Treatment of refractory open-angle glaucoma using ultrasonic circular cyclocoagulation: a prospective case series

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Objective:To evaluate the efficacy and safety of the ultrasonic circular cyclocoagulation (UC3) procedure in patients with refractory primary open-angle glaucoma.Research design and methods:Prospective non-comparative interventional case series performed in two French glaucoma centers. Twenty-eight eyes of 28 patients with primary open-angle glaucoma, intraocular pressure (IOP) >21 mmHg, an average of 1.4 failed previous surgeries and an average of 3.8 hypotensive medications were insonified with a therapy probe comprising six piezoelectric transducers. The six transducers were activated and all patients were treated with a 6 second exposure time. Complete ophthalmic examinations were performed before the procedure, and at 1 day, 1 week, 1, 2, 3, 6 and 12 months after.Main outcome measures:Primary outcomes were surgical success (defined as IOP reduction from baseline ≥20% and IOP >5 mmHg) at the last follow-up visit, and vision-threatening complications. Secondary outcomes were mean IOP at each follow-up visit compared to baseline, medication use, complications, and re-interventions.Results:IOP was significantly reduced (P < 0.05), from a mean preoperative value of 29.0 ± 7.2 mmHg (n = 3.8 hypotensive medications) to a mean value of 21.6 ± 9.4 mmHg at last follow-up (n = 3.8 hypotensive medications and n = 1.29 procedures) (mean IOP reduction of 26%). Complete success (IOP reduction >20% without re-intervention and without hypotensive medications adjunction) was achieved in 50% of eyes at last follow-up (mean IOP reduction of 45% in these same eyes) and qualified success (IOP reduction >20% with possible re-interventions) was achieved in 68% of eyes at last follow-up. No major intra- or post-operative complications occurred.Conclusions:UC3 procedure seems to be an effective and well tolerated method to reduce intraocular pressure in patients with primary open-angle glaucoma. Studies directly comparing the efficacy and safety of the UC3 procedure with that of trabeculectomy or diode laser are needed.