Abstract
Purpose To assess the efficacy and safety of HIFU-based ultrasonic cyclocoagulation in Chinese patients with end-stage refractory glaucoma. Method Patients were recruited consecutively from May 2016 to May 2017 in the Zhongshan Ophthalmic Center. Ultrasonic cyclocoagulation was performed on every patient, using the EyeOP1 ultrasound emitting device. Return visits were set at 1 day, 7 days, 1 month, and 3 months after the treatment. An intraocular pressure (IOP) reduction of ≥20% while IOP ≥ 5 mmHg was deemed as success. Mean IOP change was assessed. Efficacy of two modes (6 sectors and 8 sectors) was also compared. Complications were recorded for safety evaluation. Results 61 eyes were treated in this study. The baseline IOP (mean ± SD) was 41.11 ± 10.65 mmHg. The percentage of IOP reduction after treatment was 29.2%, 43.2%, 34.8%, and 23.1% at 1 day, 7 days, 1 month, and 3 months, respectively. Overall success rate at 3 months was 50.0% (26/52). No significant difference was found between the 6 sectors group and the 8 sectors group in terms of the success rate (48.6% vs. 52.9%, p=0.768) as well as IOP reduction (p=0.417) at 3 months. Primary angle-closure glaucoma (PACG) had the highest success rate (80.0%, 12/15). Scleral thinning existed in 12 eyes, among which 2 developed hypotony (2 mmHg and 3 mmHg). Average pain score decreased massively compared with baseline data. Conclusion With high percentage of IOP reduction and a good safety profile observed in our study, HIFU-based ultrasonic cyclocoagulation might become a promising alternative to cyclodestructive methods. Long-term efficacy and safety need further assessment. The study was registered with Chinese Clinical Trial Registry (http://www.chictr.org.cn; Registration number: ChiCTR-OOC-17014028).
Highlights
High-intensity-focused ultrasound (HIFU) technology is being used to destroy target tissue with HIFU focused onto a small point, where the temperature will go up critically due to thermal effect of ultrasound [1]
By coagulating part of the ciliary body, whose epithelium can secrete aqueous humor, HIFU-based ultrasonic cyclocoagulation is regarded as a potential way to reduce intraocular pressure (IOP). e 1-year success rate of ultrasonic cyclocoagulation reported in some literature was about 50% in 1980s [5]
Patients could be divided into four groups in our study: primary open-angle glaucoma (POAG) (10/61; 16.4%), primary angle closure glaucoma (PACG) (18/61; 29.5%), neovascular glaucoma (NVG) (29/61; 47.5%), and traumatic glaucoma (4/61; 6.6%). 55 patients presented no light perception visual acuity, while the rest (6 patients) ranged from finger count to light perception
Summary
High-intensity-focused ultrasound (HIFU) technology is being used to destroy target tissue with HIFU focused onto a small point, where the temperature will go up critically due to thermal effect of ultrasound [1]. It can effectively avoid damage to the surrounding tissue. HIFU has been widely adopted in the treatment of prostate cancer [2], breast cancer [3], and liver cancer [4]. By coagulating part of the ciliary body, whose epithelium can secrete aqueous humor, HIFU-based ultrasonic cyclocoagulation is regarded as a potential way to reduce intraocular pressure (IOP). E 1-year success rate of ultrasonic cyclocoagulation reported in some literature was about 50% in 1980s [5]. Occurrence of other severe complications such as scleral perforation, severe hypotony, or phthisis after the treatment was hard to avoid. Occurrence of other severe complications such as scleral perforation, severe hypotony, or phthisis after the treatment was hard to avoid. us, the treatment was gradually abandoned two decades ago [6]
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