizing the current knowledge about this procedure and future possible developments.

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

“…Besides, due to the shrinkage of the ciliary body after sonification, the potential space between the ciliary body and the sclera is enlarged, leading to increased outflow of aqueous humor through supraciliary and suprachoroidal space [ 16 , 21 ]. In vivo study also revealed an increase of intrascleral hyporeflective spaces and conjunctival microcysts 1 month after the treatment, indicating an enhanced transscleral AH outflow [ 22 ].…”

Transient choroidal detachment after ultrasonic circular cyclocoagulation

“…While the majority of the complications are minor and not vision-threatening complications, there have been cases of transient macular oedema (1/28) and of transient choroidal detachment with hypotony (1/28) 1–5. Comparatively to the already available cyclocoagulation procedures, UCCC has shown less severe complications, as shown in tables 1–4.…”

Efficacy and safety of ultrasonic circular cyclocoagulation with second-generation probe in glaucoma: A retrospective study

“…The second-generation probe may cause more inflammatory reactions than the first-generation probe by increasing the surface area and duration of exposure to the ultrasound beam. [8,21] UC3 procedure might not be indicated in uveitic glaucoma because of inefficiency. In the present study, all uveitic glaucoma were considered as failure: 1 for significant loss of vision due to post-operative macular edema and the 2 others needed a retreatment to reach the target IOP.…”

“…[4][5][6] Hence, cyclodestructive procedures are usually reserved for refractory glaucoma in eyes with little or no visual potential. [7][8][9] High-intensity focused ultrasound (HIFU) was first proposed as an alternative for lowering IOP in the 1980s. [6,[10][11][12] Following recent breakthroughs in HIFU technology, a new cyclocoagulation device, the EyeOP1 (EyeTechCare, Rillieux-la-Pape, France), was developed for selective thermal coagulation of the ciliary body, sparing the adjacent ocular structures.…”