Glaucoma is a chronic disease with progressive degeneration of optic nerve fibers resulting in decreased visual field. Elevated intraocular pressure is considered the most important and the only treatable risk factor. This manuscript describes a simple, surgeon-friendly, non-incisional technique, named Ultrasound Cyclo Plasty, for reducing intraocular pressure in glaucoma patients.
Glaucoma is a chronic disease caused by the progressive degeneration of the optical nerve fibers, resulting in decreased visual field that can lead to severe visual impairment, and eventually blindness. This manuscript describes a simple, surgeon-friendly, non-incisional technique, named Ultrasound Cyclo Plasty (UCP), for reducing intraocular pressure (IOP) in glaucoma patients. The technique determines a selective coagulation necrosis of the ciliary body; in addition, the stimulation of supra-choroidal and trans-scleral portions of the uveo-scleral outflow pathway has been recently proposed. UCP shows several technical improvements in ultrasound technology compared to previous techniques, providing more precise focusing on the target zone. The procedure is performed in the operating room under peribulbar anesthesia. Briefly, the coupling cone is put in contact with the eye and the ring probe, that contains six piezoelectric transducers which produce the ultrasound beams, is inserted inside it. Their proper centering over the ocular surface represents a crucial step for the correct targeting of the ciliary body. Sterile balanced salt solution is used to fill the empty spaces to ensure ultrasound acoustic propagation. Surgical treatment consists in the sequential automatic activation of each of the six transducers, for a total duration of less than 3 min. The patient leaves the hospital 1 h after the procedure with the treated eye patched. In the present study, 10 patients with open-angle glaucoma were followed-up during at least 12 months after the procedure. IOP was reduced at each interval compared to pre-operative, as well as the number of hypotensive medications. Twenty percent of patients did not respond to the treatment, and needed subsequent surgery to better control IOP. Treatment tolerability was good, with no cases of hypotony or phthisis. The UCP procedure is simpler, faster, safer, and less invasive than traditional cyclodestructive procedures with similar results in reducing IOP.
Glaucoma represents one of the major causes of blindness worldwide, affecting about 100 million people1. It is an optical neuropathy generated by the progressive degeneration of the nerve fibers that converge on the optic nerve, resulting functionally in a decrease of the visual field that can progress to visual disability and eventually blindness without adequate treatment2.
Elevated IOP is still considered the main risk factor for glaucoma onset and progression, and currently the only treatable parameter to reduce the visual field loss3. IOP reduction can be achieved by both reducing the production of aqueous humor and/or increasing its outflow through trabecular meshwork by the use of topical or systemic drugs, laser, or surgery3,4. Many physical processes have been already introduced to induce the coagulation necrosis of the ciliary body following heating or freezing5,6,7,8,9,10,11,12. However, the lack of selectivity for the target tissue and the unpredictable dose-effect relationship in reducing IOP limit their use only to eyes with glaucoma resistant to conventional medical and surgical therapies4.
Over the last years, a new device, named UCP, that employs high-intensity focused ultrasound (HIFU) has been developed, with the purpose of overcoming the limitations of traditional cyclodestructive techniques by achieving a more selective coagulation of the ciliary body and avoiding possible damages to the adjacent ocular structures13,14,15,16,17,18,19,20,21. In addition, the stimulation of supra-choroidal and trans-scleral portions of the uveo-scleral outflow pathway has been recently proposed as a possible adjunctive mechanism of the procedure in reducing IOP22. To date, seven major clinical studies have been conducted using the UCP device in different types and severity grades of glaucoma, demonstrating the effectiveness and the safety of this non-incisional procedure14,15,19,20,21,22,23,24.
The aim of this study is to describe the above-mentioned procedure in detail, in order to spread the knowledge of its introduction to the scientific medical community, and to provide useful tips and tricks to surgeons who would like to approach this novel field.
Glaucoma is a chronic progressive disease affecting the optic nerve for which new effective treatments are needed to improve long-term prognosis. The reduction of IOP is still considered the only effective therapy to prevent or delay visual field loss, in eyes both with and without elevated IOP3.
UCP is a new non-incisional cyclodestructive procedure that can lower IOP, acting in two different ways: it reduces the aqueous humor inflow determining the selective necrosis …
The authors have nothing to disclose.
The authors have no acknowledgements to declare.
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Mepivacaina 20mg/ml injectable solution | Angelini, Roma, Italy | N01BB03 | Local anesthetic for injection |
Naropina 10mg/ml injectable solution | AstraZeneca, Milano, Italy | N01BB09 | Local anesthetic for injection |
Oftasteril 5% eye drops | Alfa Intes, Napoli, Italy | S01AX18 | 5% povidone-iodine eye drops |
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Tobradex eye drops | Alcon Italia Spa, Milano, Italy | S01CA01 | Antibiotic and steroid eye drops |