Short-Term Observation of Ultrasonic Cyclocoagulation in Chinese Patients with End-Stage Refractory Glaucoma: A Retrospective Study

Distribution of ultrasound cyclo plasty probe models in Chinese patients with glaucoma

PURPOSE

To investigate the distribution of ultrasound cyclo plasty (UCP) probe models in Chinese patients with glaucoma.

METHODS

Patients needing glaucoma surgery were recruited at Zhongshan Ophthalmic Center from January 2019 to December 2019. Patient demographics were recorded and analyzed. Visual acuity, intraocular pressure (IOP), retinal nerve fiber layer (RNFL), mean defect of visual field (MD), ocular axial length (AL) and horizontal corneal diameter (white to white, WTW) of eyes with glaucoma were measured. In addition, the UCP probe models were calculated using a nomogram tool and two ocular anatomical parameters: WTW and AL.

RESULTS

A total of 1281 patients (2000 eyes) were included in the study, including 559 males (43.64%) and 722 females (56.36%). The age of the patients ranged from 18 to 91 years, with a mean age of 61.43 ± 12.21 years. IOP ranged from 22.0 to 60.0 mmHg, with a mean of 26.17 ± 3.52 mmHg. The mean AL and WTW were 22.96 ± 1.43 (ranging from 19.07 to 35.00) and 11.55 ± 0.50 (ranging from 9.6 to 13.7), respectively. According to the results calculated by the nomogram tool, Chinese patients' eyes mainly adapted to Model 12, with a percentage of 69.05%. Model 13 and Model 11 were suitable for 26.65% and 3.35% of the patients, respectively. A total of 0.95% of Chinese patients did not have a suitable probe model.

CONCLUSION

For Chinese patients who needed glaucoma surgery, UCP probe models were mainly attributed to Model 12, followed by Model 13, and Model 11 was the least used.

The Agreement of the Nomogram Tool and Ultrasound Biomicroscopy Images in Calculating Ultrasound Cycloplasty Probe Model in Chinese Patients

PURPOSE

The aim of the study was to compare and explore the agreement between the nomogram tool and ultrasound biomicroscopy (UBM) images method to calculate the ultrasound cycloplasty (UCP) probe model in Chinese glaucoma patients.

METHODS

Retrospective analysis of Chinese glaucoma patients who visited Zhongshan Ophthalmic Center in Guangzhou from January to December 2019 and were eligible for UCP surgery. Visual acuity, intraocular pressure (IOP), ocular axial length (AL), and horizontal corneal diameter (white to white [WTW]) were measured. UBM images with clear ciliary body imaging and AL and WTW data were sent to trained personnel for probe model measurements. The data calculated by both methods were analyzed using unweighted and weighted κ statistics. The level of agreement refers to Landis and Koch's guideline for the strength of agreement indicated with weighted κ values.

RESULTS

1,061 eyes of 642 patients were involved, with a mean age of 61.66 ± 11.66 years. Their best-corrected visual acuity converted to logarithm of minimal-angle-of-resolution (logMAR) scores of -0.18-3.00 with a mean value of 0.69 ± 0.77. IOP was 22.0-60.0 mm Hg with a mean of 27.97 ± 5.66 mm Hg. The mean AL and WTW were 22.88 ± 1.33 (19.15-32.14) mm and 11.52 ± 0.49 (10.00-12.90) mm, respectively. The agreement between the two methods was fair (weighted κ = 0.299), matching in 62.86% of eyes (weighted κ = 0.299, κ = 0.264). The agreement in primary open angle glaucoma, acute primary angle-closure glaucoma, chronic primary angle-closure glaucoma, and secondary glaucoma patients was 60.85% (weighted κ = 0.336, κ = 0.301), 65.06% (weighted κ = 0.146, κ = 0.127), 62.26% (weighted κ = 0.204, κ = 0.184), and 57.97% (weighted κ = 0.332, κ = 0.280) of eyes, respectively.

CONCLUSION

The agreement between UBM images and the nomogram tool to calculate the UCP probe model of Chinese patients is at a fair level. The nomogram tool prefers to use larger probes. Improvements to the nomogram tool, such as including data from more ethnic groups and being able to calculate separately for different types of glaucoma, are needed to improve accuracy. The inclusion of parameters or images from more directions of the eye may help measure probe models more accurately for both the nomogram tool and the UBM image measurement.

Two-Year Outcomes of Ultrasound Cyclo Plasty as a First Procedure in Glaucoma

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.

