Ultrasound ciliary plasty in refractory glaucoma treatment – a medium-term follow-up study Original reaserch study

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Bartłomiej Bolek
Edward Wylęgała


Objectives: To assess the efficacy and safety of ultrasound ciliary plasty (UCP) for treating refractory glaucoma during one year follow-up.
Material and methods: A total of 57 patients (37 F, 20 M; mean age: 67.6 years) with primary and secondary refractory glaucoma were enrolled to undergo UCP. The inclusion criteria for the study were: ≥ 18 years, uncontrolled open-angle glaucoma (IOP > 21 mmHg), contraindication to incisional glaucoma surgery, intolerance to glaucoma medications despite well-controlled IOP. The exclusion criteria were: pregnancy, age < 18 years, IOP > 30 mmHg, angle-closure glaucoma and neovascular glaucoma. Complete ophthalmic examinations were performed preoperatively and as well as 1 week and 1, 3, 6, 12 months postoperatively. An IOP reduction of 20% or > 5 mmHg as compared to the baseline value was considered as successful treatment. Complete success was defined as cessation of antiglaucoma medications.
Results: The mean IOP at the last follow-up was reduced by 26.9%. The success rate was 87.7% and the complete success rate was 12.3%. The mean ± SD values of the number of antiglaucoma medications were: 4.0 ± 0.9, 0.9 ± 1.1, 0.9 ± 1.1, 1.1 ± 1.1, 1.8 ± 1.4, 2.1 ± 1.4, 2.4 ± 1.4 (p < 0.001 for all values), respectively. The best-corrected logMAR visual acuities were: 0.37 ± 0.46, 0.47 ± 0.45 (p = 0.003), 0.46 ± 0.45 (p = 0.004), 0.31 ± 0.37 (p = 0.151), 0.36 ± 0.45 (p = 0.880), 0.39 ± 0.47 (p = 0.504), respectively. Following the procedure, choroid detachment was observed in three patients (5.3%) and macular in two patients (3.5%). No other major intraoperative or postoperative complications occurred.
Conclusion: Ultrasound ciliary plasty is a safe and well-tolerated procedure in medium-term follow-up. Further studies with a larger group of patients and longer follow-up are needed to confirm these results.


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Bolek B, Wylęgała E. Ultrasound ciliary plasty in refractory glaucoma treatment – a medium-term follow-up study. Ophthatherapy [Internet]. 2020Sep.30 [cited 2021Jul.25];7(3):246-54. Available from: https://journalsmededu.pl/index.php/ophthatherapy/article/view/1095
Surgery and laser therapy


