title: High-intensity focused ultrasound treatment in refractory glaucoma patients: results at 1 year of prospective clinical study.
abstract: OBJECTIVE
  To evaluate the safety and efficacy of the ultrasonic circular cyclo-coagulation procedure using high-intensity focused ultrasound by a miniaturized annular device containing 6 piezoceramic transducers in patients with refractory glaucoma.
  
  
  METHODS
  This was a prospective interventional noncomparative study of 20 eyes of 20 patients with refractory glaucoma. All eyes were treated with 6 activated transducers operating at 21 MHz. Ultrasound biomicroscopy and a complete ophthalmic examination were performed before the procedure and at 1 day, 1 week, and 1, 3, 6, and 12 months after the procedure. Primary outcomes were surgical success (defined as intraocular pressure (IOP) reduction from baseline ≥20% and IOP &gt;5 mm Hg) at the last follow-up visit. Secondary outcomes were mean IOP at each follow-up visit compared to baseline, medication use, complications, and re-interventions.
  
  
  RESULTS
  Intraocular pressure was significantly reduced (p&lt;0.01) from a mean preoperative value of 36.4 ± 5.7 mm Hg to a mean postoperative value of 22.5 ± 10.3 mm Hg at 12 months. Four patients needed to be re-treated. The mean IOP reduction achieved was 38%. Surgical success was achieved in 13 of 20 eyes (65%). No major intraoperative or postoperative complications occurred.
  
  
  CONCLUSIONS
  Ultrasonic circular cyclo-coagulation using high-intensity focused ultrasound delivered by a circular miniaturized device containing 6 piezoceramic transducers is an effective and well-tolerated method to reduce IOP in patients with refractory glaucoma.
authors.affiliation: The Sam Rothberg Glaucoma Center, Goldschleger Eye Institute, Sheba Medical Center, Tel Aviv University, Tel Hashomer - Israel.
authors.forename: Shlomo
authors.initials: S
authors.lastname: Melamed
authors.affiliation: The Sam Rothberg Glaucoma Center, Goldschleger Eye Institute, Sheba Medical Center, Tel Aviv University, Tel Hashomer - Israel.
authors.forename: Modi
authors.initials: M
authors.lastname: Goldenfeld
authors.affiliation: The Sam Rothberg Glaucoma Center, Goldschleger Eye Institute, Sheba Medical Center, Tel Aviv University, Tel Hashomer - Israel.
authors.forename: Daniel
authors.initials: D
authors.lastname: Cotlear
authors.forename: Alon
authors.initials: A
authors.lastname: Skaat
authors.affiliation: The Sam Rothberg Glaucoma Center, Goldschleger Eye Institute, Sheba Medical Center, Tel Aviv University, Tel Hashomer - Israel.
authors.forename: Iris
authors.initials: I
authors.lastname: Moroz
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002924:Ciliary Body / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005901:Glaucoma / Q000503:physiopathology / Q000601:surgery*; D006068:Gonioscopy; D006801:Humans; D007429:Intraocular Pressure / Q000502:physiology; D008297:Male; D033401:Microscopy, Acoustic; D008875:Middle Aged; D011183:Postoperative Complications; D011446:Prospective Studies; D014065:Tonometry, Ocular; D016896:Treatment Outcome; D059708:Ultrasonic Surgical Procedures / Q000379:methods*