Efficacy and safety of ultrasonic circular cyclocoagulation with second-generation probe in glaucoma: A retrospective study

Autoři: Chloé Chamard aff001;  Vincent Daien aff001;  Hyosun Han aff001;  David S. Greenfield aff004;  Max Villain aff001
Působiště autorů: Department of Ophthalmology, Gui de Chauliac Hospital, Montpellier, France aff001;  INSERM (Institut National de la Santé Et de la Recherche Médicale), Montpellier, France aff002;  The Save Sight Institute, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia aff003;  Department of Ophthalmology, University of Miami Miller School of Medicine, Bascom Palmer Eye Institute, Palm Beach Gardens, Florida, United States of America aff004
Vyšlo v časopise: PLoS ONE 15(1)
Kategorie: Research Article
doi: https://doi.org/10.1371/journal.pone.0227389



To assess the efficacy and safety of the second-generation probe of ultrasonic circular cyclocoagulation (UC3) in naive or refractory glaucoma, with a 6-month follow-up.


A retrospective consecutive case-series study included patients having a UC3 procedure with the second-generation probe of the EyeOP1 device, intraocular pressure (IOP) ≥ 21 mmHg and under maximum tolerated medical treatment, with or without previous glaucoma surgery. Surgical success was defined at the 6-month post-operative visit as IOP > 5 and ≤ 21 mmHg with IOP reduction ≥ 20% from baseline, without any reoperation, and visual acuity better than negative light perception.


100 patients were included and 97 (97.0%; 97 eyes) attended the 6-month follow-up. At 6 months, surgical success was obtained in 48 eyes (49.5%). Intraocular pressure was reduced from a mean ± SD preoperative value of 28.0 ± 5.6 mmHg to 19.3 ± 7.1 mmHg at 6 months (p<0.0001). The proportion of eyes requiring oral acetazolamide decreased from 57.0% to 30.0% between baseline and 6 months after surgery (p = 0.0007). We observed 15 (15.0%) cases of postsurgical macular edema, 8 (8.0%) of hypotony, and 20 (20.0%) of visual acuity loss > 2 Snellen lines. Postsurgical macular edema was associated with a history of epiretinal membranes, uveitis or retinal detachment. Risk factors for hypotony were a history of diabetes or trabeculectomy.


The second-generation UC3 probe significantly reduced IOP in eyes with naive and refractory glaucoma but severe post-operative complications were often observed. Further studies are needed to better identify responders and decrease the high risk for complications associated with the procedure.

Klíčová slova:

Edema – Eyes – Glaucoma – Ophthalmic procedures – Retinal detachment – Surgical and invasive medical procedures – Trabeculectomy – Visual acuity


1. Heijl A, Leske MC, Bengtsson B, Hyman L, Bengtsson B, Hussein M, et al. Reduction of intraocular pressure and glaucoma progression: results from the Early Manifest Glaucoma Trial. Arch Ophthalmol. 2002 Oct;120(10):1268–79. doi: 10.1001/archopht.120.10.1268 12365904

2. Kass MA, Heuer DK, Higginbotham EJ, Johnson CA, Keltner JL, Miller JP, et al. The Ocular Hypertension Treatment Study: a randomized trial determines that topical ocular hypotensive medication delays or prevents the onset of primary open-angle glaucoma. Arch Ophthalmol. 2002 Jun;120(6):701–13; discussion 829–830. doi: 10.1001/archopht.120.6.701 12049574

3. Miglior S, Zeyen T, Pfeiffer N, Cunha-Vaz J, Torri V, Adamsons I, et al. Results of the European Glaucoma Prevention Study. Ophthalmology. 2005 Mar;112(3):366–75. doi: 10.1016/j.ophtha.2004.11.030 15745761

4. Dunphy EB, Albaugh CH. Cyclodiathermy: An Operation for the Treatment of Glaucoma. Trans Am Ophthalmol Soc. 1941;39:193–213. 16693249

5. Caprioli J, Strang SL, Spaeth GL, Poryzees EH. Cyclocryotherapy in the treatment of advanced glaucoma. Ophthalmology. 1985 Jul;92(7):947–54. doi: 10.1016/s0161-6420(85)33951-9 2410846

6. Coleman DJ, Lizzi FL, Driller J, Rosado AL, Burgess SE, Torpey JH, et al. Therapeutic ultrasound in the treatment of glaucoma. II. Clinical applications. Ophthalmology. 1985 Mar;92(3):347–53. doi: 10.1016/s0161-6420(85)34028-9 3991122

7. Huang G, Lin SC. When should we give up filtration surgery: indications, techniques and results of cyclodestruction. Dev Ophthalmol. 2012;50:173–83. doi: 10.1159/000334800 22517183

8. Mastropasqua R, Fasanella V, Mastropasqua A, Ciancaglini M, Agnifili L. High-Intensity Focused Ultrasound Circular Cyclocoagulation in Glaucoma: A Step Forward for Cyclodestruction? J Ophthalmol. 2017;2017:7136275. doi: 10.1155/2017/7136275 28512580

9. Ndulue JK, Rahmatnejad K, Sanvicente C, Wizov SS, Moster MR. Evolution of Cyclophotocoagulation. J Ophthalmic Vis Res. 2018;13(1):55–61. doi: 10.4103/jovr.jovr_190_17 29403591

10. Burgess SE, Silverman RH, Coleman DJ, Yablonski ME, Lizzi FL, Driller J, et al. Treatment of glaucoma with high-intensity focused ultrasound. Ophthalmology. 1986 Jun;93(6):831–8. doi: 10.1016/s0161-6420(86)33672-8 3526229

