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Editors Selection IGR 17-4

Surgical Treatment: Ultrasound cycloplasty

Comment by Shan Lin on:

86555 High-intensity Focused Ultrasound Treatment in Moderate Glaucoma Patients: Results of a 2-Year Prospective Clinical Trial, Leshno A; Rubinstein Y; Singer R et al., Journal of Glaucoma, 2020; 29: 556-560

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Leshno et al. report the results of their observational study on the safety and efficacy of ultrasound cycloplasty (UCP) using high-intensity focused ultrasound (HIFU) for the treatment of moderate glaucoma.¹ This study enrolled 15 subjects with open-angle glaucoma (nine were primary open-angle glaucoma and six were pseudoexfoliation glaucoma) and tracked the effects of UCP-HIFU for two years. Success (defined as intraocular pressure [IOP] reduction of 20% or greater and at least 5 mmHg) was achieved in 87% of eyes at their last follow-up. Among the 11 patients who were able to complete the two-year follow-up, 10 (91%) had achieved surgical success. IOP reduction was achieved in all subjects and was maintained over the various time points, with a mean reduction of 31%. The number of medications decreased from 2.5 ± 0.8 to 2.2± 1.0 at the two-year visit although this was not statistically significant (P = 0.502). There were no major adverse events noted in any of the treated eyes. Most eyes (75%) had mild inflammation on the first postoperative day and one eye had transient hypotony.

The field of glaucoma has seen numerous laser and surgical procedures come and go despite early results which appeared favorable, but when analyzed on a more extended basis, turned out to be not as effective or safe as originally thought.

Even though there was no control group of non-UCP-HIFU treated eyes or an alternative treatment method such as laser trabeculoplasty or one of many available minimally invasive glaucoma surgeries (MIGS), this study is still helpful in understanding the long-term effects of this novel non-invasive procedure. The field of glaucoma has seen numerous laser and surgical procedures come and go despite early results which appeared favorable, but when analyzed on a more extended basis, turned out to be not as effective or safe as originally thought. The results of the present study provide useful data for current clinical use and a foundation for further expanded studies with larger cohorts and perhaps comparison with traditional and emerging surgical procedures.

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