High intensity focused ultrasound as first line treatment in patients with chronic angle closure glaucoma at risk for malignant glaucoma.
OBJECTIVE
Evaluation of high intensity focused ultrasound (HIFU) transscleral cyclocoagulation as an alternative to trabeculectomy in the treatment of refractory chronic angle closure glaucoma (CACG).


METHODS
This prospective one armed single center pilot study was conducted on patients with medically uncontrolled CACG who underwent high intensity focused ultrasound (HIFU) cyclocoagulation as first line surgical treatment, using the Eye-OP1 HIFU device (Eyetechcare-Rillieux-la-Pape, France) driven by ultrasound biomicroscopic (UBM) ciliary body localization. All patients had documented progression of their glaucoma despite conventional medical and laser therapy. The primary efficacy outcome was intraocular pressure (IOP) reduction; secondary outcomes included changes in number of glaucoma medications and complications after cyclocoagulation.


RESULTS
The study involved 8 eyes of 7 patients between May 2013 and September 2014. The average follow-up was 5.6±2.1 months. The mean IOP was reduced from 18.4±3.5mmHg preoperatively to 14.8±4.1mmHg 6 months postoperatively. The average number of glaucoma medications decreased from 3.4±1.1 at baseline to 3.3±0.7 after 6 months. Visual acuity remained stable (median 0.17 log MAR preoperatively and 0.19 log MAR at last follow-up visit). No significant side effect occurred during the 6 months follow-up period.


CONCLUSIONS
HIFU cyclocoagulation appears to be a safe and reliable alternative to filtering surgery in the management of chronic angle closure glaucoma among patients with a high risk of malignant glaucoma.
Ophthalmology department, Institut du glaucome, university Paris-Descartes, centre hospitalier Paris-Saint-Joseph, 185, rue Raymond-Losserand, 75674 Paris cedex 14, France. Electronic address: martingraber@sfr.fr.
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M
Graber
Ophthalmology department, Institut du glaucome, university Paris-Descartes, centre hospitalier Paris-Saint-Joseph, 185, rue Raymond-Losserand, 75674 Paris cedex 14, France.
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Z
Khoueir
Ophthalmology department, Institut du glaucome, university Paris-Descartes, centre hospitalier Paris-Saint-Joseph, 185, rue Raymond-Losserand, 75674 Paris cedex 14, France.
A
A
Beauchet
Ophthalmology department, Institut du glaucome, university Paris-Descartes, centre hospitalier Paris-Saint-Joseph, 185, rue Raymond-Losserand, 75674 Paris cedex 14, France.
N
N
Benhatchi
Ophthalmology department, Institut du glaucome, university Paris-Descartes, centre hospitalier Paris-Saint-Joseph, 185, rue Raymond-Losserand, 75674 Paris cedex 14, France.
S
S
Hammoud
Ophthalmology department, Institut du glaucome, university Paris-Descartes, centre hospitalier Paris-Saint-Joseph, 185, rue Raymond-Losserand, 75674 Paris cedex 14, France.
Y
Y
Lachkar
D000328:Adult; D000368:Aged; D002908:Chronic Disease; D018450:Disease Progression; D005260:Female; D015812:Glaucoma, Angle-Closure / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D057086:High-Intensity Focused Ultrasound Ablation; D006801:Humans; D007429:Intraocular Pressure / Q000502:physiology; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D012307:Risk Factors; D014130:Trabeculectomy; D016896:Treatment Outcome; D014792:Visual Acuity
Chronic angle closure glaucoma; Cyclocoagulation; Cyclodestruction; Glaucome à angle fermé chronique; HIFU; High intensity focused ultrasound; Intraocular pressure; Le glaucome malin; Malignant glaucoma; Pression intraoculaire; Résultats de traitement; Treatment outcomes; Ultrasons focalisés de haute intensité