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Agnifili L, Palamini A, Brescia L, Porreca A, Oddone F, Tanga L, Ruggeri ML, Quarta A, Mastropasqua R, Di Nicola M, Mastropasqua L. Uveoscleral Outflow Routes after MicroPulse Laser Therapy for Refractory Glaucoma: An Optical Coherence Tomography Study of the Sclera. Int J Mol Sci 2024; 25:5913. [PMID: 38892100 PMCID: PMC11172512 DOI: 10.3390/ijms25115913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Revised: 05/21/2024] [Accepted: 05/26/2024] [Indexed: 06/21/2024] Open
Abstract
To analyze in vivo scleral changes induced by MicroPulse transscleral laser therapy (MP-TLT) in refractory glaucoma using anterior segment-optical coherence tomography (AS-OCT). Forty-two candidate patients for MP-TLT were consecutively enrolled and underwent AS-OCT at baseline and after six months. MP-TLT success was defined as an intraocular pressure (IOP) reduction by one-third. The main outcome measures were the mean superior (S-), inferior (I-), and total (T-) intra-scleral hypo-reflective space area (MISHA: mm2) and scleral reflectivity (S-SR, I-SR, T-SR; arbitrary scale) as in vivo biomarkers of uveoscleral aqueous humor (AH) outflow. The IOP was the secondary outcome. The relations between the baseline-to-six months differences (D) of DS-MISHA, DI-MISHA, and DT-MISHA and DS-SR, DI-SR, DT-SR, and DIOP, were investigated. At 6 months, the median IOP reduction was 21% in the failures and 38% in the successes. The baseline S-MISHA, I-MISHA, and T-MISHA did not differ between the groups, while S-SR and T-SR were higher in the successes (p < 0.05). At six months, successful and failed MP-TLTs showed a 50% increase in S-MISHA (p < 0.001; p = 0.037), whereas I-SR and T-SR reduced only in the successes (p = 0.002; p = 0.001). When comparing DS-MISHA, DI-MISHA, and DT-MISHA and DS-SR, DI-SR, and DT-SR, there were no significant differences between the groups. In the successful procedures, DIOP was positively correlated with DT-MISHA and DI-MISHA (ρ = 0.438 and ρ = 0.490; p < 0.05). MP-TLT produced potentially advantageous modifications of the sclera in refractory glaucoma. Given the partial correlation between these modifications and post-treatment IOP reduction, our study confirmed that the activation of the uveoscleral AH outflow route could significantly contribute to the IOP lowering after MP-TLT.
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Affiliation(s)
- Luca Agnifili
- Ophthalmology Clinic, Department of Medicine and Ageing Science, “G. d’Annunzio” University Chieti-Pescara, 66100 Chieti, Italy (L.B.)
| | - Andrea Palamini
- Ophthalmology Clinic, Department of Medicine and Ageing Science, “G. d’Annunzio” University Chieti-Pescara, 66100 Chieti, Italy (L.B.)
| | - Lorenza Brescia
- Ophthalmology Clinic, Department of Medicine and Ageing Science, “G. d’Annunzio” University Chieti-Pescara, 66100 Chieti, Italy (L.B.)
| | - Annamaria Porreca
- Laboratory of Biostatistics, Department of Medical, Oral and Biotechnological Sciences, “G. d’Annunzio” University Chieti-Pescara, 66100 Chieti, Italy; (A.P.)
| | | | - Lucia Tanga
- IRCCS Fondazione Bietti, Via Livenza, 3, 00198 Rome, Italy
| | - Maria Ludovica Ruggeri
- Ophthalmology Clinic, Department of Medicine and Ageing Science, “G. d’Annunzio” University Chieti-Pescara, 66100 Chieti, Italy (L.B.)
| | - Alberto Quarta
- Ophthalmology Clinic, Department of Medicine and Ageing Science, “G. d’Annunzio” University Chieti-Pescara, 66100 Chieti, Italy (L.B.)
| | - Rodolfo Mastropasqua
- Department of Neuroscience, Imaging and Clinical Science, “G. d’Annunzio” University Chieti-Pescara, 66100 Chieti, Italy
| | - Marta Di Nicola
- Laboratory of Biostatistics, Department of Medical, Oral and Biotechnological Sciences, “G. d’Annunzio” University Chieti-Pescara, 66100 Chieti, Italy; (A.P.)
| | - Leonardo Mastropasqua
- Ophthalmology Clinic, Department of Medicine and Ageing Science, “G. d’Annunzio” University Chieti-Pescara, 66100 Chieti, Italy (L.B.)
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2
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Chan PPM, Larson MD, Dickerson JE, Mercieca K, Koh VTC, Lim R, Leung EHY, Samuelson TW, Larsen CL, Harvey A, Töteberg-Harms M, Meier-Gibbons F, Shu-Wen Chan N, Sy JB, Mansouri K, Zhang X, Lam DSC. Minimally Invasive Glaucoma Surgery: Latest Developments and Future Challenges. Asia Pac J Ophthalmol (Phila) 2023; 12:537-564. [PMID: 38079242 DOI: 10.1097/apo.0000000000000646] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 10/12/2023] [Indexed: 12/21/2023] Open
Abstract
The development of minimally invasive glaucoma surgeries (MIGSs) was intended to provide safe and modestly efficacious modalities for early intervention of mild-to-moderate glaucoma, with minimal trauma and rapid recovery. They were mainly ab interno procedures that reduce intraocular pressure by facilitating the aqueous outflow by bypassing the trabecular meshwork resistance, reinforcing the uveoscleral flow via the supraciliary space, and reducing aqueous production by the ciliary body. While the cumulating evidence helps shape the role of the available MIGS, the exponential new development and advancement in this field has expanded the territory of MIGS. Apart from developing subconjunctival MIGS filtration devices (Xen gel stent and PRESERFLO MicroShunt), there is a tendency to revisit the "traditional" MIGS for alternative use and to modify the procedures with consideration of the fundamental aqueous outflow physiology. Combined MIGS has also been suggested, based on the theory that their different mechanisms may provide additive or synergistic effects. The advancement of laser procedures is also promising and could supplement unmet needs along the glaucoma treatment algorithm. This review examines the broad array of MIGS, updates the recent findings, discusses their potential alternative applications, and explores future challenges.
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Affiliation(s)
- Poemen P M Chan
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
- Department of Ophthalmology and Visual Sciences, Lam Kin Chung. Jet King-Shing Ho Glaucoma Treatment and Research Centre, The Chinese University of Hong Kong, Hong Kong, China
| | | | - Jaime E Dickerson
- Sight Sciences, Menlo Park, CA, USA
- University of North Texas Health Science Center, North Texas Eye Research Institute, Fort Worth, TX, USA
| | | | - Victor Teck Chang Koh
- Department of Ophthalmology, National University Health System, Singapore
- Centre for Innovation and Precision Eye Health, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Ridia Lim
- Department of Ophthalmology, Sydney Eye Hospital, Sydney, Australia
- Save Sight Institute, Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Enne Hiu Ying Leung
- The C-MER Dennis Lam & Partners Eye Center, C-MER International Eye Care Group, Hong Kong, China
| | - Thomas W Samuelson
- Minnesota Eye Consultants, Bloomington, MN, US
- Department of Ophthalmology, University of Minnesota, MN, US
| | - Christine L Larsen
- Minnesota Eye Consultants, Bloomington, MN, US
- Department of Ophthalmology, University of Minnesota, MN, US
| | | | - Marc Töteberg-Harms
- Department of Ophthalmology, Augusta University, Medical College of Georgia, Augusta, GA, USA
| | | | | | - Jessica Belle Sy
- Department of Ophthalmology, Sydney Eye Hospital, Sydney, Australia
- Baguio General Hospital and Medical Center, Baguil City, Benguet, Philippines
| | - Kaweh Mansouri
- Glaucoma Center, Swiss Visio, Clinique de Montchoisi, Lausanne, Switzerland
| | - Xiulan Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Dennis S C Lam
- The C-MER Dennis Lam & Partners Eye Center, C-MER International Eye Care Group, Hong Kong, China
- The International Eye Research Institute of The Chinese University of Hong Kong (Shenzhen), Shenzhen, China
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3
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Almobarak FA, Alrubean A, Alsarhani WK, Aljenaidel A, Osman EA. Two-Year Outcomes of Ultrasound Cyclo Plasty as a First Procedure in Glaucoma. Semin Ophthalmol 2023:1-8. [PMID: 36762779 DOI: 10.1080/08820538.2023.2170715] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
PURPOSE To evaluate the 2-year outcomes of ultrasound cyclo plasty (UCP) as a first procedure in glaucoma. METHODS This retrospective cohort study included patients with uncontrolled glaucoma who underwent UCP as an initial glaucoma procedure. The main outcome measures were intraocular pressure (IOP), the number of antiglaucoma medications, visual acuity, and the presence of vision-threatening complications. Surgical outcomes of each eye were classified as either complete success, qualified success, or failure based on the main outcome measures. Differences in IOP control and success rates were compared in eyes with primary open-angle glaucoma (POAG) and primary angle-closure glaucoma (PACG). RESULTS We included 98 eyes of 88 patients in the study. The mean follow-up period was 27.25 ± 10.1 months. At 12 and 24 months, mean IOP decreased significantly from 23.16 ± 6.4 mmHg to 16.57 ± 6.0 mmHg and 16.18 ± 5.2 mmHg, respectively, and the number of antiglaucoma medications decreased from 3.27 ± 0.9 to 1.86 ± 1.4 and 1.70 ± 1.7, respectively (p < .01 for all). There were no changes in visual acuity throughout the follow-up compared with preoperative levels. The cumulative probabilities of success were 64.3% (±4.8) [78.9% (±9.4) complete success, and 72.9% (±6.4) qualified success], and 42.9% (±5.0) [52.6% (±11.5) complete success, and 56.3% (±7.2) qualified success] at 12 and 24 months, respectively. The most common complications were cataract development/progression, anterior chamber inflammation, and macular edema. There were no significant differences in IOP, number of antiglaucoma medications, or survival rates between POAG and PACG groups. CONCLUSIONS UCP can be used as an initial glaucoma procedure for reducing IOP and the number of antiglaucoma medications and offers comparable outcomes in POAG and PACG.
