Safety and efficacy of ultrasound ciliary plasty as a primary intervention in glaucoma patients

Abstract

Aim: To evaluate the safety and the efficacy of the ultrasound ciliary plasty (UCP) on the intraocular pressure (IOP) control in glaucomatous eyes without previous glaucoma surgery.

Methods: A retrospective study included patients with primary and secondary glaucoma who underwent UCP in Dar AlShifa Hospital, Kuwait between January 2017 to June 2018. High-intensity focused ultrasound procedures were performed under peribulbar anesthesia using the 2nd generation probe with 8s duration of each of the 6 shots. Complete ophthalmologic examinations were scheduled pre-treatment, and at 1d, 1wk, 1, 3, 6 and 12mo post-treatment. Primary outcomes were the IOP reduction and success rates at 12mo, while the secondary outcomes were the occurrence of vision threatening complications and visual acuity.

Results: The records of 62 eyes of 62 patients were analyzed with mean age of 63.8y (67.7% males). There was statistically significant reduction in the mean IOP from 35.2±8.3 mm Hg before treatment to 20.6±8.7 mm Hg at 12th month (P<0.0005) with a mean percentage IOP reduction of 42.3% with significant reduction in the mean number of antiglaucomatous drugs from 3.2±0.4 before treatment to 2.1±1.02 at 12mo (P<0.0005). Qualified success was achieved in 77.4% of eyes at 12mo. No major intra- or post-treatment complications were reported.

Conclusion: Second-generation UCP prove to be effective in reducing IOP in naive glaucoma patients with lower success rates in cases of neovascular and uveitic glaucomas.

Keywords: glaucoma; intraocular pressure; ultrasound ciliary plasty.

Figures

Figure 1. Scatter gram plot for IOP before treatment (X axis) and IOP at 12mo after treatment (Y axis)

All the points below the diagonal dashed lines represent eyes with IOP reduction ≥30% from the baseline values.

Figure 2. Means of IOP of the included eyes at baseline and at different points along the follow-up period.

Figure 3. Success rates among different categories of glaucoma included in the study

POAG: Primary open angle glaucoma; CACG: Chronic angle-closure glaucoma; NVG: Neovascular glaucoma; PEX: Pseudoexfoliative glaucoma.