Safety and efficacy of multiple cyclocoagulation of ciliary bodies by high-intensity focused ultrasound in patients with glaucoma.

PURPOSE: To evaluate long-term efficacy and safety of repeated ultrasonic circular cyclocoagulation (UCCC) in patients with uncontrolled glaucoma.

METHODS

Forty eyes of 40 patients affected by primary or secondary uncontrolled glaucoma under maximal tolerated medical therapy were enrolled in this prospective non-comparative case series study. A complete ophthalmic examination was performed before and after each month for 1 year. The UCCC treatment was repeated at 4 months if the intraocular pressure (IOP) was > 21 mmHg without major complications. Complete success was defined as a final IOP > 5 mmHg and ≤ 21 mmHg without hypotensive medication adjunction and no major or vision-threatening complications.

RESULTS

The mean preoperative IOP was 32.5 ± 9.9 mmHg. Four months after the first UCCC treatment the overall IOP reduction was 27.8%. Twenty-two of the treated eyes did not achieve the complete success and a second treatment was performed in 20 of these eyes. Four months after the second UCCC procedure, the IOP reduction was 20.3% from preoperative values and 34.7% from baseline. Twelve of the retreated eyes needed a third treatment. Four months after the third UCCC treatment, the overall IOP reduction was 34% and 52.6% from baseline. No major complications occurred during or after any of the procedures. At 12 months, complete success was achieved in 85% (34/40) of treated eyes, with a maximum of three procedures and a significant medication reduction.

CONCLUSIONS

Multiple UCCC treatments are safe, and additional treatments increase the overall procedure efficacy.