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Affiliation(s)
- Faisal A Almobarak
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,Glaucoma Research Chair, King Saud University, Riyadh, Saud Arabia
| | - Ahmed Alrubean
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,Department of Ophthalmology, College of Medicine, Al-Imam Muhammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
| | - Waleed K Alsarhani
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,Department of Ophthalmology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.,Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada
| | - Abdullah Aljenaidel
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Essam A Osman
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,Glaucoma Research Chair, King Saud University, Riyadh, Saud Arabia
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Paul C, Divya J, Sengupta S, Kamal R, Paul A, Mitra I. Efficacy and safety of ultrasound cycloplasty in Indian eyes with open-angle glaucoma. Indian J Ophthalmol 2022; 70:4168-4171. [PMID: 36453307 PMCID: PMC9940526 DOI: 10.4103/ijo.ijo_827_22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Purpose To evaluate the safety and efficacy of ultrasound cycloplasty in eyes with primary or secondary open-angle glaucoma, not amenable to adequate control of intra-ocular pressure (IOP) with medical treatment. Methods Prospective interventional cohort study of 28 eyes of 28 subjects in a tertiary eye care centre in India in patients with open-angle glaucoma. All enrolled eyes underwent ultrasound cycloplasty with the second-generation probe with six shots of 8 s each, operated by a single surgeon between November 2018 and January 2020. They were followed up for a period of 12 months. The primary treatment outcome was IOP and the secondary outcomes were vision and postoperative complications. Results A total of 28 eyes of 28 patients were studied, and the mean age was 63.82 ± 6.46 years. Primary open-angle glaucoma (75%) was the most common etiology. There was significant reduction in IOP from the baseline (24.93 ± 4.27 mmHg) to the postoperative value (15.82 ± 3.14 mmHg) at the end of 12 months (P < 0.00001). Mean reduction in IOP was 9.14 ± 4.09 mmHg at 12 months (36.66%). Number of ocular hypotensives reduced significantly from baseline (3.32 ± 0.47) to 12-month postoperative follow-up (0.68 ± 0.74) (P < 0.00001). Qualified success was achieved in 89.28% eyes. No major complications were noted. Conclusion Ultrasound cycloplasty is found to be effective and safe in eyes with open-angle glaucoma because of the primary or secondary etiology, being more effective in the former.
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Affiliation(s)
- Chandrima Paul
- Director, B B Eye Foundation, Kolkata, West Bengal, India,Correspondence to: Dr. Chandrima Paul, 2/5, Sarat Bose Road, Sukhsagar, Near Minto Park, Bhowanipore, Kolkata - 700 020, West Bengal, India. E-mail:
| | - J Divya
- Fellow, Comprehensive Ophthalmology, B B Eye Foundation, Kolkata, West Bengal, India
| | | | - Richa Kamal
- Vitreo-Retina Services, B B Eye Foundation, Kolkata, West Bengal, India
| | - Anujeet Paul
- Mahatma Gandhi Medical College and Research Institute, Pondicherry, India
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5
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Behera G, Kaliaperumal S. Commentary: High-intensity focused ultrasound - A panacea in the making? Indian J Ophthalmol 2022; 70:4172-4173. [PMID: 36453308 PMCID: PMC9940530 DOI: 10.4103/ijo.ijo_2037_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Geeta Behera
- Department of Ophthalmology, Jawaharlal Institute of Post-Graduate Medical Education and Research (JIPMER), Puducherry, India,Correspondence to: Dr. Geeta Behera, Assistant Professor of Ophthalmology, Jawaharlal Institute of Post-Graduate Medical Education and Research (JIPMER), Puducherry - 605 006, India. E-mail:
| | - Subashini Kaliaperumal
- Department of Ophthalmology, Jawaharlal Institute of Post-Graduate Medical Education and Research (JIPMER), Puducherry, India
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6
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Chen D, Guo XJ, Luo SK, Lu Y, Tang XR. Efficacy and safety of high-intensity focused ultrasound cyclo-plasty in glaucoma. BMC Ophthalmol 2022; 22:401. [PMID: 36207670 PMCID: PMC9542456 DOI: 10.1186/s12886-022-02622-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 09/26/2022] [Indexed: 11/21/2022] Open
Abstract
Background High-intensity focused ultrasound cyclo-plasty (UCP) is a recently developed glaucoma surgery. This study collected and analysed the clinical data of patients who underwent UCP to observe the efficacy and safety of this surgery in Chinese glaucoma patients. Methods This was a retrospective study. The clinical data of all the patients who underwent UCP at Affiliated Foshan Hospital, Southern Medical University, were collected and analysed to evaluate the efficacy and safety of UCP. The main outcome measure was intraocular pressure, and the secondary outcome measures were best corrected visual acuity (logMAR) and complications. Results Fifty-eight patients (61 eyes) were recruited for this study. IOP was dramatically decreased during the 12 months after UCP (p<0.05). The median IOP reduction during the 18 months post-procedure was more than 30%. The greatest reduction was at 1 month post-UCP (60.86%). The qualified success rate was more than 60% during the 18-month follow-up (Fig. 1). Poor follow up was found after 6-month post-UCP. The highest success rate was obtained at 7 days post-UCP (94.55%). No statistically significant decrease in BCVA in the vison group was observed at the follow-up visits, except for 1 day post-UCP. There was a statistically significant reduction in the use of IOP lowering medications during the 6 months post-UCP. No severe complications occurred. Conclusion UCP is a safe and effective procedure for primary and refractive glaucoma at least during the 6 months post-UCP procedure. Studies with longer follow-up time and better follow up are needed to further confirm the long-term efficacy and safety of UCP in Chinese glaucoma patients. Supplementary Information The online version contains supplementary material available at 10.1186/s12886-022-02622-5.
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Affiliation(s)
- Di Chen
- Department of Ophthalmology, Affiliated Foshan Hospital, Southern Medical University, Foshan, 528000, China
| | - Xiu-Juan Guo
- Department of Ophthalmology, Affiliated Foshan Hospital, Southern Medical University, Foshan, 528000, China.
| | - Shu-Ke Luo
- Department of Ophthalmology, Affiliated Foshan Hospital, Southern Medical University, Foshan, 528000, China
| | - Yan Lu
- Department of Ophthalmology, Affiliated Foshan Hospital, Southern Medical University, Foshan, 528000, China
| | - Xiu-Rong Tang
- Department of Ophthalmology, Affiliated Foshan Hospital, Southern Medical University, Foshan, 528000, China
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7
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Almobarak FA, Alrubean A, Alsarhani WK, Aljenaidel A, Osman E. Ultrasound Cyclo Plasty in Glaucoma: Two-Year Outcomes. J Glaucoma 2022; 31:834-838. [PMID: 35882024 DOI: 10.1097/ijg.0000000000002078] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 07/03/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate the two-year outcomes of Ultrasound Cyclo Plasty (UCP) in uncontrolled glaucoma. METHODS A retrospective cohort study included patients with uncontrolled primary or secondary glaucoma who underwent UCP at King Abdul Aziz University Hospital, Riyadh, Saudi Arabia between 2016 and 2021. The main outcome measures were: intraocular pressure (IOP), number of antiglaucoma medications, and presence of vision-threatening complications. The surgical outcome of each eye was classified as complete success, qualified success, or failure, based on the main outcome measures. RESULTS One hundred and eighty-two eyes of 158 patients were included in the study. The mean follow-up period was 29.71 months (±18.1). The IOP and number of antiglaucoma medications decreased significantly from a mean of 23.46 mm Hg (±6.3) and 3.33 (±0.9) to 17.33 (±7.1) and 2.14 (±1.4), and 16.24 (±6.3) and 1.90 (±1.5) on the 12th and 24th months respectively. The overall success rates were 78.0% (143/182) and 85.6% (95/111), and the failure rates were 21.4% (39/182) and 14.4% (16/111) on the 12th and 24th months respectively. The most common complications were cataract development/progression and anterior chamber reaction. CONCLUSIONS UCP offers a reasonable IOP control and reduction of the antiglaucoma medications burden.
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Affiliation(s)
- Faisal A Almobarak
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,Glaucoma Research Chair, King Saud University, Riyadh, Saud Arabia
| | - Ahmed Alrubean
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,Department of Ophthalmology, College of Medicine, Al-Imam Muhammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
| | - Waleed K Alsarhani
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,Department of Ophthalmology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.,Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Abdullah Aljenaidel
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Essam Osman
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,Glaucoma Research Chair, King Saud University, Riyadh, Saud Arabia
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Ultrasound Cyclo Plasty After Failed Glaucoma Surgery: Outcomes and Complications. Ophthalmol Ther 2022; 11:1601-1610. [PMID: 35751759 PMCID: PMC9253205 DOI: 10.1007/s40123-022-00538-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 06/06/2022] [Indexed: 11/10/2022] Open
Abstract
Introduction The purpose of this study is to report the outcomes and complications of ultrasound cyclo plasty (UCP) after failed glaucoma surgery. Methods A retrospective case series included patients with previously failed glaucoma surgery who underwent UCP at King Abdul Aziz University Hospital, Riyadh, Saudi Arabia, between 2016 and 2021. The main outcome measures were: intraocular pressure (IOP), number of antiglaucoma medications and presence of vision-threatening complications. The surgical outcome of each eye was based on the main outcome measures. Results Seventy eyes of 70 patients were included in the study. The mean follow-up period was 31.89 months (± 17.5). The IOP and the number of antiglaucoma medications decreased significantly from a mean of 23.91 mmHg (± 6.3) and 3.43 (± 0.8) to 17.88 mmHg (± 8.1) and 2.48 (± 1.3) and of 16.74 (± 7.9) and 2.11 (± 1.3) at the 12th and 24th months postoperatively, respectively (p < 0.01 for both). The success rates were 77.1% (54/70) and 48.6% (34/70), while the failure rates were 22.9% (16/70) and 2.9% (2/70) at the 12th and 24th months postoperatively, respectively. The cumulative probabilities of success were 70.0% (± 5.5%) and 47.1% (± 6.0%) at the 12th and 24th months postoperatively, respectively. The most common complications were anterior chamber reaction (24.3%), cataract development/progression (18.6%), hypotony/choroidal detachment (4.3%), phthisis bulbi (1.4%) and aqueous misdirection (1.4%). Conclusions UCP is an effective treatment modality to control IOP and decrease the burden of antiglaucoma medications in eyes with previously failed glaucoma surgery. Monitoring and counseling of possible postoperative complications are needed.
