Safety and efficacy of multiple cyclocoagulation of ciliary bodies by high-intensity focused ultrasound in patients with glaucoma

PURPOSE: To evaluate long-term efficacy and safety of repeated ultrasonic circular cyclocoagulation (UCCC) in patients with uncontrolled glaucoma. METHODS: Forty eyes of 40 patients affected by primary or secondary uncontrolled glaucoma under maximal tolerated medical therapy were enrolled in this prospective non-comparative case series study. A complete ophthalmic examination was performed before and after each month for 1 year. The UCCC treatment was repeated at 4 months if the intraocular pressure (IOP) was > 21 mmHg without major complications. Complete success was defined as a final IOP > 5 mmHg and ≤ 21 mmHg without hypotensive medication adjunction and no major or vision-threatening complications. RESULTS: The mean preoperative IOP was 32.5 ± 9.9 mmHg. Four months after the first UCCC treatment the overall IOP reduction was 27.8%. Twenty-two of the treated eyes did not achieve the complete success and a second treatment was performed in 20 of these eyes. Four months after the second UCCC procedure, the IOP reduction was 20.3% from preoperative values and 34.7% from baseline. Twelve of the retreated eyes needed a third treatment. Four months after the third UCCC treatment, the overall IOP reduction was 34% and 52.6% from baseline. No major complications occurred during or after any of the procedures. At 12 months, complete success was achieved in 85% (34/40) of treated eyes, with a maximum of three procedures and a significant medication reduction. CONCLUSIONS: Multiple UCCC treatments are safe, and additional treatments increase the overall procedure efficacy.