Outcomes and Predictors of Failure of Ultrasound Cyclo Plasty for Primary Open-Angle Glaucoma

Aims: To evaluate the outcomes of ultrasound cyclo plasty (UCP) for primary open-angle glaucoma (POAG) and identify the predictors of failure. Methods: This retrospective cohort study included patients with POAG who underwent UCP at King Abdul Aziz University Hospital, Riyadh, Saudi Arabia, between 2016 and 2021. The main outcome measures were the intraocular pressure (IOP), the number of antiglaucoma medications, and the presence of vision-threatening complications. The surgical outcome of each eye was based on the main outcome measures. Cox proportional hazard regression analysis was performed to identify the possible predictors of UCP failure. Results: Sixty-six eyes of fifty-five patients were included herein. The mean follow-up period was 28.95 (±16.9) months. The mean IOP decreased significantly from 23.02 (±6.1) to 18.22 (±7.0) and 16.44 (±5.3) mm Hg on the 12th and 24th months, respectively; the mean number of antiglaucoma medications decreased significantly from 3.23 (±0.9) to 2.15 (±1.5) and 2.09 (±1.6), respectively. The cumulative probabilities of overall success were 71.2 ± 5.6% and 40.9 ± 6.1% on the 12th and 24th months, respectively. High baseline IOP and the number of antiglaucoma medications were associated with a higher risk of failure (hazard ratio = 1.10 and 3.01, p = 0.04 and p < 0.01, respectively). The most common complications were cataract development or progression (30.8%) and prolonged or rebound anterior chamber reaction (10.6%). Conclusions: UCP reasonably controls the IOP and reduces the antiglaucoma medication burden in eyes with POAG. Nevertheless, the success rate is modest, with a high baseline IOP and number of medications.

Various modalities of cyclodestruction in non-refractory glaucoma: a comparative study

PURPOSE

The aim of the study is to study the safety and efficacy of three cyclodestructive treatments; high-intensity focused ultrasound (HIFU) cyclocoagulation versus micropulse cyclophotocoagulation (MP-CPC) versus transscleral continuous-wave cyclophotocoagulation (CW-CPC) for treatment of non-refractory glaucoma.

METHODS

This is a prospective comparative single-center study. Thirty non-refractory, medically uncontrolled, primary open-angle glaucoma patients with good vision were randomized to a single session of HIFU, MP-CPC or CW-CPC. Intraocular pressure (IOP) reduction, number of medications, success rate, visual acuity and complications were compared between the three groups. Success was defined as an IOP reduction of 30% and IOP between 6 and 21 mmHg with or without medications, in the absence of vision-threatening complications.

RESULTS

Thirty patients were enrolled in our study: 10 patients received HIFU, 10 patients received MP-CPC and 10 patients received CW-CPC. At 6 months, IOP was reduced by 31.5%, 23.9% and 19.4% (P = 0.4) achieving a success rate of 50%, 60% and 50% (P = 0.8) for continuous, micropulse and HFU groups, respectively, with reduction in the number of drops and stop of oral acetazolamide. Although the difference in the rate of complications between groups was not significant, CW-CPC group had more complications.

CONCLUSIONS

Cyclophotocoagulation could be an option in the treatment of non-refractory glaucoma even in patients with good visual acuity, with similar outcomes between the three types of cyclodestruction.

Ultrasonic circular cyclocoagulation prospective safety and effectiveness study

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.

Ultrasound cycloplasty in Chinese glaucoma patients: Results of a 6-month prospective clinical study

PURPOSE

The aim of this study was to evaluate the short-term efficacy and safety of ultrasound cycloplasty (UCP) procedure in Chinese glaucoma patients.

METHODS

As a single-centre, prospective, non-comparative study, 23 eyes of 23 patients suffering from glaucoma with uncontrolled intraocular pressure (IOP) ≥ 21 mmHg underwent a multi-dose UCP treatment with the activations of 6, 8 or10 sectors. Types of glaucoma include primary open-angle glaucoma (POAG) (7/23), primary angle closure glaucoma (PACG) (9/23) and secondary glaucoma (SG) (7/23). A complete ophthalmic examination including intraocular pressure (IOP) measurements was performed before UCP procedure and at 1 day, 1 month, 3months and 6 months after the procedure. An IOP reduction of ≥20% and IOP > 5 mmHg without increasing hypotensive medication at the follow-up visit was defined as therapeutic success. The post-operative complications were also recorded and compared to baseline for safety evaluation.

RESULTS

The mean baseline IOP of 23 treated eyes was 37.2 ± 12.1 mmHg. The IOP reduction after UCP procedure were 23%, 49%, 33% and 34% at 1 day, 1 month, 3 months and 6 months, respectively. Thus, the corresponding overall therapeutic success rates reached 61% (14/23), 83% (19/23), 65% (15/23) and 61% (14/23), respectively. Baseline IOPs of 8 and 10 sectors group (37.0 ± 9.9 mmHg and 50.1 ± 12.2 mmHg) were significantly higher than that of 6 sectors group (30.1 ± 8.2 mmHg). Therapeutic success rates of 6, 8 and 10 sectors groups reached 44% (4/9), 56% (5/9) and 100% (5/5), respectively. There were the highest percentage of IOP reduction (50% and 41%) and therapeutic success rate (6/7; 86% and 7/9; 78%) in SG group and PACG groups respectively. In addition, pre-operative ocular pain symptoms of four patients were all disappeared within one week after UCP. No serious intra-operative or post-operative complications occurred.

CONCLUSION

UCP procedure is an effective and well-tolerated treatment to reduce IOP in Chinese glaucoma patients, which offered a novel alternative for glaucoma treatment.

Ultrasound cyclo plasty for the management of refractory glaucoma in chinese patients: a before-after study

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.

Efficacy and safety of high-dose ultrasound cyclo-plasty procedure in refractory glaucoma

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.