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Nagar A, Daas A, Danieliute L, Alaghband P, Yu-Wai-Man C, Amon A, Galvis E, Lim KS. Effect of high-intensity focused ultrasound (HiFU) treatment on intraocular pressure and aqueous humour dynamics: 12 -months results. Eye (Lond) 2021; 35:2499-2505. [PMID: 33159175 PMCID: PMC8377105 DOI: 10.1038/s41433-020-01260-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 09/10/2020] [Accepted: 10/22/2020] [Indexed: 11/08/2022] Open
Abstract
PURPOSE High intensity focused ultrasound (HiFU) is a cyclodestructive therapy for controlling intraocular pressure (IOP) in glaucoma. The mechanism of action is thought to be through destruction of the ciliary epithelium as well as increased uveoscleral outflow. We reviewed the change in aqueous humour dynamics parameters including aqueous humour flow rate, tonographic outflow facility (TOF) and uveoscleral outflow at 12 months. PATIENTS AND METHODS This is a prospective observational study. Consecutive patients with open angle glaucoma (OAG) or ocular hypertension (OHT) requiring further IOP lowering were enroled in the study between August 2016 and January 2017. Patients were commenced on medication washout period prior to baseline and twelve months' visit. RESULTS Sixteen patients (OAG) in the treatment group underwent assessment at twelve months follow up. Mean age was 63.1 ± 11 years. Eleven patients were African/Caribbean and 5 were Caucasian. Nine patients were female and 7 were male. Mean post-washout IOP was reduced by 21% (28.3 ± 5.7 at baseline vs 22.4 ± 8.4 mmHg at 12 months, p = 0.04). Aqueous humour flow rate was reduced by 16% at twelve months (2.40 ± 0.6 at baseline vs 2.02 ± 0.6 µl/min at 12 months, p = 0.0493). There was no statistically significant change in the TOF (0.12 ± 0.09 at baseline vs 0.08 ± 0.05 µl/min/mmHg at 12 months, p = 0.08) or uveoscleral outflow (0.6 ± 1.3 at baseline vs 1.3 ± 0.85 µl/min at 12 months, p = 0.15). CONCLUSION In this study, we demonstrated that the observed IOP reduction was likely due to aqueous humour flow rate reduction. The TOF and uveoscleral outflow were not detectibly changed.
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Affiliation(s)
- Anindyt Nagar
- Department of Ophthalmology, St Thomas' Hospital, London, SE1 7EH, UK
- King's College London, London, SE1 7EH, UK
| | - Arij Daas
- Department of Ophthalmology, St Thomas' Hospital, London, SE1 7EH, UK
- King's College London, London, SE1 7EH, UK
| | - Lina Danieliute
- Department of Ophthalmology, St Thomas' Hospital, London, SE1 7EH, UK
- King's College London, London, SE1 7EH, UK
| | - Pouya Alaghband
- Department of Ophthalmology, St Thomas' Hospital, London, SE1 7EH, UK
- King's College London, London, SE1 7EH, UK
| | - Cynthia Yu-Wai-Man
- Department of Ophthalmology, St Thomas' Hospital, London, SE1 7EH, UK
- King's College London, London, SE1 7EH, UK
| | - Andrew Amon
- Department of Ophthalmology, St Thomas' Hospital, London, SE1 7EH, UK
| | - Elizabeth Galvis
- Department of Ophthalmology, St Thomas' Hospital, London, SE1 7EH, UK
| | - Kin Sheng Lim
- Department of Ophthalmology, St Thomas' Hospital, London, SE1 7EH, UK.
- King's College London, London, SE1 7EH, UK.
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Morais Sarmento T, Figueiredo R, Garrido J, Passos I, Rebelo AL, Candeias A. Ultrasonic circular cyclocoagulation prospective safety and effectiveness study. Int Ophthalmol 2021; 41:3047-3055. [PMID: 33881668 DOI: 10.1007/s10792-021-01867-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 04/15/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE To evaluate the efficacy and safety of ultrasound cycloplasty procedures (UCP) in patients with uncontrolled glaucoma. METHODS Prospective longitudinal study with UCP was performed by EyeOP1© probe with 8 s duration on 6 or 8 sectors, according to baseline intraocular pressure (IOP). Complete ophthalmic examination was performed pre- and post-operatively at 1st day, 1st week, 1st, 3rd, 6th, 9th and 12th months. UCP was repeated beyond 3rd month if IOP was > 21 mmHg, under maximum therapy, without major complications. Primary outcomes were complete (IOP reduction ≥ 20% or reduction in number of antiglaucomatous drugs and IOP ≥ 5 mmHg without occurrence of major complications) and qualified (IOP reduction ≥ 20% or reduction in number of antiglaucomatous drugs and IOP ≥ 5 mmHg) surgical success rates at 12 months. Secondary outcomes were mean IOP reduction, mean number of drugs reduction, rates of failure, number of repeated procedures, mean time to failure and occurrence of complications. RESULTS Fourteen eyes of 13 patients (11 male) with advanced glaucoma (Hoddap classification) were included. Six were surgically naïve. Mean age was 68.29 ± 10.66 years. Four eyes were treated in 8 sectors (28.5%). Patients were followed for 12 months after first UCP procedure. Overall surgical success was achieved in 92.9% at 6 months and in 100% of cases at 12 months. Mean IOP significantly reduced from 28.50 ± 7.61 mmHg to 13.79 ± 6.97 at 1 month, 17.36 ± 8.58 at 3 months, 17.79 ± 6.29 at 6 months, 16.3 ± 4.6 at 9 months and to 15.23 ± 5.09 at 12 months (p < 0.01). Mean number of drugs reduced from 3.71 ± 0.61 to 2.43 ± 1.51 at 3 months, 2.86 ± 1.1 at 6 months, 2.64 ± 0.93 at 9 months and to 2.92 ± 0.86 at 12 months (p < 0.05). Major reversible complications included choroidal detachment in 2 (14.29%) and corneal edema in 1 eye (7.14%), without permanent visual acuity reduction. Minor reversible complications included anterior chamber reaction (92.25%), conjunctival hyperemia (71.43%) and superficial keratitis (57.4%). Four eyes (28.57%) had indication for repeating UCP, with mean period to failure of 8.1 ± 3.95 months. CONCLUSION UCP procedures are effective in reducing IOP in severe glaucoma. Its application and repetition seem to be a medium-long term acceptable alternative to cyclodestructive surgery. However, long-term efficacy and safety require yet further investigation.
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Affiliation(s)
- Tiago Morais Sarmento
- Ophthalmology Department of Hospital Espírito Santo de Évora, Serviço de Oftalmologia Do Hospital Do Espírito Santo de Évora, Largo Senhor da Pobreza, 7000-811, Évora, Portugal.
