scholarly journals High-Intensity Focused Ultrasound Circular Cyclocoagulation in Glaucoma: A Step Forward for Cyclodestruction?

2017 ◽  
Vol 2017 ◽  
pp. 1-14 ◽  
Author(s):  
Rodolfo Mastropasqua ◽  
Vincenzo Fasanella ◽  
Alessandra Mastropasqua ◽  
Marco Ciancaglini ◽  
Luca Agnifili
Keyword(s):  
High Intensity ◽  
Ciliary Body ◽  
Focused Ultrasound ◽  
Current Knowledge ◽  
High Intensity Focused Ultrasound ◽  
High Rate ◽  
Dose Effect ◽  
Computer Assisted ◽  
Refractory Glaucoma ◽  
High Level

The ciliary body ablation is still considered as a last resort treatment to reduce the intraocular pressure (IOP) in uncontrolled glaucoma. Several ablation techniques have been proposed over the years, all presenting a high rate of complications, nonselectivity for the target organ, and unpredictable dose-effect relationship. These drawbacks limited the application of cyclodestructive procedures almost exclusively to refractory glaucoma. High-intensity focused ultrasound (HIFU), proposed in the early 1980s and later abandoned because of the complexity and side effects of the procedure, was recently reconsidered in a new approach to destroy the ciliary body. Ultrasound circular cyclocoagulation (UC3), by using miniaturized transducers embedded in a dedicated circular-shaped device, permits to selectively treat the ciliary body in a one-step, computer-assisted, and non-operator-dependent procedure. UC3 shows a high level of safety along with a predictable and sustained IOP reduction in patients with refractory glaucoma. Because of this, the indication of UC3 was recently extended also to naïve-to-surgery patients, thus reconsidering the role and timing of ciliary body ablation in the surgical management of glaucoma. This article provides a review of the most used cycloablative techniques with particular attention to UC3, summarizing the current knowledge about this procedure and future possible developments.

scholarly journals New Modalities of Cycloablation and High-Intensity-Focused Ultrasound

2020 ◽  
pp. 121-131
Author(s):  
Natasha Nayak Kolomeyer ◽  
Marlene R. Moster
Keyword(s):  
Intraocular Pressure ◽  
High Intensity ◽  
Ciliary Body ◽  
Focused Ultrasound ◽  
Treatment Options ◽  
Laser System ◽  
High Intensity Focused Ultrasound ◽  
Refractory Glaucoma ◽  
Visual Potential ◽  
History Of

Abstract Cycloablative or cyclodestructive procedures aim to lower intraocular pressure (IOP) by decreasing the function of the ciliary body and thereby decreasing the rate of aqueous production. Cycloablative procedures were typically used in refractory glaucoma in eyes with poor visual potential; however, more focused energy and targeted destruction of the ciliary body have led to an increase in cyclodestructive treatment options that are now an important adjunct to our surgical armamentarium. This chapter highlights the history of these procedures while focusing on current modalities including transscleral diode cyclophotocoagulation (TSCPC), micropulse transscleral diode cyclophotocoagulation (MP-TSCPC, MicroPulse P3, IRIDEX IQ810 Laser System, Mountain View, CA, USA), and High-Intensity Focused Ultrasound (HIFU). Specifically, this chapter discusses the protocols, indications, results, and complications of each featured procedure.

Ultrasound Circular Cyclo-Coagulation – Innovation in Glaucoma with High Intensity Focused Ultrasound

2011 ◽  
Vol 05 (02) ◽  
pp. 109 ◽  
Author(s):  
Sharon Cato ◽  
Florent Aptel ◽  
Philippe Denis ◽  
Gail ter Haar ◽  
Shlomo Melamed ◽  
...  
Keyword(s):  
High Intensity ◽  
Ciliary Body ◽  
Focused Ultrasound ◽  
Malignant Tumour ◽  
Pharmacological Therapy ◽  
Single Step ◽  
High Intensity Focused Ultrasound ◽  
Treatment Modalities ◽  
Treatment Area ◽  
Pilot Studies

Existing treatment modalities for glaucoma, including pharmacological therapy, lasers, surgery and shunts, are all associated with shortcomings. Ultrasonic coagulation of the ciliary body with pinpoint precision using high intensity focused ultrasound (HIFU) enables significant reduction of aqueous inflow and intraocular pressure (IOP). Energy is focused through non-optically transparent media with controlled energy absorption, reducing effects on adjacent tissues. Energy deposition and tissue heating at the focus site do not depend on tissue pigmentation, thus improving predictability. Currently, high-frequency miniaturised transducers create small focal zones for improved treatment area targeting, and ultrasound focusing provides enhanced control. The high operating frequency allows a sharp transition between the focal zone and the untreated area, reducing risks of heating adjacent healthy tissue. Such transducers are used extensively in malignant tumour treatments. Novel Ultrasound Circular Cyclo-Coagulation (UC3) with a miniaturised annular transducer uses HIFU technology. The circular geometry of the device allows precise, constant and reproducible positioning. Results from animal studies and from a clinical pilot study of patients with refractory glaucoma indicate that ultrasonic coagulation of the ciliary body using HIFU delivered by a circular miniaturised transducer is an effective and well-tolerated method of reducing IOP. The single-step procedure is short, easy to perform and accurate. Glaucoma impacts patients’ quality of life, including unpleasant treatment side effects and social and physical aspects. Gold-standard trabeculectomy shortcomings highlight the need for precise, focused surgical modalities. HIFU is a non-invasive, cost-effective innovation that, should the multicentre clinical trial demonstrate similar results to the preclinical and pilot studies, will be a useful addition to current glaucoma management techniques.

High-intensity focused ultrasound treatment in patients with refractory glaucoma

2016 ◽  
Vol 255 (3) ◽  
pp. 599-605 ◽  
Author(s):  
Giuseppe Giannaccare ◽  
A. Vagge ◽  
C. Gizzi ◽  
A. Bagnis ◽  
S. Sebastiani ◽  
...  
Keyword(s):  
High Intensity ◽  
Focused Ultrasound ◽  
High Intensity Focused Ultrasound ◽  
Ultrasound Treatment ◽  
Refractory Glaucoma
Sign in / Sign up

Export Citation Format

Share Document