Abstract
Purpose This study aims to assess scleral and conjunctival thickness using optical coherence tomography after ultrasound ciliary plasty (UCP) procedure with reference to scleral marks appearing in the area where the ultrasound energy was applied. Materials and Methods Seventy-eight patients with primary and secondary refractory glaucoma participated in this study. Complete ophthalmic examinations including measurements of scleral and conjunctival thickness were performed preoperatively and at 1 week, and 1, 3, 6, 12, 18, and 24 months postoperatively. The parameters were determined using the Swept Source OCT with anterior attachment. Thirty-eight patients (58 scleral marks—23 superior and 35 inferior) fulfilled the inclusion criteria and completed the follow-up period of 24 months. Results The mean ± SD scleral and conjunctival thickness in superior scleral mark before the procedure and at 1 week, and 1, 3, 6, 12, 18, and 24 months after the procedure was 684.57 ± 83.58 μm, 771.78 ± 112.03 μm (p < 0.001), 771.74 ± 100.12 μm (p < 0.001), 731.38 ± 83.92 μm (p=0.012), 719.52 ± 73.20 μm (p=0.037), 702.91 ± 66.50 μm (p=0.247), 694.13 ± 72.22 μm (p=0.482), and 699.35 ± 70.68 μm (p=0.200), respectively. The mean ± SD scleral and conjunctival thickness in inferior scleral mark before the procedure and at 1 week, and 1, 3, 6, 12, 18, and 24 months after the procedure was 816.86 ± 79.30 μm, 936.37 ± 107.33 μm (p < 0.001), 946.00 ± 130.40 μm (p < 0.001), 896.63 ± 123.40 μm (p < 0.001), 877.69 ± 114.38 μm (p=0.003), 843.03 ± 71.55 μm (p=0.021), 811.86 ± 68.91 μm (p=0.731), and 805.03 ± 69.52 μm (p=0.248), respectively. The transient thickening of the sclera was observed after the procedure; however, after 12 months postoperatively, the parameters returned to the initial value and no significant difference was noted. Conclusion The sclera thickness increases after UCP. However, with time the thickness reduces to its initial value with no significant difference. Clinical implication of the scleral changes lasts shorter than the measured significant difference in scleral thickness.
Highlights
Cyclodestruction methods are used to treat mild and severe forms of glaucoma. ese methods reduce intraocular pressure (IOP) by decreasing the production of aqueous humor by partially damaging the nonpigmented epithelium of the ciliary body
A study conducted by Mastropasqua et al showed anatomical modifications of sclera and conjunctiva in one month after Ultrasound ciliary plasty (UCP) [6]. e authors assessed cyst occurrence in the area of ultrasound energy application intending to prove alternative outflow of aqueous humor through the uveoscleral pathway. ere is no study examining scleral mark in terms of scleral thinning after UCP. e present study aims to assess scleral and conjunctival thickness using optical coherence tomography (OCT) after UCP with reference to scleral marks appearing in the area of ultrasound energy application in the long-term period
After 12 months, the parameters returned to the initial values with no significant difference (Figure 6). e decrease in IOP and the number of antiglaucoma medications used were statistically significant (Table 3). ere is no correlation between scleral and conjunctival thickness and IOP
Summary
Cyclodestruction methods are used to treat mild and severe forms of glaucoma. ese methods reduce intraocular pressure (IOP) by decreasing the production of aqueous humor by partially damaging the nonpigmented epithelium of the ciliary body. Ese methods reduce intraocular pressure (IOP) by decreasing the production of aqueous humor by partially damaging the nonpigmented epithelium of the ciliary body. Ultrasound ciliary plasty (UCP), compared to commonly used diode laser cyclodestruction, allows precise energy concentration through opaque structures, without uncontrolled absorption, at a desired depth and area [1]. In the area where the ultrasound energy was applied, a scleral mark occurs, which macroscopically appears like scleral thinning. E authors assessed cyst occurrence in the area of ultrasound energy application intending to prove alternative outflow of aqueous humor through the uveoscleral pathway. Ere is no study examining scleral mark in terms of scleral thinning after UCP. E present study aims to assess scleral and conjunctival thickness using optical coherence tomography (OCT) after UCP with reference to scleral marks appearing in the area of ultrasound energy application in the long-term period A study conducted by Mastropasqua et al showed anatomical modifications of sclera and conjunctiva in one month after UCP [6]. e authors assessed cyst occurrence in the area of ultrasound energy application intending to prove alternative outflow of aqueous humor through the uveoscleral pathway. ere is no study examining scleral mark in terms of scleral thinning after UCP. e present study aims to assess scleral and conjunctival thickness using optical coherence tomography (OCT) after UCP with reference to scleral marks appearing in the area of ultrasound energy application in the long-term period
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