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Chiara Del Noce, Alessandro Bagnis, Michele M Iester, Carlo Enrico Traverso; Treatment of refractory glaucoma using high-intensity focused ultrasound cycloablation. Invest. Ophthalmol. Vis. Sci. 2017;58(8):3474.
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To evaluate the clinical efficacy and safety of ultrasound cyclophotocoagulation in lowering intraocular pressure (IOP) in refractory glaucoma patients.
Twenty-one glaucomatous patients (age: 74.85 years +/- 17.09) were enrolled in this observational study. Five patients had neovascular glaucoma, 7 primary open angle glaucoma and 9 chronic angle closure glaucoma.The main inclusion criterion was the diagnosis of glaucoma with a baseline IOP > 21 mmHg while on maximum topical and systemic medical hypotensive treatment. All underwent ultrasound cycloablation treatment with the EyeOP1 device with 8 activated transducers lasting 4 s (group 1), 6 s (group 2) or 8 s (group 3), respectively.Patients were assessed before and at 1, 7, 14, 30, 90, 180 days and 12 months days after the procedure. Primary outcomes were the mean IOP reduction in the overall population and in groups 1, 2 and 3.
No patient experienced pain during the procedure. The mean preoperative IOP was 31.95 mmHg and decreased to 21.71 mm Hg (p< 0.001) at one year after the procedure. At last follow-up the mean number of drops was 1.95 per day, corresponding to a reduction of 24.12% of the quantity of drops taken (p= 0.002). Only 6 patients continued acetazolamide tablets after 1 year in an average amount of 0.9 tablets per day, showing a reduction of 40% of the therapy (p< 0.001) while all the other patients could discontinue any oral therapy. Group 3 patients showed a greater IOP reduction than the other two groups (mean IOP reduction of 38.12% for group 3 vs. 29.05% for group 2 and 28.57% for group 1; p= 0.322 and p< 0.001; respectively).According to the three different types of glaucoma treated we found the best results in IOP lowering among angle closure glaucoma patients (mean IOP reduction of 39.11%; p< 0.05), followed by the group of open angle glaucoma (mean IOP reduction of 32.98%; p= 0.02) and the neovascular glaucoma (mean IOP reduction of 25%; p= 0.006).
Ultrasound cyclophotocoagulation is a simple, effective and safe procedure. This technique is a good alternative to other cycloablation methods and is well tolerated by patients who show less postoperative eye pain and inflammation.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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