11. Silverman RH, Vogelsang B, Rondeau MJ, Coleman DJ. Therapeutic ultrasound for the treatment of glaucoma. Am J Ophthalmol. 1991 Mar 15;111(3):327–37. doi: 10.1016/s0002-9394(14)72318-9 2000903

12. Sterk CC, vd Valk PH, van Hees CL, van Delft JL, van Best JA, Oosterhuis JA. The effect of therapeutic ultrasound on the average of multiple intraocular pressures throughout the day in therapy-resistant glaucoma. Graefes Arch Clin Exp Ophthalmol. 1989;227(1):36–8. doi: 10.1007/bf02169822 2920906

13. Aptel F, Charrel T, Palazzi X, Chapelon J-Y, Denis P, Lafon C. Histologic effects of a new device for high-intensity focused ultrasound cyclocoagulation. Invest Ophthalmol Vis Sci. 2010 Oct;51(10):5092–8. doi: 10.1167/iovs.09-5135 20484580

14. Charrel T, Aptel F, Birer A, Chavrier F, Romano F, Chapelon J-Y, et al. Development of a miniaturized HIFU device for glaucoma treatment with conformal coagulation of the ciliary bodies. Ultrasound Med Biol. 2011 May;37(5):742–54. doi: 10.1016/j.ultrasmedbio.2011.01.017 21439719

15. Aptel F, Charrel T, Lafon C, Romano F, Chapelon J-Y, Blumen-Ohana E, et al. Miniaturized high-intensity focused ultrasound device in patients with glaucoma: a clinical pilot study. Invest Ophthalmol Vis Sci. 2011 Nov 11;52(12):8747–53. doi: 10.1167/iovs.11-8137 21948551

16. Aptel F, Dupuy C, Rouland J-F. Treatment of refractory open-angle glaucoma using ultrasonic circular cyclocoagulation: a prospective case series. Curr Med Res Opin. 2014 Aug;30(8):1599–605. doi: 10.1185/03007995.2014.910509 24689838

17. Melamed S, Goldenfeld M, Cotlear D, Skaat A, Moroz I. High-intensity focused ultrasound treatment in refractory glaucoma patients: results at 1 year of prospective clinical study. Eur J Ophthalmol. 2015 Dec;25(6):483–9. doi: 10.5301/ejo.5000620 25982212

18. Denis P, Aptel F, Rouland J-F, Nordmann J-P, Lachkar Y, Renard J-P, et al. Cyclocoagulation of the ciliary bodies by high-intensity focused ultrasound: a 12-month multicenter study. Invest Ophthalmol Vis Sci. 2015 Jan 20;56(2):1089–96. doi: 10.1167/iovs.14-14973 25604688

19. Giannaccare G, Vagge A, Gizzi C, Bagnis A, Sebastiani S, Del Noce C, et al. High-intensity focused ultrasound treatment in patients with refractory glaucoma. Graefes Arch Clin Exp Ophthalmol. 2017 Mar;255(3):599–605. doi: 10.1007/s00417-016-3563-z 27915382

20. Aptel F, Denis P, Rouland J-F, Renard J-P, Bron A. Multicenter clinical trial of high-intensity focused ultrasound treatment in glaucoma patients without previous filtering surgery. Acta Ophthalmol. 2016 Aug;94(5):e268–277. doi: 10.1111/aos.12913 26547890

21. Deb-Joardar N, Reddy KP. Application of high intensity focused ultrasound for treatment of open-angle glaucoma in Indian patients. Indian J Ophthalmol. 2018;66(4):517–23. doi: 10.4103/ijo.IJO_1024_17 29582811

22. von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP, et al. [The Strengthening the Reporting of Observational Studies in Epidemiology [STROBE] statement: guidelines for reporting observational studies]. Gac Sanit. 2008 Apr;22(2):144–50. doi: 10.1157/13119325 18420014

23. Hodapp E, Parrish RK, Anderson DR. Clinical decisions in glaucoma. St. Louis, Mo: Mosby; 1993. 204 p.

24. Gedde SJ, Schiffman JC, Feuer WJ, Herndon LW, Brandt JD, Budenz DL, et al. Treatment outcomes in the Tube Versus Trabeculectomy (TVT) study after five years of follow-up. Am J Ophthalmol. 2012 May;153(5):789-803.e2.

25. Shaarawy T, World Glaucoma Association, editors. Guidelines on design and reporting of glaucoma surgical trials. Amsterdam: Kugler; 2009. 83 p. (WGA guidelines).

26. European Glaucoma Society Terminology and Guidelines for Glaucoma, 4th Edition—Chapter 3: Treatment principles and optionsSupported by the EGS Foundation. Br J Ophthalmol. 2017 Jun;101(6):130–95. doi: 10.1136/bjophthalmol-2016-EGSguideline.003 28559477

27. Emanuel ME, Grover DS, Fellman RL, Godfrey DG, Smith O, Butler MR, et al. Micropulse Cyclophotocoagulation: Initial Results in Refractory Glaucoma. J Glaucoma. 2017 Aug;26(8):726–9. doi: 10.1097/IJG.0000000000000715 28671927

28. Dastiridou AI, Katsanos A, Denis P, Francis BA, Mikropoulos DG, Teus MA, et al. Cyclodestructive Procedures in Glaucoma: A Review of Current and Emerging Options. Adv Ther. 2018;35(12):2103–27. doi: 10.1007/s12325-018-0837-3 30448885

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