Safety And Efficacy Of Ultrasound Cycloplasty (UCP) In Patients With Refractory Glaucoma

Objective Refractory glaucoma is a special type of glaucoma which the high intraocular pressure(IOP)can not be control by maximum dose medicines,laser and regular filtration surgery.Refractory glaucoma is very thorny to treatment.Up to now,glaucoma drainage device implantation,cyclocryotherapy,semiconductor diode laser transscleral photocoagulation and endoscopic cyclophotocoagulation are the usually clinic choose to treat refractory glaucoma.Anyway,both of these methods are either come with many complications or have very complex operation process.Ultrasound cycloplasty(UCP)by high-intensity focused ultrasound is a novel way rised in the past5 to 10 years to treatment refractory glaucoma and had widely used in Europe and India with good efficacy and safety.But UCP haven't apply commonly in China.This study try to evaluate the efficacy and safety of the UCP in reducing IOP in patients with refractory glaucoma,and explore preliminary whether there is different treatment respond to UCP between different type of refractory glaucoma.Methods This is a prospective study conducted in the First Affiliated Hospital of Anhui Medical University.Thirty-six patients(36 eyes)with refractory glaucoma(Neovascular glaucoma:24,Open angle glaucoma:2,Angle-closed glaucoma:2,Traumatic glaucoma:8)were collected.Complete ophthalmic examination including Visual acuity,Goldmann applanation tonometer,Ultrasound Biomicroscopy(UBM),white to white,optic axis,slit lamp examination and subjective pain scale(evaluate by Visual Analogue Score,VAS)were finished before operation.All the patients were underwent UCP operation successfully.Visual acuity,Goldmann applanation tonometer,slit lamp and subjective pain scale were performed at 1day,1week,1,2,3 and 6 months after the procedure.Primary outcomes were surgical success(defined as 5?IOP?21mm Hg,or reduction from baseline ?20% and >5mm Hg,according to the WGA)at the last follow-up visit.Secondary outcomes were mean IOP at each follow-up visit compared with baseline,complications and pain release.Results In all patients,IOP were significantly reduced(p < 0.05)from a mean pre-operative value of 53.61 ± 12.4mm Hg to 29.56 ± 15.8mm Hg at last follow-up visit(mean IOP reduction of 45%),success was achieves in 77.8% of eyes(28/36).The mean score of subjective pain scale change from 5.69 before operation to 0.86 at last follow-up visit(0 for comfortable to 10 for severe pain).In patients with neovascular glaucoma(NVG),IOP were significantly reduced(p<0.05)from a mean pre-operative value of 57.79±9.65 mm Hg to 33.92±15.88 mm Hg at last follow-up visit(mean IOP reduction of 41.30%),success was achieves in 75.00% of eyes(18/24).In patients with other types of refractory glaucoma,IOP were significantly reduced(p<0.05)from a mean pre-operative value of 45.33 ± 12.27 mm Hg to 21.08±9.78 mm Hg at last follow-up visit(mean IOP reduction of 53.50%),success was achieves in 83.33% of eyes(10/12).The different of decline rate between the two groups was statistically significant,but no statistically significant in the different of success rate between the two groups.Complications including intraoperative pain(6),hyphema(2),scleral marks(3),hypotony(2),conjunctival congestion(24)and subconjunctival hemorrhage(4).Conclusion UCP is an effective and safe method to reduce IOP in patients with refractory glaucoma,which provide a novel way when confront with refractory glaucoma,and it's seems like that UCP has less effective on patients with NVG compared with patients with other types of refractory glaucoma.