1. Aptel F, Charrel T, Palazzi X et al. Histologic effects of a new device for High-Intensity focused Ultrasound Cyclocoagulation. Investig Ophthalmol Vis Sci 2010; 51: 5092-8.
2. Charrel T, Aptel F, Birer A et al. Development of a Miniaturized HIFU Device for Glaucoma Treatment With Conformal Coagulation of the Ciliary Bodies. Ultrasound MedBiol. 2011; 37: 742-54.
3. Aptel F, Charrel T, Lafon C et al. Miniaturized high-intensity focused ultrasound device in patients with glaucoma: A clinical pilot study. Investig Ophthalmol Vis Sci. 2011; 52: 8747-53.
4. Bolek B, Ulfik Kl, Dembski M et al. Ultradźwiękowa plastyka ciała rzęskowego − technika zabiegu i wstępne wyniki. Mag Lek Okulisty. 2017; 11: 138-48.
5. Ocular Hypertension Treatment Study: A randomized trial determines that topical ocular hypotensive medication delays or prevents the onset of primary open-angle glaucoma. Arch Ophthalmol. 2002; 120: 701-13.
6. Heijl A, Leske MC, Bengtsson B et al. Reduction of intraocular pressure and glaucoma progression: Results from the Early Manifest Glaucoma. Trial Arch Ophthalmol. 2002; 120: 1268-79.
7. Jankowska-Szmul J, Dobrowolski D, Wylegala E. CO2 laser-assisted sclerectomy surgery compared with trabeculectomy in primary open-angle glaucoma and exfoliative glaucoma. A 1-year follow-up. Acta Ophthalmol. 2018; 96: e582-e91.
8. Vernon SA, Koppens JM, Menon GJ et al. Diode laser cycloablation in adult glaucoma: Long-term results of a standard protocol and review of current literature. Clin Exp Ophthalmol. 2006; 34(5): 411-20.
9. Walland MJ. Diode laser cyclophotocoagulation: Longer term follow up of a standardized treatment protocol. Clin Exp Ophthalmol. 2000; 28: 263-7.
10. Frezzotti P, Mittica V, Martone G et al. Longterm follow-up of diode laser transscleral cyclophotocoagulation in the treatment of refractory glaucoma. Acta Ophthalmol. 2010; 88: 150-5.
11. Pucci V, Tappainer F, Borin S et al. Long-term follow-up after transscleral diode laser photocoagulation in refractory glaucoma. Ophthalmologica. 2003; 217: 279-83.
12. Tan AM, Chockalingam M, Aquino MC et al. Micropulse transscleral diode laser cyclophotocoagulation in the treatment of refractory glaucoma. Clin Exp Ophthalmol. 2010; 38: 266-72.
13. Pantcheva MB, Kahook MY, Schuman JS et al. Comparison of acute structural and histopathological changes in human autopsy eyes after endoscopic cyclophotocoagulation and trans-scleral cyclophotocoagulation. Br J Ophthalmol. 2007; 91: 248-52.
14. Lin SC, Chen MJ, Lin MS et al. Vascular effects on ciliary tissue from endoscopic versus trans-scleral cyclophotocoagulation. Br J Ophthalmol. 2006; 90: 496-500.
15. Berke S, Cohen A, Sturm R et al. Endoscopic Cyclophotocoagulation (Ecp) and Phacoemulsification in the Treatment of Medically Controlled Primary Open-Angle Glaucoma. J Glaucoma. 2000; 9: 129.
16. Siegel MJ, Boling WS, Faridi OS et al. Combined endoscopic cyclophotocoagulation and phacoemulsification versus phacoemulsification alone in the treatment of mild to moderate glaucoma. Clin Exp Ophthalmol. 2015; 43: 531-9.
17. Noecker RJ, Kahook MY, Berke SJ et al. Uncontrolled intraocular pressure after endoscopic cyclophotocoagulation. J Glaucoma. 2008; 17(3): 250-1.
18. Noecker RJ, Group ECS. Complications of Endoscopic Cyclophotocoagulation. The ASCRS Symp Cataract IOL Refract Surgery; San Diego, CA. 2007; 24(4): 177-82.
19. Aptel F, Lafon C. Therapeutic applications of ultrasound in ophthalmology. Int J Hyperth. 2012; 28: 405-18.
20. Aptel F, Denis P, Rouland JF et al. Multicenter clinical trial of high-intensity focused ultrasound treatment in glaucoma patients without previous filtering surgery. Acta Ophthalmol. 2016; 94: 268-77.
21. Deb-Joardar N, Reddy K. Application of high intensity focused ultrasound for treatment of open-angle glaucoma in Indian patients. Indian J Ophthalmol. 2018; 66: 517-23.
22. Giannaccare G, Vagge A, Sebastiani S et al. Ultrasound Cyclo-Plasty in Patients with Glaucoma: 1-Year Results from a Multicentre Prospective Study. Ophthalmic Res. 2019; 61: 137-42.
23. Denis P, Aptel F, Rouland JF et al. Cyclocoagulation of the ciliary bodies by high-intensity focused ultrasound: A 12-month multicenter study. Investig. Ophthalmol. Vis Sci. 2015; 56: 1089-96. http://iovs.arvojournals.org/Article.aspx?doi=10.1167/iovs.14-14973.
24. Sousa DC, Ferreira NP, Marques-Neves C et al. High-intensity focused ultrasound cycloplasty: Analysis of pupil dynamics. J Curr Glaucoma Pract. 2018; 12: 102-6.
25. Bolek B, Wylegala A, Mazur R et al. Pupil irregularity after ultrasound ciliary plasty in glaucoma treatment. Acta Ophthalmol. 2019; 97: S263.
26. Bolek B, Wylęgała A, Wylęgała. Assessment of Scleral and Conjunctival Thickness of the Eye after Ultrasound Ciliary Plasty. J Ophthalmol. 2020; 2020: 9659014. https://doi.org/10.1155/2020/9659014.