| | - Ricardo Figueiredo
- Ophthalmology Department of Hospital Espírito Santo de Évora, Serviço de Oftalmologia Do Hospital Do Espírito Santo de Évora, Largo Senhor da Pobreza, 7000-811, Évora, Portugal
| | - João Garrido
- Ophthalmology Department of Hospital Espírito Santo de Évora, Serviço de Oftalmologia Do Hospital Do Espírito Santo de Évora, Largo Senhor da Pobreza, 7000-811, Évora, Portugal
| | - Inês Passos
- Ophthalmology Department of Centro Hospitalar, Universitário Lisboa Central, Lisbon, Portugal
| | - Ana Luísa Rebelo
- Ophthalmology Department of Hospital Espírito Santo de Évora, Serviço de Oftalmologia Do Hospital Do Espírito Santo de Évora, Largo Senhor da Pobreza, 7000-811, Évora, Portugal
| | - Augusto Candeias
- Ophthalmology Department of Hospital Espírito Santo de Évora, Serviço de Oftalmologia Do Hospital Do Espírito Santo de Évora, Largo Senhor da Pobreza, 7000-811, Évora, Portugal
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Figus M, Sartini F, Covello G, Posarelli C. High-intensity focused ultrasound in the treatment of glaucoma: a narrative review. EXPERT REVIEW OF OPHTHALMOLOGY 2021. [DOI: 10.1080/17469899.2021.1902309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Michele Figus
- Ophthalmology, Department of Surgical, Medical, Molecular Pathology and of Critical Area, University of Pisa, Pisa, Italy
| | - Francesco Sartini
- Ophthalmology, Department of Surgical, Medical, Molecular Pathology and of Critical Area, University of Pisa, Pisa, Italy
| | - Giuseppe Covello
- Ophthalmology, Department of Surgical, Medical, Molecular Pathology and of Critical Area, University of Pisa, Pisa, Italy
| | - Chiara Posarelli
- Ophthalmology, Department of Surgical, Medical, Molecular Pathology and of Critical Area, University of Pisa, Pisa, Italy
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Torky MA, Alzafiri YA, Abdelhameed AG, Awad EA. Phaco-UCP; combined phacoemulsification and ultrasound ciliary plasty versus phacoemulsification alone for management of coexisting cataract and open angle glaucoma: a randomized clinical trial. BMC Ophthalmol 2021; 21:53. [PMID: 33478426 PMCID: PMC7819220 DOI: 10.1186/s12886-021-01818-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 01/13/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Various surgical techniques have been described, to be combined with cataract surgery in glaucoma patients, aiming for an additional reduction of intraocular pressure (IOP), hence minimizing the burden of anti-glaucoma medication (AGM). Ultrasound ciliary plasty (UCP) is a recent microinvasive glaucoma surgery (MIGS) recommended for primary and refractory glaucoma. This study was conducted to evaluate the safety and efficacy of a new technique; combined phacoemulsification and ultrasound ciliary plasty (Phaco-UCP) as a primary surgical treatment for coexisting cataract and open angle glaucoma. METHODS A randomized clinical trial, including 61 eyes of 61 patients with visually significant cataract and open angle glaucoma, randomized to either Phaco-UCP (study group; 31 eyes) or phacoemulsification alone (Phaco-alone) (control group; 30 eyes). Primary outcomes included reduction in IOP and/or the number of AGM. Secondary outcomes included visual acuity improvement and complications. Qualified Success was defined as an IOP reduction ≥ 20% from baseline value, with an IOP 6-21 mmHg, with no additional AGM or glaucoma surgery. Failure was defined as either < 20% IOP reduction, despite AGM use, the need of glaucoma surgeries or serious complications. RESULTS At 18 months postoperatively, Phaco-UCP group had a median IOP reduction of 7 mmHg (Q1, Q3 = 3, 10) compared to 2 mmHg (Q1, Q3 = 2, 3) in Phaco-alone group (P < 0.001). Phaco-UCP group had significantly higher success rate at all time points reaching 67.7% at the last follow-up versus 16.7% only in Phaco-alone group (P< 0.001). The median number of AGM significantly decreased from [3 (Q1, Q3 = 2, 4), 3 (Q1, Q3 = 2,3)] respectively, (P =0.3)] at baseline to [1 (Q1,Q3 = 1, 2), 2 (Q1,Q3 = 2, 2)] respectively, (P < 0.001)] at 18 months postoperatively. No serious intraoperative or postoperative complications were encountered in either group. CONCLUSION Phaco-UCP is a simple, safe and effective procedure for management of coexisting cataract and open angle glaucoma. TRIAL REGISTRATION ClinicalTrials.gov identifier, NCT04430647 ; retrospectively registered. June 12, 2020.
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Affiliation(s)
- Magda A Torky
- Department of Ophthalmology, Mansoura Ophthalmic Center, Faculty of medicine, Mansoura University, Al-Gomhoria Street, Mansoura, 35516, Egypt
| | - Yousef A Alzafiri
- Department of Ophthalmology, Dar Al Shifa hospital, 30000, Hawally City, Kuwait
| | - Ameera G Abdelhameed
- Department of Ophthalmology, Mansoura Ophthalmic Center, Faculty of medicine, Mansoura University, Al-Gomhoria Street, Mansoura, 35516, Egypt.
| | - Eman A Awad
- Department of Ophthalmology, Mansoura Ophthalmic Center, Faculty of medicine, Mansoura University, Al-Gomhoria Street, Mansoura, 35516, Egypt
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13
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Longfang Z, Die H, Jie L, Yameng L, Mingyuan L, Xiaojing P. Efficacy and safety of single Ultrasound Cyclo-Plasty to treat refractory glaucoma: Results at 1 year. Eur J Ophthalmol 2020; 32:268-274. [PMID: 33225725 DOI: 10.1177/1120672120973605] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To evaluate clinical efficacy and safety of single Ultrasound Cyclo-Plasty (UCP) in the treatment of advanced refractory glaucoma. METHODS From January 2018 to August 2018, 25 patients (25 eyes) with refractory glaucoma and intraocular pressure (IOP) not controlled by drugs or conventional filtering surgery were included in the study. All subjects (neovascular glaucoma [n = 12], secondary glaucoma [n = 6], angle closure glaucoma [n = 6], and primary open angle glaucoma [n = 1]) underwent 8-sector Ultrasound Cyclo-Plasty. Patients were followed-up at Day 1, Week 1, and at 1, 3, 6, and 12 months, during which the IOP, the number of IOP lowering drugs and the occurrence of ocular complications were recorded. Clinical outcomes were IOP reduction, success rate, and ocular complications. According to the glaucoma type, patients were divided into a neovascular group (NVG) and a non-NVG group for sub-analysis. RESULTS All patients underwent a single UCP procedure and mean IOP reduced significantly from 39.7 ± 6.1 mmHg before UCP to 27.1 ± 11.0 mmHg at 1 year (p < 0.01) corresponding to a mean IOP reduction of 29.6%. The mean number of IOP-lowering drugs used was 2.4 ± 1.2 at baseline and 2.3 ± 1.0 at 12 months. Success rate after a single UCP procedure was achieved in 41.7% patients at 1 year, with a higher success rate in non-NVG than in the NVG group. No major postoperative complications were reported. The main complication was conjunctival congestion, anterior chamber inflammation, scleral ring congestion, and scleral inprint. Of these, scleral ring congestion and scleral imprint are relatively rare complications, which can still be observed 12 months after UCP treatment. CONCLUSION UCP for refractory glaucoma is effective in reducing IOP and has a good safety profile. Success rate is lower after a single UCP in NVG than for other types of glaucoma.
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Affiliation(s)
- Zhou Longfang
- Shandong Provincial Key Laboratory of Ophthalmology-State Key Laboratory Cultivation Base, Qingdao Eye Hospital of Shandong First Medical University Shandong Eye Institute, Qingdao, China
| | - Hu Die
- Shandong Provincial Key Laboratory of Ophthalmology-State Key Laboratory Cultivation Base, Qingdao Eye Hospital of Shandong First Medical University Shandong Eye Institute, Qingdao, China
| | - Lan Jie
- Shandong Provincial Key Laboratory of Ophthalmology-State Key Laboratory Cultivation Base, Qingdao Eye Hospital of Shandong First Medical University Shandong Eye Institute, Qingdao, China
| | - Liu Yameng
- Shandong Provincial Key Laboratory of Ophthalmology-State Key Laboratory Cultivation Base, Qingdao Eye Hospital of Shandong First Medical University Shandong Eye Institute, Qingdao, China
| | - Lv Mingyuan
- Shandong Provincial Key Laboratory of Ophthalmology-State Key Laboratory Cultivation Base, Qingdao Eye Hospital of Shandong First Medical University Shandong Eye Institute, Qingdao, China
| | - Pan Xiaojing
- Shandong Provincial Key Laboratory of Ophthalmology-State Key Laboratory Cultivation Base, Qingdao Eye Hospital of Shandong First Medical University Shandong Eye Institute, Qingdao, China
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14
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Gavrilina PD, Gamidov AA, Baum OI, Bolshunov AV, Khomchik OV, Sobol EN. [Transscleral laser therapy in the treatment of glaucoma]. Vestn Oftalmol 2020; 136:113-120. [PMID: 33084288 DOI: 10.17116/oftalma2020136061113] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Nowadays glaucoma is one of the leading causes of irreversible blindness worldwide. The main goal in preservation of vision in glaucoma patients is reducing intraocular pressure (IOP), which is considered the main controlled risk factor for progression of glaucomatous optic neuropathy. The article discusses the effectiveness and safety of various transscleral laser technologies in the treatment of glaucoma. Modern transscleral laser technologies that affect the uveoscleral drainage and scleral hydro-permeability are less traumatic and more gentle making them promising in the treatment of patients with early stages of glaucoma, and not only in terminal glaucoma with pain syndrome resistant to conventional treatment ("last resort surgery").
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Affiliation(s)
- P D Gavrilina
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - A A Gamidov
- Research Institute of Eye Diseases, Moscow, Russia
| | - O I Baum
- Institute of Photon Technologies of the Federal Scientific Research Centre "Crystallography and Photonics", Troitsk, Russia
| | | | - O V Khomchik
- Research Institute of Eye Diseases, Moscow, Russia
| | - E N Sobol
- Institute of Photon Technologies of the Federal Scientific Research Centre "Crystallography and Photonics", Troitsk, Russia
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15
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Wang T, Wang R, Su Y, Li N. Ultrasound cyclo plasty for the management of refractory glaucoma in chinese patients: a before-after study. Int Ophthalmol 2020; 41:549-558. [PMID: 33070270 DOI: 10.1007/s10792-020-01606-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 10/01/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Cyclocryotherapy and transscleral cyclophotocoagulation are commonly used procedures for the treatment of refractory glaucoma, but still with many complications. Ultrasound cyclo plasty (UCP) is a novel technique that determines a selective and more precise coagulation necrosis of the ciliary body to reduce intraocular pressure (IOP), but its efficacy and safety have been less investigated in Chinese population. This study aimed to evaluate the clinical efficacy and safety of UCP in Chinese patients with refractory glaucoma. METHODS We designed a prospective, before-after study involving 36 eyes of 36 patients with refractory glaucoma that underwent uneventful UCP. Mean IOP, mean IOP reduction and subjective pain scale scores before and after UCP were compared to evaluate the efficacy of UCP in these patients. Procedural success defined as no abnormality of the treatment sites, and complications were recorded, along with confirmation of the safety of UCP. RESULTS The 36 UCP patients had a mean IOP of 53.61 ± 12.4 mmHg and a mean VAS score of 5.69 ± 3.02 preoperatively. Successful operation was achieved in 28 patients, with a success rate of 77.8%. In the follow-up observation at day 1, day 7, and month 1, 2, 3 and 6 postoperatively, both mean IOP and mean VAS score were significantly lower than those before operation (both P < 0.0001). The median baseline IOP reduction ranged from 22 to 36%. The mean reduction was 42.5% in 36 patients when taking IOP at the last follow-up visit as the last. No significant changes in visual acuity were achieved in 4 patients after UCP, and no adverse outcomes were present in other patients after timely treatment of complications such as conjunctival hyperemia, subconjunctival hemorrhage, or hyphema. CONCLUSIONS UCP is a novel yet reliable option for Chinese patients with refractory glaucoma since its high efficacy and safety.
