title: Miniaturized high-intensity focused ultrasound device in patients with glaucoma: a clinical pilot study.
abstract: OBJECTIVE
  To evaluate the relative safety and potential efficacy of high-intensity focused ultrasound cyclocoagulation by a miniaturized annular device containing six piezoceramic transducers in patients with refractory glaucoma.
  
  
  METHODS
  This was a three-center prospective interventional pilot study. Twelve eyes of 12 patients with refractory glaucoma were insonified using a ring-shaped probe containing six miniaturized high-frequency transducers operating at 21 MHz. Ultrasound biomicroscopy (UBM) and a complete ophthalmic examination were performed before the procedure and at 1 day, 1 week, 1 month, and 3 months after the procedure. Additional visits were performed 6 and 12 months after the procedure.
  
  
  RESULTS
  Intraocular pressure was significantly reduced (P < 0.01) from a mean preoperative value of 37.9 ± 10.7 mm Hg to a mean postoperative value of 27.3 ± 12.4, 25.2 ± 11.3, 25.2 ± 7.7, 24.8 ± 9.8, and 26.3 ± 5.1 mm Hg at 1 day, 1 week, 1 month, 3 months, and 6 months, respectively, and to a mean value of 24.7 ± 8.5 at the last follow-up visit. No major intraoperative or postoperative complications occurred. Minor postoperative corneal complications developed in four patients with previous corneal abnormalities: superficial punctate keratitis (n = 3) and central superficial corneal ulceration (n = 1). UBM showed cystic involution of the ciliary body in 9 of the 12 eyes and a suprachoroidal fluid space in 8 of the 12 eyes.
  
  
  CONCLUSIONS
  Ultrasonic circular cyclocoagulation using high-intensity focused ultrasound delivered by a circular miniaturized device containing six piezoceramic transducers seems to be an effective and well-tolerated method to reduce intraocular pressure in patients with refractory glaucoma.
authors.affiliation: Department of Ophthalmology, Hospices Civils de Lyon, Hôpital Edouard Herriot, Lyon, France. aptel_florent@hotmail.com
authors.forename: Florent
authors.initials: F
authors.lastname: Aptel
authors.forename: Thomas
authors.initials: T
authors.lastname: Charrel
authors.forename: Cyril
authors.initials: C
authors.lastname: Lafon
authors.forename: Fabrice
authors.initials: F
authors.lastname: Romano
authors.forename: Jean-Yves
authors.initials: JY
authors.lastname: Chapelon
authors.forename: Esther
authors.initials: E
authors.lastname: Blumen-Ohana
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Nordmann
authors.forename: Philippe
authors.initials: P
authors.lastname: Denis
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002924:Ciliary Body / Q000098:blood supply / Q000000981:diagnostic imaging; D005260:Female; D005500:Follow-Up Studies; D005901:Glaucoma / Q000000981:diagnostic imaging* / Q000628:therapy*; D006801:Humans; D007429:Intraocular Pressure; D008297:Male; D033401:Microscopy, Acoustic / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D008875:Middle Aged; D008904:Miniaturization / Q000379:methods*; D010865:Pilot Projects; D014159:Transducers; D016896:Treatment Outcome; D014464:Ultrasonic Therapy / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods