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

Chloé Chamard,Hyosun Han,Max Villain,David S Greenfield,Vincent Daien

doi:10.1371/journal.pone.0227389

Chloé Chamard, Hyosun Han + Show 3 more

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https://doi.org/10.1371/journal.pone.0227389

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Journal: PloS one	Publication Date: Jan 24, 2020
Citations: 1	License type: CC BY 4.0

Affiliation: Hôpital Gui de Chauliac, University of Miami

Abstract

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 studies are needed to better identify responders and decrease the high risk for complications associated with the procedure.

Highlights

Lowering intraocular pressure (IOP) is the only approach with proven effectiveness in preventing visual field deterioration and delaying the progression of glaucoma.[1,2,3] most surgical treatments aim at increasing aqueous humor evacuation, an alternative strategy is to reduce its production
A 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
Postsurgical macular edema was associated with a history of epiretinal membranes, uveitis or retinal detachment

Summary

Introduction

Lowering intraocular pressure (IOP) is the only approach with proven effectiveness in preventing visual field deterioration and delaying the progression of glaucoma.[1,2,3] most surgical treatments aim at increasing aqueous humor evacuation, an alternative strategy is to reduce its production. 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.

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