Short- and Long-Term Effects on the Ciliary Body and the Aqueous Outflow Pathways of High-Intensity Focused Ultrasound Cyclocoagulation

Aptel, Florent; Béglé, Aurélie; Razavi, Arash; Romano, Fabrice; Charrel, Thomas; Chapelon, Jean‐Yves; Denis, Philippe; Lafon, Cyril

doi:10.1016/j.ultrasmedbio.2014.04.017

Cited by 45 publications

(48 citation statements)

References 16 publications

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“…Recently, the micropulse diode laser [14] and UCP [8] have been introduced among others as novel techniques to partially destroy the ciliary body, with a more predictable and controlled IOP reduction as compared to traditional cyclodestructive procedures. Recent studies showed that UCP also induces the stimulation of the suprachoroidal and transscleral portions of the uveoscleral outflow pathway, thus allowing another additional hypotensive effect [7,9,15]. The technique is simpler, faster, safer, and less invasive than traditional cyclodestructive procedures [3][4][5], with comparable results in terms of IOP reduction.…”

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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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: 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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“…Experimental studies have shown a selective and circumferentially distributed coagulation necrosis of the treated ciliary processes and ciliary body (Aptel et al 2010(Aptel et al , 2014b. To date, three clinical studies have been conducted with this new method.…”

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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“…21 The first effect is a reduction in the aqueous humour production via remodelling of the ciliary processes in the pars plicata segment, which has been described as the main mechanism of action. 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.…”

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

confidence: 99%

“…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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Short- and Long-Term Effects on the Ciliary Body and the Aqueous Outflow Pathways of High-Intensity Focused Ultrasound Cyclocoagulation

Cited by 45 publications

References 16 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

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

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

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