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Affiliation(s)
- Tao Wang
- Department of Ophthalmology, The First Affiliated Hospital of Anhui Medical University, Meishan Road, Shushan District, Hefei, 230022, Anhui Province, China
| | - Ruixue Wang
- Department of Ophthalmology, The First Affiliated Hospital of Anhui Medical University, Meishan Road, Shushan District, Hefei, 230022, Anhui Province, China
| | - Yu Su
- Department of Ophthalmology, Anhui Provincial Children's Hospital, Hefei, 230022, Anhui Province, China
| | - Ning Li
- Department of Ophthalmology, The First Affiliated Hospital of Anhui Medical University, Meishan Road, Shushan District, Hefei, 230022, Anhui Province, China.
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Bolek B, Wylęgała A, Wylęgała E. Assessment of Scleral and Conjunctival Thickness of the Eye after Ultrasound Ciliary Plasty. J Ophthalmol 2020; 2020:9659014. [PMID: 33029390 PMCID: PMC7532393 DOI: 10.1155/2020/9659014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 08/18/2020] [Accepted: 08/27/2020] [Indexed: 12/16/2022] Open
Abstract
PURPOSE This study aims to assess scleral and conjunctival thickness using optical coherence tomography after ultrasound ciliary plasty (UCP) procedure with reference to scleral marks appearing in the area where the ultrasound energy was applied. MATERIALS AND METHODS Seventy-eight patients with primary and secondary refractory glaucoma participated in this study. Complete ophthalmic examinations including measurements of scleral and conjunctival thickness were performed preoperatively and at 1 week, and 1, 3, 6, 12, 18, and 24 months postoperatively. The parameters were determined using the Swept Source OCT with anterior attachment. Thirty-eight patients (58 scleral marks-23 superior and 35 inferior) fulfilled the inclusion criteria and completed the follow-up period of 24 months. RESULTS The mean ± SD scleral and conjunctival thickness in superior scleral mark before the procedure and at 1 week, and 1, 3, 6, 12, 18, and 24 months after the procedure was 684.57 ± 83.58 μm, 771.78 ± 112.03 μm (p < 0.001), 771.74 ± 100.12 μm (p < 0.001), 731.38 ± 83.92 μm (p=0.012), 719.52 ± 73.20 μm (p=0.037), 702.91 ± 66.50 μm (p=0.247), 694.13 ± 72.22 μm (p=0.482), and 699.35 ± 70.68 μm (p=0.200), respectively. The mean ± SD scleral and conjunctival thickness in inferior scleral mark before the procedure and at 1 week, and 1, 3, 6, 12, 18, and 24 months after the procedure was 816.86 ± 79.30 μm, 936.37 ± 107.33 μm (p < 0.001), 946.00 ± 130.40 μm (p < 0.001), 896.63 ± 123.40 μm (p < 0.001), 877.69 ± 114.38 μm (p=0.003), 843.03 ± 71.55 μm (p=0.021), 811.86 ± 68.91 μm (p=0.731), and 805.03 ± 69.52 μm (p=0.248), respectively. The transient thickening of the sclera was observed after the procedure; however, after 12 months postoperatively, the parameters returned to the initial value and no significant difference was noted. CONCLUSION The sclera thickness increases after UCP. However, with time the thickness reduces to its initial value with no significant difference. Clinical implication of the scleral changes lasts shorter than the measured significant difference in scleral thickness.
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Affiliation(s)
- Bartłomiej Bolek
- Chair and Clinical Department of Ophthalmology, School of Medicine in Zabrze, Medical University of Silesia in Katowice, District Railway Hospital, Katowice, Poland
| | - Adam Wylęgała
- Chair and Clinical Department of Ophthalmology, School of Medicine in Zabrze, Medical University of Silesia in Katowice, District Railway Hospital, Katowice, Poland
| | - Edward Wylęgała
- Chair and Clinical Department of Ophthalmology, School of Medicine in Zabrze, Medical University of Silesia in Katowice, District Railway Hospital, Katowice, Poland
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Liu HT, Zhang Q, Jiang ZX, Xu YX, Wan QQ, Tao LM. Efficacy and safety of high-dose ultrasound cyclo-plasty procedure in refractory glaucoma. Int J Ophthalmol 2020; 13:1391-1396. [PMID: 32953577 DOI: 10.18240/ijo.2020.09.09] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 05/08/2020] [Indexed: 11/23/2022] Open
Abstract
AIM To evaluate the efficacy and safety of high-dose ultrasound cyclo-plasty (UCP) for the treatment of refractory glaucoma in Chinese patients. METHODS In this 6-month retrospective study, 37 eyes of 37 patients suffering from severe glaucoma with uncontrolled intraocular pressure (IOP) of ≥21 mm Hg underwent 8-s ultrasonic cyclocoagulation with ten active piezoelectric elements. A complete ophthalmic examination was performed before and at 1d, 1, 3, 6mo after UCP. Therapeutic success was defined as IOP reduction from baseline ≥20% and IOP ≥5 mm Hg without adding new glaucoma medication compare to baseline at the 6-month follow-up visit. In addition to mean IOP at each follow-up visit, medications used and complications were also detected and compared to baseline. RESULTS After UCP procedure, the mean IOP was significantly reduced (P<0.01) from the preoperative 44.1±11.9 mm Hg to postoperative 26.7±11.8 mm Hg at 3mo, and 30.4±14.5 mm Hg at 6mo. The overall mean IOP reductions achieved at 3 and 6mo were 39% and 31% compared to baseline IOP. Sixty-one percent of patients responded well to UCP treatment with a mean IOP reduction of 48% at 3mo and 42% at 6mo. Ocular pain in most of patients were alleviated. No serious intraoperative or postoperative complications occurred. CONCLUSION High-dose UCP treatment is an effective and safe procedure to reduce IOP in Chinese patients with severe glaucoma.
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Affiliation(s)
- He-Ting Liu
- Department of Ophthalmology, the Second Affiliated Hospital of Anhui Medical University, Hefei 230601, Anhui Province, China
| | - Qing Zhang
- Department of Ophthalmology, the Second Affiliated Hospital of Anhui Medical University, Hefei 230601, Anhui Province, China
| | - Zheng-Xuan Jiang
- Department of Ophthalmology, the Second Affiliated Hospital of Anhui Medical University, Hefei 230601, Anhui Province, China
| | - Yu-Xin Xu
- Department of Ophthalmology, the Second Affiliated Hospital of Anhui Medical University, Hefei 230601, Anhui Province, China
| | - Qian-Qian Wan
- Department of Ophthalmology, the Second Affiliated Hospital of Anhui Medical University, Hefei 230601, Anhui Province, China
| | - Li-Ming Tao
- Department of Ophthalmology, the Second Affiliated Hospital of Anhui Medical University, Hefei 230601, Anhui Province, China
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Anand N, Klug E, Nirappel A, Solá-Del Valle D. A Review of Cyclodestructive Procedures for the Treatment of Glaucoma. Semin Ophthalmol 2020; 35:261-275. [DOI: 10.1080/08820538.2020.1810711] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Nandita Anand
- Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Emma Klug
- Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Abraham Nirappel
- Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - David Solá-Del Valle
- Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
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The Effect of High-Intensity Focused Ultrasound on Aqueous Humor Dynamics in Patients with Glaucoma. Ophthalmol Glaucoma 2020; 3:122-129. [PMID: 32672595 DOI: 10.1016/j.ogla.2019.12.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 11/26/2019] [Accepted: 12/05/2019] [Indexed: 11/20/2022]
Abstract
PURPOSE To investigate the effects of high-intensity focused ultrasound (HiFU) on aqueous humor dynamics in patients with glaucoma. DESIGN Comparative, nonrandomized, interventional study. PARTICIPANTS Adult patients with a diagnosis of open-angle glaucoma or ocular hypertension with suboptimal intraocular pressure (IOP) control despite maximum medical treatment who required further IOP optimization. METHODS All patients underwent comprehensive ophthalmic examination before aqueous humor dynamics study measurements, including fluorophotometry and digital Schiøtz tonography. All patients received 6 seconds of HiFU therapy. Aqueous humor dynamics studies were repeated 3 months after the treatment (patients had 4-week washout from their glaucoma medication before their aqueous humor dynamics study measurements at baseline and the 3-month visit). MAIN OUTCOME MEASURES Intraocular pressure, facility of topographic outflow, aqueous flow rate, and uveoscleral outflow. RESULTS Thirty eyes of 30 patients were included in the study. At the 3-month postoperative visit, the mean postwashout IOP was reduced by 16% (31.7±5.3 vs. 26.6±4.8 mmHg, P = 0.004), and aqueous flow rate was decreased by 15% (2.07±0.73 vs. 1.77±0.55 μl/min, P = 0.05) from baseline. Neither the tonographic outflow facility nor the uveoscleral outflow was significantly different from baseline. There is a 20% risk of treatment failure (those who needed further glaucoma surgical intervention) within 1 month after a single HiFU treatment (n = 6). Only 25 patients (80%) were able to undergo post-treatment washout measurements, and in these eyes, only 26.6% of eyes achieved >20% IOP reduction at 3 months compared with baseline. CONCLUSIONS We investigated the aqueous humor dynamics effects of a cyclodestructive procedure and specifically HiFU in patients with uncontrolled open-angle glaucoma on maximum tolerated medical therapy. High-intensity focused ultrasound reduced IOP 3 months postoperatively by 16% and aqueous flow decreased by 15% without any significant effect on tonographic outflow facility and uveoscleral outflow.
