title: Uveo-scleral outflow pathways after ultrasonic cyclocoagulation in refractory glaucoma: an anterior segment optical coherence tomography and in vivo confocal study.
abstract: OBJECTIVE
  To evaluate, using anterior segment optical coherence tomography (AS-OCT) and in vivo confocal microscopy (IVCM), the uveo-scleral aqueous humour (AH) outflow pathways after ultrasonic circular cyclocoagulation (UCCC).
  
  
  METHODS
  Forty-four patients with refractory glaucoma underwent 4 or 6 s UCCC (group 1, 24 eyes; group 2, 20 eyes). UCCC was successful when the preoperative intraocular pressure (IOP) reduced by one-third. AS-OCT and IVCM were performed at baseline and at month 1 to evaluate the sclera and conjunctiva. The main outcomes were mean intra-scleral hyporeflective spaces area (MIHSA: mm2) at AS-OCT, mean density and area of conjunctival microcysts (MMD: cysts/mm2; MMA: µm2) at IVCM. The relations between MIHSA, MMA and MMD with IOP were analysed.
  
  
  RESULTS
  Mean baseline IOP was 26.9±2.8 mm Hg in group 1 and 27.5±4.0 in group 2. Intra-scleral hyporeflective spaces and microcysts were observed in both groups, without significant differences in MIHSA, MMA and MMD. At month 1, UCCC was successful in 63.6% of patients (41.6% in group 1, 80% in group 2), and IOP reduced to 18.8±3.2 (30.1%) and 17.1±2.7 mm Hg (38.7%), respectively (p<0.001). MIHSA showed a twofold and threefold increase in group 1 and 2 (p<0.05), with a significant difference between groups (p<0.05). MMA and MMD increased in both groups (p<0.05), with values higher in group 2 (p<0.05). Significant relations were found between MIHSA and IOP in both groups (p<0.01).
  
  
  CONCLUSIONS
  UCCC induced anatomical modifications of sclera and conjunctiva, which suggested that the trans-scleral AH outflow enhancement is one of the possible mechanisms exploited by ultrasounds to reduce IOP.
authors.affiliation: Ophthalmology Unit, Department of Neurological, Neuropsychological, Morphological and Movement Sciences, University of Verona, Verona, Italy.
authors.forename: Rodolfo
authors.initials: R
authors.lastname: Mastropasqua
authors.affiliation: Department of Medicine and Ageing Science, Ophthalmology Clinic, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Agnifili
authors.affiliation: Department of Medicine and Ageing Science, Ophthalmology Clinic, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Fasanella
authors.affiliation: Department of Medicine and Ageing Science, Ophthalmology Clinic, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy.
authors.forename: Lisa
authors.initials: L
authors.lastname: Toto
authors.affiliation: Department of Medicine and Ageing Science, Ophthalmology Clinic, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy.
authors.forename: Lorenza
authors.initials: L
authors.lastname: Brescia
authors.affiliation: Department of Surgical Science, Ophthalmic Clinic, University of L'Aquila, L'Aquila, Italy.
authors.forename: Silvio
authors.initials: S
authors.lastname: Di Staso
authors.affiliation: Department of Medicine and Ageing Science, Ophthalmology Clinic, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy.
authors.forename: Emanuele
authors.initials: E
authors.lastname: Doronzo
authors.affiliation: Ophthalmology Unit, Department of Neurological, Neuropsychological, Morphological and Movement Sciences, University of Verona, Verona, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Marchini
mesh_terms: D000368:Aged; D000869:Anterior Eye Segment / Q000000981:diagnostic imaging*; D001082:Aqueous Humor / Q000378:metabolism*; D005260:Female; D005500:Follow-Up Studies; D005901:Glaucoma / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007429:Intraocular Pressure; D008297:Male; D018613:Microscopy, Confocal / Q000379:methods; D008875:Middle Aged; D012590:Sclera / Q000000981:diagnostic imaging / Q000378:metabolism / Q000601:surgery*; D041623:Tomography, Optical Coherence / Q000379:methods*; D059708:Ultrasonic Surgical Procedures / Q000379:methods*; D014602:Uvea / Q000000981:diagnostic imaging / Q000378:metabolism / Q000601:surgery*
keywords: Aqueous humour; Conjunctiva; Glaucoma; Sclera and Episclera; Treatment Surgery