Ultrasound treatment reduces IOP in patients with glaucoma
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The Ultrasound Cyclo Plasty procedure using high intensity focused ultrasound was effective, safe and well-tolerated for reducing IOP in patients with moderate glaucoma, according to a prospective interventional noncomparative study published in the Journal of Glaucoma.
“In our cohort all patients had immediate response to the treatment with long-term high surgical success rates lasting up to 2 years,” Ari Leshno, MD, of the Sam Rothberg Glaucoma Center at Goldschleger Eye Institute at Sheba Medical Center in Tel Hashomer, Israel, and the Sackler Faculty of Medicine at Tel Aviv University in Tel Aviv, Israel, and colleagues wrote.
Investigators included 15 patients (mean baseline IOP of 26 mm Hg) with moderate open angle glaucoma in this study between July 2016 and December 2016. They performed thorough ophthalmic examinations and took IOP measurements before the procedure and at 1 day, 1 week, 4 weeks, 3 months, 6 months, 1 year and 2 years after the procedure.
The primary outcome was defined as surgical success with an IOP reduction of 20% or 5 mm Hg or more.
Eleven patients from the original cohort (73%) completed the study period.
A positive response with an IOP reduction was found in all patients. The greatest IOP reduction was achieved during the first 7 days post-procedure (average IOP reduction was 46%). During the first 6 months, IOP increased and stabilized with a mean of 31% to 34% reduction from baseline (P < .05).
Thirteen patients from the original cohort (87%) achieved surgical success. Ten of the 11 patients who completed the study (91%) achieved surgical success at the last post-procedure follow-up. One patient achieved complete success with no hypotensive medications, and 12 achieved qualified success with hypotensive medications.
There were no significant complications during any of the procedures.
“Further larger prospective-control trials are needed to better determine which patients will benefit the most from this treatment and quantify more accurately its efficacy,” the researchers wrote. “Our results, which are consistent with previous reports, support the potential incorporation of this treatment modality in the future management of glaucoma patients.” – by Erin T. Welsh
Disclosures: This study was funded by Eyetechcare of Rillieux-la-Pape, France. The authors report no other relevant financial disclosures.
Perspective
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Carl H. Jacobsen, OD, FAAO
Glaucoma is controlled by lowering IOP. Topical medications, laser trabeculoplasty, filtering surgeries and cyclo-destructive procedures (for blind, painful eyes) have been our go-to treatments for many years. Of late, MIGS devices and procedures have shown promise. Also, gentler endoscopic and trans-scleral cyclo-destructive approaches have been developed for seeing eyes. All told, we have more treatments available than ever. Do we need another? Yes, we do. Is Ultrasound Cyclo Plasty (UCP) the next big thing? No, it is not, at least not yet.
Leshno and colleagues in their prospective, interventional, non-comparative study, found that UCP was a safe, effective and well-tolerated method of IOP reduction. However, this study included only 15 patients, was sponsored by the device manufacturer and did not include a control group. UCP was developed as a treatment for glaucoma in 1985. In 2011, the technique was improved and refined. Still, UCP has failed to enter the mainstream of glaucoma management. Until this intervention is proven via a multicenter clinical trial, it is hard to imagine UCP having much of an impact on glaucoma care.
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