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Abstract
PRéCIS:: The ultrasound ciliary plasty (UCP) procedure affects corneal parameters, although the effect is transient. Ultrasound energy affects the sclera, leading to induced astigmatism. The area of energy application correlates with the astigmatism axis. PURPOSE To assess the postoperative corneal topography for 1 year after UCP. MATERIALS AND METHODS In total, 78 patients with primary and secondary refractory glaucoma were enrolled in the study. The primary outcome measures were the corneal parameters obtained with anterior segment swept-source optical coherence tomography. Intraocular pressure, number of antiglaucoma medications, and best-corrected logMAR visual acuities were analyzed as secondary outcome measures. Measurements were performed preoperatively and at 1 week, and 1, 3, 6, and 12 months postoperatively. A total of 39 patients (39 eyes) completed the follow-up period of 12 months. RESULTS There was a significant difference in the anterior/posterior steep/flat keratometry and anterior/posterior astigmatism values immediately after UCP. However, 3 months postoperatively these parameters returned to their initial values and there were no significant differences noted. The mean±SD values of anterior astigmatism preoperatively and at 1 week, and 1, 3, 6, and 12 months postoperatively were 1.12±0.66 D, 2.17±0.91 D (P<0.001), 2.05±0.93 D (P<0.001), 1.55±0.75 D (P=0.004), 1.31±0.70 D (P=0.024), and 1.20±0.73 D (P=0.406), respectively. The astigmatism axis tended to approach 90 degrees meridian with a significant difference 1 week postoperatively. Central and minimal corneal thickness remained unchanged, whereas the intraocular pressure and the number of antiglaucoma medications decreased significantly. CONCLUSIONS UCP influenced the corneal topography parameters in the immediate postoperative period; however, with time, all parameters returned to their initial values.
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A Comparative Study between Ultrasound Cycloplasty and Cyclocryotherapy for the Treatment of Neovascular Glaucoma. J Ophthalmol 2020; 2020:4016536. [PMID: 32047661 PMCID: PMC7001673 DOI: 10.1155/2020/4016536] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Revised: 11/21/2019] [Accepted: 01/06/2020] [Indexed: 11/18/2022] Open
Abstract
Purpose To compare the clinical efficacy, safety, and histological effect between ultrasound cycloplasty (UCP) and cyclocryotherapy in the treatment of neovascular glaucoma. Methods Two groups of neovascular glaucoma patients who underwent two types of treatment, respectively, namely, 26 patients treated by UCP and 23 by cyclocryotherapy, were treated and observed during the clinical study for six months. The primary outcome was evaluated by the surgical success, which was defined as the intraocular pressure (IOP) reduction of greater than or equal to 20% from the baseline and the IOP value of greater than 5 mmHg at the last follow-up. The secondary outcome referred to pain relief, complications, and the mean of the IOP at each follow-up. In the animal experiment, 18 New Zealand rabbits were divided into two groups and treated by UCP and cyclocryotherapy, respectively. The changes in the tissues and in the expression of matrix metalloproteinase-1 (MMP-1) were observed immediately. Results The mean IOP baseline for the UCP and cyclocryotherapy groups was 54.6 ± 9.7 mmHg and 53.3 ± 11.7 mmHg, respectively. After six months of follow-up, the IOP value decreased to 30.3 ± 9.4 mmHg for the patients treated by UCP and to 30.4 ± 9.1 mmHg for those treated by cyclocryotherapy. The two groups achieved a satisfying success rate in the treatment of neovascular glaucoma of up to 70% at least. Vision impairment was observed in some patients treated with cyclocryotherapy, and these patients suffered from more complications and less pain relief than the patients who were treated with UCP. The histological study showed that the ciliary body was completely destroyed after cyclocryotherapy and that MMP-1 was found only in the ciliary muscle. After the UCP treatment, MMP-1 could still be found in the ciliary body, and only the double-layer epithelial cells presented with coagulative necrosis. Conclusion The UCP treatment and cyclocryotherapy both showed good efficacy in significantly reducing the IOP. However, the UCP treatment was safer with less postoperative complications and adverse effects. Thus, the overall treatment effect of the UCP was more efficient than that of cyclocryotherapy.
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Carpineto P, Agnifili L, Senatore A, Agbeanda A, Lappa A, Borrelli E, Di Martino G, Oddone F, Mastropasqua R. Scleral and conjunctival features in patients with rhegmatogenous retinal detachment undergoing scleral buckling: an anterior segment optical coherence tomography and in vivo confocal microscopy study. Acta Ophthalmol 2019; 97:e1069-e1076. [PMID: 31125179 DOI: 10.1111/aos.14148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 05/05/2019] [Indexed: 11/26/2022]
Abstract
PURPOSE To investigate the scleral and conjunctival features in patients with rhegmatogenous retinal detachment (RRD) undergoing scleral buckling (SB), using anterior segment optical coherence tomography (AS-OCT) and in vivo confocal microscopy (IVCM). METHODS Twenty RRD eyes were consecutively enrolled. AS-OCT was performed at RRD diagnosis (RRD-D) and day 1, week 1, month 1 and month 6 after SB to evaluate the sclera, in the affected and unaffected quadrants (AQ, UQ). IVCM was performed at RRD-D, and at month 1 and month 6, to evaluate the conjunctiva in AQ and UQ. The main outcomes were as follows: mean intra-scleral hypo-reflective spaces area (MIHSA) at AS-OCT; mean density and area of microcysts (MMD, MMA) at IVCM; and intra-ocular pressure (IOP). The relations between MIHSA, MMA, MMD and IOP were evaluated. RESULTS Rhegmatogenous retinal detachment- diagnosis (RRD-D) overall-mean intra-scleral hypo-reflective spaces (MISHA), -MMD and -MMA were significantly higher in affected eye (AE) compared with UE (p < 0.05) and in AQ compared with UQ (p < 0.05). After SB, overall-, AQ- and UQ-MISHA further increased (p < 0.05), whereas overall-MMD and -MMA did not change. At all follow-up, AQ and UQ parameters did not show significant differences between them. RRD-D IOP was 14.3 ± 2.8 and 15.5 ± 2.7 mmHg in the AE and UE, respectively (p < 0.05). After SB, week-1, month-1 and -6 IOP was significantly lower than RRD-D (p < 0.05). Rhegmatogenous retinal detachment- diagnosis (RRD-D), 1- and 6-month overall and AQ-MISHA and AQ-MMD negatively correlated with IOP (p < 0.05). CONCLUSION Rhegmatogenous retinal detachment (RRD) and SB induced scleral and conjunctival changes that suggested an activation of fluid outflow through the entire unconventional aqueous humour pathway; these modifications may in part account for the relative hypotony after RRD and SB.
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Affiliation(s)
- Paolo Carpineto
- Ophthalmology Clinic Department of Medicine and Aging Science University G. d'Annunzio of Chieti‐Pescara Chieti Italy
| | - Luca Agnifili
- Ophthalmology Clinic Department of Medicine and Aging Science University G. d'Annunzio of Chieti‐Pescara Chieti Italy
| | - Alfonso Senatore
- Ophthalmology Clinic Department of Medicine and Aging Science University G. d'Annunzio of Chieti‐Pescara Chieti Italy
| | - Aharrh‐Gnama Agbeanda
- Ophthalmology Clinic Department of Medicine and Aging Science University G. d'Annunzio of Chieti‐Pescara Chieti Italy
| | - Andrea Lappa
- Ophthalmology Clinic Department of Medicine and Aging Science University G. d'Annunzio of Chieti‐Pescara Chieti Italy
| | - Enrico Borrelli
- Ophthalmology Clinic Department of Medicine and Aging Science University G. d'Annunzio of Chieti‐Pescara Chieti Italy
| | - Giuseppe Di Martino
- School of Hygiene Department of Medicine and Aging Science University G. d'Annunzio of Chieti‐Pescara Chieti Italy
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Posarelli C, Covello G, Bendinelli A, Fogagnolo P, Nardi M, Figus M. High-intensity focused ultrasound procedure: The rise of a new noninvasive glaucoma procedure and its possible future applications. Surv Ophthalmol 2019; 64:826-834. [DOI: 10.1016/j.survophthal.2019.05.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Revised: 05/09/2019] [Accepted: 05/13/2019] [Indexed: 10/26/2022]
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How many aqueous humor outflow pathways are there? Surv Ophthalmol 2019; 65:144-170. [PMID: 31622628 DOI: 10.1016/j.survophthal.2019.10.002] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Revised: 09/29/2019] [Accepted: 10/04/2019] [Indexed: 12/31/2022]
Abstract
The aqueous humor (AH) outflow pathways definition is still matter of intense debate. To date, the differentiation between conventional (trabecular meshwork) and unconventional (uveoscleral) pathways is widely accepted, distinguishing the different impact of the intraocular pressure on the AH outflow rate. Although the conventional route is recognized to host the main sites for intraocular pressure regulation, the unconventional pathway, with its great potential for AH resorption, seems to act as a sort of relief valve, especially when the trabecular resistance rises. Recent evidence demonstrates the presence of lymphatic channels in the eye and proposes that they may participate in the overall AH drainage and intraocular pressure regulation, in a presumably adaptive fashion. For this reason, the uveolymphatic route is increasingly thought to play an important role in the ocular hydrodynamic system physiology. As a result of the unconventional pathway characteristics, hydrodynamic disorders do not develop until the adaptive routes cannot successfully counterbalance the increased AH outflow resistance. When their adaptive mechanisms fail, glaucoma occurs. Our review deals with the standard and newly discovered AH outflow routes, with particular attention to the importance they may have in opening new therapeutic strategies in the treatment of ocular hypertension and glaucoma.
