Efficacy and Safety of Ultrasound Cycloplasty for Refractory Glaucoma: A 3-Year Study

Precis: Ultrasound cycloplasty (UCP) treatment using high-intensity focused ultrasound is an effective and safe therapy to reduce intraocular pressure (IOP) in patients with refractory glaucoma over a 3-year period. Purpose: The purpose of this study was to evaluate the 3-year efficacy and safety of UCP in patients with refractory glaucoma. Patients and Methods: In all, 104 patients with refractory glaucoma recruited from 2 university hospitals underwent UCP. Examinations were performed 7 days, 1 week, 1, 3, 6, 12, 24, and 36 months after the UCP procedure. Primary outcomes were therapeutic success at 3 years (IOP reduction from baseline >= 20% and IOP >5 mm Hg without other surgical procedures) and vision-threatening complications. Secondary outcomes included mean IOP change from baseline at each follow-up visit, medication use, complications, and subsequent UCP and/or other postsurgical interventions. Results: At 3 years post-UCP, the therapeutic success rate was 55%. For 75% of the patients, results were obtained with only one procedure. For the overall study population, IOP was reduced significantly (P<0.005) from 27.6 +/- 8.9 mm Hg (n=3.0 topical hypotensive medication) to 17.0 +/- 6.8 mm Hg at 36 months (n=2.8 topical hypotensive medication) (33% reduction). For the success patients, the IOP was initially 29.3 +/- 8.8 mm Hg (n=3.0 topical hypotensive medication) and 15.6 +/- 4.3 mm Hg at 36 months (n=2.8 topical hypotensive medication) (43% reduction). The rate of complications was low and there were no cases of phthisis. Conclusion: The UCP procedure was efficacious with few complications and should be considered as an alternative to other IOP-lowering therapies including laser cyclocoagulation in patients with refractory glaucoma.