Ultrasound Circular Cyclo-Coagulation – Innovation in Glaucoma with High Intensity Focused Ultrasound
when the condition is already symptomatic. The disease is explained to a greater or lesser extent and treated, but there can be issues with patient behaviour towards compliance, adherence to treatment and effectiveness, leading to further loss of vision. Issues that can affect patients’ compliance with their eye drop treatment include perceived benefits, tolerability of adverse side effects, comfort, ease of use and frequency of application. Depending on when the diagnosis was made, there may be a significant loss of vision within patients’ lifetime.38–47
Sometimes, because of the late stage of the
condition, there is a significant impact on quality of life both from the treatment and the condition, and a significant loss of vision within patients’ lifetime.38,42,48
The current UK treatment regimen recommends first-line treatment with prostaglandin analogue or prostamide eye drops for patients newly diagnosed with early or moderate chronic open-angle glaucoma. When this treatment is insufficient to stabilise the disease, further medication is added to the patients’ regimens. Once medical treatment
is no longer sufficient, laser treatment may be offered. Surgery with pharmacological augmentation is offered to patients with advanced glaucoma who are at risk of progressing to sight loss despite treatment.49 Medical treatments have disadvantages: poor tolerance due to adverse side effects, difficulty in instilling the eye drops and lack of compliance, which all impact on patients’ quality of life. Lasers and surgery are associated with risks and a significant fear factor, which again affect patients’ quality of life and, although these treatments are effective for a certain time, how long their effect is sustained is disputed. The greatest negative effect on quality of life is when patients lose their driving licences, sometimes long before there is a noticeable visual loss from their perspective.50–52
The ideal scenario for the management of glaucoma is when it is detected early, controlled without the use of eye drops or invasive techniques, and an effective, safe treatment is available in the long term. In that way, the loss of patients’ driving licence can be prevented and significant impact on quality of life avoided.38,42,50
n
Ultrasound Circular Cyclo-Coagulation – From Theory to Therapy A report on a presentation by Florent Aptel Edouard Herriot Hospital, Lyon
A study to develop a novel miniaturised device that allows safe, rapid and easy treatment of glaucoma using high intensity focused ultrasound (HIFU) cyclocoagulation was undertaken to create a one-step, accurate procedure allowing the whole circumference of the ciliary body to be treated. The strategy adopted, Ultrasound
Circular Cyclo-Coagulation (UC3), capitalises on the circular symmetry of the eyeball to treat the ciliary body.
The device did not exceed the dimensions of the eye and treatment conformed to the ciliary body. The circular geometry of the device
Figure 1: Variations in Mean Intraocular Pressure in Treated and Non-treated Eyes between Different Days Post-treatment and Day 0 of Treatment with Ultrasound Circular Cyclo-Coagulation
Group 1 Non-treated eye 5 2.5 0.9 0 -1.1 -5 -5.9 -10 -8.9 -9.7 -12.8 -15 -15.2 -16.6 -20 D1–D0 IOP = intraocular pressure. D7–D0 D15–D0 D21–D0 D28–D0 D1–D0 D7–D0 D15–D0 D21–D0 D28–D0 -0.2 -0.6 -2.0 -4.3 -0.8 -1.3 -3.8 -1.5 -3.8 -4.7 -6.2 -7.4 -1.4 -1.0 -2.0 -3.8 -4.5 -5.6 -7.9 -5.0 2.0 Treated eye Non-treated eye Group 2 Treated eye Non-treated eye Group 3 Treated eye
EUROPEAN OPHTHALMIC REVIEW
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Variation in mean IOP (mmHg)
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