Ultrasound ciliary plasty to treat glaucoma: efficacy and safety results on 152 patients

Purpose To evaluate the efficacy and safety of the Ultrasound Ciliary Plasty (UCP) procedure using Focused ultrasound with second generation probe on a consecutive series of 152 glaucoma patients. Methods Prospective clinical series of 169 eyes of 152 patients with primary and secondary open angle or angle closure glaucoma treated between April 2015 and September 2016 in 2 University Hospitals. Procedures were conducted with second generation therapy probe comprising 6 piezoelectric transducers, with 8 seconds exposure time per transducer (standard protocol). Complete ophthalmic examinations were performed before the procedure, and at 1 day, 1 week, 1, 3, 6 and 12 months after. Primary outcome was IOP reduction compared to baseline. Secondary outcomes were success rate (defined as IOP reduction from baseline ≥20% and IOP >5 mmHg without adding medication compared to baseline), vision-threatening complications, hypotensive medication use, complications, and re-interventions. Results No major intra- or post-operative complications occurred. Ocular exam did not reveal lesions of ocular structures other than ciliary body and no or few signs of anterior chamber inflammation. Semi-mydriasis was observed on fifteen eyes, reduced or resolved in a few weeks/months. Intraocular pressure was significantly reduced from a mean preoperative value of 27.1 ± 9.3 mmHg (3.1 hypotensive medications) to a mean value of 19.1 ± 7.6 mmHg (3.2 hypotensive medications) at last follow-up, corresponding of a mean IOP reduction of 27%. Nineteen patients were re-treated using focused ultrasound, 7 patients were considered as failure and treated by filtering surgery, and 8 patients with Diode laser cyclo-destructive procedure. Conclusions Ultrasound Ciliary Plasty using High Intensity Focused Ultrasound is an effective method to reduce intraocular pressure in patients with glaucoma.