High-intensity focused ultrasound treatment in patients with refractory glaucoma

Giannaccare, Giuseppe; Vagge, Aldo; Gizzi, Corrado; Bagnis, Alessandro; Sebastiani, Stefano; Noce, Chiara Del; Fresina, Michela; Traverso, Carlo Enrico; Campos, Emilio C.

doi:10.1007/s00417-016-3563-z

Cited by 49 publications

(67 citation statements)

References 35 publications

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“…In the present study, UCP allowed an IOP reduction of approximately 30% throughout the entire 1-year followup period, in agreement with previous works, which reported a mean IOP reduction ranging from 26 to 38% [8,[16][17][18][19][20]. The treatment also allowed at the same time the reduction of the daily number of hypotensive medications.…”

Section: Discussionsupporting

confidence: 92%

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Ultrasound Cyclo-Plasty in Patients with Glaucoma: 1-Year Results from a Multicentre Prospective Study

et al. 2018

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Purpose: The aim of this study was to evaluate the safety and efficacy of ultrasound cyclo-plasty (UCP) for reducing intraocular pressure (IOP) in patients with glaucoma. Methods: This is a multicentre prospective study conducted in 3 Italian glaucoma centres. UCP was performed by EyeOP1, which delivers ultrasound beams using 6 piezoelectric transducers activated for 4/6 s (first generation) or 8 s (second generation). Primary outcomes were the mean IOP reduction and the rates of success after 1 year. Secondary outcomes were the mean IOP reduction at each follow-up, and the reduction of the number of hypotensive medications. Results: In total, 49 eyes from 47 patients were treated. One year postoperatively, the mean IOP had decreased from 27.7 ± 9.2 to 19.8 ± 6.9 mm Hg (p < 0.001), and the mean number of hypotensive drops and tablets had decreased from 3.2 and 0.5 to 2.3 and 0.2, respectively (p < 0.05). Postoperative IOP reduction was significantly related to preoperative IOP (r² = 0.5034; p < 0.0001). Second-generation probes determined a significantly higher IOP reduction (p < 0.05). Qualified success was achieved in 25 eyes (51.1%) and complete success in 21 (42.9%), while failure was recorded in 12 (24.5%). Conclusions: UCP is safe and effective for reducing IOP. The procedure determines a greater IOP reduction in patients with higher preoperative IOP. Second-generation probes improve outcomes without detrimental effects on safety.

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Section: Discussionsupporting

confidence: 92%

“…Other additional limitations include the inhomogeneous patient characteristics which reflect a realworld glaucoma population, and the use of success criteria different from the World Glaucoma Association criteria [23] in order to conduct a more reliable comparison with the existing literature [18][19][20].…”

Section: Discussionmentioning

confidence: 99%

Ultrasound Cyclo-Plasty in Patients with Glaucoma: 1-Year Results from a Multicentre Prospective Study

et al. 2018

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“…After experimental studies [13,14] and a clinical pilot, [15] several prospective clinical studies investigated ultrasonic circular cyclocoagulation (UC3) for refractory glaucoma. [16][17][18][19] In 2015, a multicenter study evaluated UC3 in 30 patients with primary open-angle glaucoma without previous filtering surgery. [20] All these studies supported the effectiveness of the procedure in reducing IOP while being safe.…”