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Hugo J, Matonti F, Beylerian M, Zanin E, Aptel F, Denis D. Safety and efficacy of high-intensity focused ultrasound in severe or refractory glaucoma. Eur J Ophthalmol 2019; 31:130-137. [PMID: 31550914 DOI: 10.1177/1120672119874594] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
PURPOSE The aim of this study was to evaluate the efficacy and safety of ultrasonic cyclocoagulation in severe or refractory glaucoma, and to analyze the procedure-related inflammation. PATIENTS AND METHODS In this retrospective study, 15 eyes of 13 patients suffering from severe or refractory glaucoma with uncontrolled intraocular pressure of ⩾21 mmHg underwent 8-s ultrasonic cyclocoagulation. A complete ophthalmic evaluation, quality of life assessment using Glau-Qol-17, endothelial cell count, and flare measurement were performed. Primary outcome was qualified surgical success (defined as intraocular pressure reduction from baseline ⩾20% and intraocular pressure >5 mmHg without hypotensive medication adjunction). Secondary outcomes were flare, endothelial cell loss, and quality of life. RESULTS Qualified success was achieved in 67% of eyes at 6 months (mean intraocular pressure reduction = 42% in these eyes). During the first month after the procedure, the mean flare reached its maximum value when the intraocular pressure was minimal; the flare slowly decreased until normalization at month 3 when the maximal intraocular pressure was noted. At month 3, there was moderate but significant endothelial cell loss (11%), and no significant alteration in quality of life was demonstrated. CONCLUSION The efficacy of ultrasonic cyclocoagulation in the present study is comparable to that reported in the literature. The kinetics of intraocular pressure and flare suggest that postoperative inflammation could be partly responsible for the early intraocular pressure decrease. The moderate endothelial cell loss, which could be caused by localized heating, and the preservation of quality of life confirm the safety of ultrasonic cyclocoagulation.
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Affiliation(s)
- Juliette Hugo
- Department of Ophthalmology, Nord Hospital, APHM, Marseille, France
| | - Frederic Matonti
- CNRS, INT, Institut Neurosciences Timone, Aix-Marseille Université, Marseille, France.,Centre Paradis Monticelli, Marseille, France
| | - Marie Beylerian
- Department of Ophthalmology, Nord Hospital, APHM, Marseille, France
| | - Emilie Zanin
- Department of Ophthalmology, Nord Hospital, APHM, Marseille, France
| | - Florent Aptel
- Department of Ophthalmology, University Hospital of Grenoble and Université Grenoble Alpes, Grenoble, France
| | - Danièle Denis
- Department of Ophthalmology, Nord Hospital, APHM, Marseille, France
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Pellegrini M, Sebastiani S, Giannaccare G, Campos EC. Intraocular inflammation after Ultrasound Cyclo Plasty for the treatment of glaucoma. Int J Ophthalmol 2019; 12:338-341. [PMID: 30809493 DOI: 10.18240/ijo.2019.02.23] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 09/07/2018] [Indexed: 12/24/2022] Open
Abstract
This is a prospective interventional clinical study evaluating intraocular inflammation developed after Ultrasound Cyclo Plasty (UCP) for the treatment of glaucoma. Eighteen eyes of 18 patients were treated with UCP second-generation probes (Eye OP1). After treatment, the mean intraocular pressure (IOP) significantly decreased from 26.8±7.2 to 18.8±6.1 mm Hg at day 1 and to 14.7±3.4 mm Hg at month 6 (all P<0.001). Mean laser flare-cell photometry value steeply increased after surgery from 12.1±7.5 to 64.1±53.9 ph/ms (P=0.001) at day 1, and then progressively decreased to respectively 60.6±49.7 at day 7, 43.5±38.5 at day 14 and 28.2±18.3 at month 1 (all P<0.05), returning at levels similar to baseline ones at month 3 and month 6 (respectively 16.7±6.2 and 12.8±10.2, both P>0.05). A significant negative correlation was found between postoperative increase of aqueous flare values and anterior chamber depth (R=-0.568, P=0.014). This timeframe may be considered reasonable for repeating UCP treatment, when required.
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Affiliation(s)
- Marco Pellegrini
- Ophthalmology Unit, S.Orsola-Malpighi University Hospital, DIMES, University of Bologna, Bologna 40138, Italy
| | - Stefano Sebastiani
- Ophthalmology Unit, S.Orsola-Malpighi University Hospital, DIMES, University of Bologna, Bologna 40138, Italy
| | - Giuseppe Giannaccare
- Ophthalmology Unit, S.Orsola-Malpighi University Hospital, DIMES, University of Bologna, Bologna 40138, Italy
| | - Emilio C Campos
- Ophthalmology Unit, S.Orsola-Malpighi University Hospital, DIMES, University of Bologna, Bologna 40138, Italy
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Dastiridou AI, Katsanos A, Denis P, Francis BA, Mikropoulos DG, Teus MA, Konstas AG. Cyclodestructive Procedures in Glaucoma: A Review of Current and Emerging Options. Adv Ther 2018; 35:2103-2127. [PMID: 30448885 PMCID: PMC6267695 DOI: 10.1007/s12325-018-0837-3] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Indexed: 11/28/2022]
Abstract
The first surgical modalities to reduce aqueous humor production by damaging the ciliary body date back to the early twentieth century. Until recently, however, cyclodestructive procedures (e.g., cyclocryotherapy and transscleral diode laser photocoagulation) have been reserved as last option procedures in refractory glaucoma patients with poor visual potential. Emerging technologic innovation has led to the development of promising, safer and less destructive techniques, such as micropulse diode cyclophotocoagulation, endoscopic cyclophotocoagulation and ultrasound cyclodestruction. Consequently, an emerging paradigm shift is under way with the selection of these surgical options in eyes with less severe glaucoma and good visual potential. Although existing evidence has not, as yet, adequately defined the role and value of these procedures, their emergence is a welcome expansion of available options for patients with moderate-to-severe glaucoma. This article reviews the pertinent evidence on both established and evolving cyclodestructive techniques and describes their growing role in the management of glaucoma.
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Affiliation(s)
- Anna I Dastiridou
- 2nd Department of Ophthalmology, Aristotle University, Thessaloniki, Greece
| | - Andreas Katsanos
- Department of Ophthalmology, University of Ioannina, Ioannina, Greece
| | | | - Brian A Francis
- Doheny and Stein Eye Institutes, University of California Los Angeles (UCLA), Los Angeles, CA, USA
| | - Dimitrios G Mikropoulos
- 3rd University Department of Ophthalmology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Miguel A Teus
- Department of Ophthalmology, Hospital Universitario "Principe de Asturias", Universidad de Alcalá, Alcala De Henares, Spain
| | - Anastasios-Georgios Konstas
- 1st and 3rd University Departments of Ophthalmology, Aristotle University of Thessaloniki, Thessaloniki, Greece.
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Short-Term Observation of Ultrasonic Cyclocoagulation in Chinese Patients with End-Stage Refractory Glaucoma: A Retrospective Study. J Ophthalmol 2018; 2018:4950318. [PMID: 30271627 PMCID: PMC6148825 DOI: 10.1155/2018/4950318] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 05/25/2018] [Accepted: 06/10/2018] [Indexed: 11/17/2022] Open
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).
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DI Staso S, Agnifili L, Ciancaglini M, Murano G, Borrelli E, Mastropasqua L. In Vivo Scanning Laser Confocal Microscopy of Conjunctival Goblet Cells in Medically-controlled Glaucoma. ACTA ACUST UNITED AC 2018; 32:437-443. [PMID: 29475934 DOI: 10.21873/invivo.11259] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 01/24/2018] [Accepted: 01/29/2018] [Indexed: 12/18/2022]
Abstract
AIM The aim of this study was to evaluate the goblet cell density (GCD) of conjunctiva in medically-controlled glaucoma using laser scanning confocal microscopy (LSCM). MATERIALS AND METHODS Fifty-five glaucomatous patients were enrolled and divided into two groups: Group 1 (27 eyes), controlled with one medication; and group 2 (28 eyes), controlled with two medications. Seventeen patients with dry eye disease (DED) and 17 healthy individuals served as controls. Patients completed the Ocular Surface Disease Index (OSDI) questionnaire and underwent determination of tear film break-up time (BUT), corneal staining, and Schirmer test I. For the GCD assessment, 12 high-quality images were acquired from the upper conjunctival epithelium (superior nasal, superior central, and superior temporal sectors). RESULTS Overall, GCD was significantly reduced in both glaucoma groups and those with DED compared to healthy controls (p<0.001), with values markedly lower in group 2 compared to group 1 (p<0.05). GCD was not significantly different between those with DED and group 2. A significant negative correlation was found of GCD with OSDI and with BUT (p<0.001; R=-0.795 and R=-0.756, respectively). CONCLUSION Glaucoma therapy leads to a marked reduction of GCs, especially in the associative regimens. Given the negative correlation with tear film function tests, GCD reduction may play a pivotal role in the pathophysiology of the glaucoma-related disease of the ocular surface.