Section: Introductionmentioning

confidence: 99%

“…[20] All these studies supported the effectiveness of the procedure in reducing IOP while being safe. [15][16][17][18][19][20] A second-generation probe was recently developed to boost clinical efficacy. It differs from the original mainly in its broader active transducer area (4 vs 2.5 mm), which allows for an average of 45% of the ciliary body circumference to be treated versus 30%.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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BackgroundTo assess the efficacy and safety of the second-generation probe of ultrasonic circular cyclocoagulation (UC3) in naive or refractory glaucoma, with a 6-month follow-up. MethodsA retrospective consecutive case-series study included patients having a UC3 procedure with the second-generation probe of the EyeOP1 device, intraocular pressure (IOP) � 21 mmHg and under maximum tolerated medical treatment, with or without previous glaucoma surgery. Surgical success was defined at the 6-month post-operative visit as IOP > 5 and � 21 mmHg with IOP reduction � 20% from baseline, without any reoperation, and visual acuity better than negative light perception. Results100 patients were included and 97 (97.0%; 97 eyes) attended the 6-month follow-up. At 6 months, surgical success was obtained in 48 eyes (49.5%). Intraocular pressure was reduced from a mean ± SD preoperative value of 28.0 ± 5.6 mmHg to 19.3 ± 7.1 mmHg at 6 months (p<0.0001). The proportion of eyes requiring oral acetazolamide decreased from 57.0% to 30.0% between baseline and 6 months after surgery (p = 0.0007). We observed 15 (15.0%) cases of postsurgical macular edema, 8 (8.0%) of hypotony, and 20 (20.0%) of visual acuity loss > 2 Snellen lines. Postsurgical macular edema was associated with a history of epiretinal membranes, uveitis or retinal detachment. Risk factors for hypotony were a history of diabetes or trabeculectomy. ConclusionsThe second-generation UC3 probe significantly reduced IOP in eyes with naive and refractory glaucoma but severe post-operative complications were often observed. Further Citation: Chamard C, Daien V, Han H, Greenfield DS, Villain M (2020) Efficacy and safety of ultrasonic circular cyclocoagulation with secondgeneration probe in glaucoma: A retrospective study. PLoS ONE 15(1): e0227389. https://doi.org/ 10.studies are needed to better identify responders and decrease the high risk for complications associated with the procedure. MethodsThis study followed the STROBE checklist for reporting observational study findings. [22] Design Retrospective consecutive case-series study with 6-month follow-up. Examinations were performed before the procedure and 1 week, 1, 3, and 6 months afterwards. Preoperative hypotensive medications remained unchanged during the first month except for cases of hypotony, then adjusted if necesary during follow-up. Re-treatment was proposed after a minimum of 3 months if surgical success was not achieved. Patients were retreated with a second UC3 procedure, DL-CPC (diode laser cyclophotocoagulation) or trabeculectomy when IOP target was not reached, according to glaucoma stage, prior treatments and visual potential.

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“…The normal intraocular tension ranges from 10–21 mmHg (Schiotz tononometer) and above 24 mmHg is the clear indication of pathological phenomenon. Increased intraocular tension could cause visual function damage with visible typical glaucomatous changes in view (3). The longer the time of increased intraocular tension lasts, the more serious is the visual function damage.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of heat shock protein (HSP-72) expression in retinal ganglion cells of rats with glaucoma

Wang

Xing

2017

Experimental and Therapeutic Medicine

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The present study was planned to observe the expression of heat shock protein 72 (HSP72) in retina of rats in a glaucoma model. A total of 50 Wistar rats were randomly divided into the high intraocular tension group (glaucoma model) and the sham control (sham operation) group. Glaucoma rat models were created by application of electrocoagulation on at least three groups of veins, reduction of venous return of aqueous humor and by enhancement of intraocular tension at the same time; 1, 2, 3, 4 and 8 weeks after operation, the intraocular tension of rats was observed respectively, and the expression/distribution of HSP72 in retina was assessed by immunohistochemical detection. As a result, the high intraocular tension group was found with obviously increased intraocular tension of the right eyes after operation (P<0.05), which was stable after one week. It was observed that the positive expression of HSP72 in retina gradually increased significantly with increase in intraocular tension in the rat model of glaucoma in comparison to controls. Furthermore, retinal ganglion cells (RGCs) of rats from both groups were cultured respectively, for confirmation. It was observed that the expression levels of HSP72 in the high intraocular tension group were higher in comparison to the sham control group. In conclusion, the enhanced expression of endogenous HSP72 may play an important role in glaucomatous optic neuro-protection.

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High-intensity focused ultrasound treatment in patients with refractory glaucoma

Abstract: Ultrasonic coagulation of the ciliary body is a safe and effective procedure for reducing IOP in refractory glaucoma. The increase in ultrasound exposure time appears to improve the response rate and the global efficacy of the procedure, with no detrimental effect on safety.

Cited by 49 publications

References 35 publications

Ultrasound Cyclo-Plasty in Patients with Glaucoma: 1-Year Results from a Multicentre Prospective Study

Ultrasound Cyclo-Plasty in Patients with Glaucoma: 1-Year Results from a Multicentre Prospective Study

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

Evaluation of heat shock protein (HSP-72) expression in retinal ganglion cells of rats with glaucoma

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