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Affiliation(s)
- Silvio DI Staso
- Department of Life, Health and Environmental Sciences, University of L'Aquila, Ophthalmology Clinic, L'Aquila, Italy
| | - Luca Agnifili
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University G. D'Annunzio Chieti Pescara, Chieti, Italy
| | - Marco Ciancaglini
- Department of Life, Health and Environmental Sciences, University of L'Aquila, Ophthalmology Clinic, L'Aquila, Italy
| | - Gianluca Murano
- Department of Life, Health and Environmental Sciences, University of L'Aquila, Ophthalmology Clinic, L'Aquila, Italy
| | - Enrico Borrelli
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University G. D'Annunzio Chieti Pescara, Chieti, Italy
| | - Leonardo Mastropasqua
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University G. D'Annunzio Chieti Pescara, Chieti, Italy
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DI Staso S, Agnifili L, DI Gregorio A, Climastone H, Galassi E, Fasanella V, Ciancaglini M. Three-dimensional Laser Scanning Confocal Analysis of Conjunctival Microcysts in Glaucomatous Patients Before and After Trabeculectomy. ACTA ACUST UNITED AC 2018; 31:1081-1088. [PMID: 29102929 DOI: 10.21873/invivo.11173] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 09/14/2017] [Accepted: 09/19/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND/AIM In glaucoma, conjunctival epithelial microcysts (CEM) have been extensively investigated by means of laser scanning confocal microscopy. In the present case series, we examined eight glaucomatous patients undergoing trabeculectomy to obtain a 3-dimensional (3-D) characterization of CEM. MATERIALS AND METHODS Image acquisition was performed in z-scan automatic volume mode by Heidelberg Retina Tomograph III/Rostock Cornea Module and a series of 40 images of 300×300 μm (384×384 pixels) to a maximum depth of 40 μm were acquired throughout the upper bulbar conjunctiva before (at the site planned for surgery) and eight weeks after trabeculectomy. The 3-D volume tissue reconstruction with maximal size of 300×300×40 μm was obtained. RESULTS In the enface view, CEM appeared as empty, optically clear, round or oval shaped sub-epithelial structures. The 3-D spatial reconstruction showed microcysts as oval-shaped and optically clear elements, which were close, but clearly separated from the epithelium. CEM were embedded in the extra-cellular spaces and located about 10 μm below the epithelial surface. After trabeculectomy, CEM increased density and area especially along the horizontal axis. CONCLUSION The 3-D in vivo confocal reconstruction of CEM permits for better clarification of their microscopic anatomy and patho-physiological significance, confirming their involvement in AH flow through the bleb-wall after filtration surgery for glaucoma.
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Affiliation(s)
- Silvio DI Staso
- Ophthalmology Unit, Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Luca Agnifili
- Ophthalmology Clinic, Department of Medicine and Aging Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Angela DI Gregorio
- Ophthalmology Unit, Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Hilary Climastone
- Ophthalmology Unit, Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Emilio Galassi
- Ophthalmology Unit, Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Vincenzo Fasanella
- Ophthalmology Clinic, Department of Medicine and Aging Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Marco Ciancaglini
- Ophthalmology Unit, Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
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DI Staso S, Agnifili L, Cecannecchia S, DI Gregorio A, Ciancaglini M. In Vivo Analysis of Prostaglandins-induced Ocular Surface and Periocular Adnexa Modifications in Patients with Glaucoma. In Vivo 2018; 32:211-220. [PMID: 29475902 PMCID: PMC5905187 DOI: 10.21873/invivo.11227] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 01/04/2018] [Accepted: 01/08/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND/AIM Prostaglandin analogues (PGAs) are a first-line medical treatment for glaucoma because of their powerful intraocular pressure (IOP) lowering effect, few systemic side-effects (SEs), and the once daily administration. Despite the high systemic safety profile, the chronic use of PGAs may induce periocular and ocular surface (OS)-related side effects, which affect a significant proportion of glaucomatous patients. In this review, we summarize the current knowledge about SEs of PGAs on periocular structures and OS, and their implications in clinical practice. MATERIALS AND METHODS A comprehensive literature search on the PubMed platform was performed. Two hundred fifty articles fulfilling key words were identified, of which 180 were excluded since they did not concern the effects of PGAs on the periocular tissues and OS, or because of their limited relevance. The following key words were used and combined, to narrow-down the literature: "prostaglandin" and "ocular surface," which identified 184 unique publications, of which 68 were selected; "prostaglandin" and "periocular" which identified 46 unique publications, of which 11 were selected. An additional search was conducted using "prostaglandin" and "Meibomian glands (MGs)", which identified twenty unique publications, of which 8 were selected. Thus, a total of 70 articles were chosen based on their relevance and were included in this review. RESULTS Prostaglandin-associated peri-orbitopathy, skin pigmentation and hypertrichosis, eyelash growth, and MGs dysfunction are the most frequent modifications of periocular tissues. They are induced by the tissue accumulation of PGAs, and FP receptor stimulation. Without preservatives, PGAs act as stimulators of conjunctival goblet cells, which are the main source of ocular surface mucoproteins, and seem to increase conjunctival epithelium microcysts proposed as in vivo hallmark of the trans-scleral aqueous humour outflow. Additional PGA-induced modifications can be recognized in the cornea, corneo-scleral limbus, conjunctival stroma and, conjunctiva-associated lymphoid tissue, mainly appearing as inflammatory changes. OS epithelia desquamation, chemosis, apoptosis, dendritic cell activation, conjunctival or episcleral vasodilation, and sub-basal nerve plexus disruption were also described in patients receiving preserved PGAs. CONCLUSION PGAs induce several modifications of the OS structures and adnexa; nonetheless, none of them significantly reduces the local safety profile of this class of drugs. Moreover, the OS changes do not affect the IOP lowering efficacy of PGAs. On these bases, local SEs of PGAs should not discourage clinicians in using this class of medications because of their efficacy, the systemic safety profile, and the better adherence.
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Affiliation(s)
- Silvio DI Staso
- Ophthalmology Unit, Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Luca Agnifili
- Ophthalmology Clinic, Department of Medicine and Aging Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Sara Cecannecchia
- Ophthalmology Unit, Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Angela DI Gregorio
- Ophthalmology Unit, Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Marco Ciancaglini
- Ophthalmology Unit, Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
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Giannaccare G, Sebastiani S, Campos EC. Ultrasound Cyclo Plasty in Eyes with Glaucoma. J Vis Exp 2018. [PMID: 29443031 DOI: 10.3791/56192] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Glaucoma is a chronic disease caused by the progressive degeneration of the optical nerve fibers, resulting in decreased visual field that can lead to severe visual impairment, and eventually blindness. This manuscript describes a simple, surgeon-friendly, non-incisional technique, named Ultrasound Cyclo Plasty (UCP), for reducing intraocular pressure (IOP) in glaucoma patients. The technique determines a selective coagulation necrosis of the ciliary body; in addition, the stimulation of supra-choroidal and trans-scleral portions of the uveo-scleral outflow pathway has been recently proposed. UCP shows several technical improvements in ultrasound technology compared to previous techniques, providing more precise focusing on the target zone. The procedure is performed in the operating room under peribulbar anesthesia. Briefly, the coupling cone is put in contact with the eye and the ring probe, that contains six piezoelectric transducers which produce the ultrasound beams, is inserted inside it. Their proper centering over the ocular surface represents a crucial step for the correct targeting of the ciliary body. Sterile balanced salt solution is used to fill the empty spaces to ensure ultrasound acoustic propagation. Surgical treatment consists in the sequential automatic activation of each of the six transducers, for a total duration of less than 3 min. The patient leaves the hospital 1 h after the procedure with the treated eye patched. In the present study, 10 patients with open-angle glaucoma were followed-up during at least 12 months after the procedure. IOP was reduced at each interval compared to pre-operative, as well as the number of hypotensive medications. Twenty percent of patients did not respond to the treatment, and needed subsequent surgery to better control IOP. Treatment tolerability was good, with no cases of hypotony or phthisis. The UCP procedure is simpler, faster, safer, and less invasive than traditional cyclodestructive procedures with similar results in reducing IOP.
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Affiliation(s)
- Giuseppe Giannaccare
- Ophthalmology Unit, S.Orsola-Malpighi Teaching Hospital, DIMES, University of Bologna;
| | - Stefano Sebastiani
- Ophthalmology Unit, S.Orsola-Malpighi Teaching Hospital, DIMES, University of Bologna
| | - Emilio C Campos
- Ophthalmology Unit, S.Orsola-Malpighi Teaching Hospital, DIMES, University of Bologna
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Safety and efficacy of multiple cyclocoagulation of ciliary bodies by high-intensity focused ultrasound in patients with glaucoma. Graefes Arch Clin Exp Ophthalmol 2017; 255:2429-2435. [DOI: 10.1007/s00417-017-3817-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 09/12/2017] [Accepted: 09/22/2017] [Indexed: 11/26/2022] Open
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High-Intensity Focused Ultrasound Circular Cyclocoagulation in Glaucoma: A Step Forward for Cyclodestruction? J Ophthalmol 2017; 2017:7136275. [PMID: 28512580 PMCID: PMC5420440 DOI: 10.1155/2017/7136275] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 01/28/2017] [Accepted: 02/20/2017] [Indexed: 12/05/2022] Open
Abstract
The ciliary body ablation is still considered as a last resort treatment to reduce the intraocular pressure (IOP) in uncontrolled glaucoma. Several ablation techniques have been proposed over the years, all presenting a high rate of complications, nonselectivity for the target organ, and unpredictable dose-effect relationship. These drawbacks limited the application of cyclodestructive procedures almost exclusively to refractory glaucoma. High-intensity focused ultrasound (HIFU), proposed in the early 1980s and later abandoned because of the complexity and side effects of the procedure, was recently reconsidered in a new approach to destroy the ciliary body. Ultrasound circular cyclocoagulation (UC3), by using miniaturized transducers embedded in a dedicated circular-shaped device, permits to selectively treat the ciliary body in a one-step, computer-assisted, and non-operator-dependent procedure. UC3 shows a high level of safety along with a predictable and sustained IOP reduction in patients with refractory glaucoma. Because of this, the indication of UC3 was recently extended also to naïve-to-surgery patients, thus reconsidering the role and timing of ciliary body ablation in the surgical management of glaucoma. This article provides a review of the most used cycloablative techniques with particular attention to UC3, summarizing the current knowledge about this procedure and future possible developments.
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Giannaccare G, Vagge A, Gizzi C, Bagnis A, Sebastiani S, Del Noce C, Fresina M, Traverso CE, Campos EC. High-intensity focused ultrasound treatment in patients with refractory glaucoma. Graefes Arch Clin Exp Ophthalmol 2016; 255:599-605. [DOI: 10.1007/s00417-016-3563-z] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 11/05/2016] [Accepted: 11/19/2016] [Indexed: 11/28/2022] Open
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