Name

Efficacité et de securité des ultrasons focalisés de haute intensité dans le traitement chirurgical des glaucomes agoniques

The purpose of this single-center retrospective real-life study was to assess the safety and the level of pressure reduction after the high-intensity focused ultrasound (HIFU) in patients with end-stage glaucoma.

32 eyes of 25 patients with end-stage glaucoma who underwent 35 HIFU procedures at the CHU Bordeaux in 2018 were included in the study. The procedure was performed by a single surgeon (CS) with the EyeOP1 device (EyeTechCare, Rillieux-la-Pape, France). The size of the probe was chosen according to the axial length and white-to-white measurements and manufacturer’s recommendations. Primary outcome was the qualified surgical success - defined as intraocular pressure reduction from baseline ⩾20% and intraocular pressure >5 mmHg without hypotensive medication adjunction or additional surgery. Secondary outcomes were the absence of postoperative complications including uveitis, macular edema, corneal decompensation, loss of best-corrected visual acuity and phthisis.

The preoperative IOP (mean ± SD) was measured at 26.27 ± 6.04 mmHg with a corneal pachymetry of 521.28 ± 42.52 μm. The mean postoperative IOP at 1 month was 16.03 ± 6.98 mmHg, at 2 months: 16.80 ± 4.83 mmHg, at 3-6 months: 20.00 ± 8.29 mmHg and at 12 months: 19.00 ± 7.84 mmHg. Qualified surgical success was achieved in 65.6% of eyes.

Three eyes required implantation of glaucoma drainage devices (Ahmed valve); 2 eyes required glaucoma filtration surgery (deep non-penetrating sclerectomy) and 3 eyes underwent a second HIFU procedure. 2 out of 3 of the repeated HIFU later achieved qualified surgical success.

Regarding postoperative complications, macular edema occurred in one eye, one eye presented granulomatous uveitis and one patient demonstrated hyphema that cleared spontaneously. During the follow-up, four patients lost lines of best corrected visual acuity (from hand movement to light perception).

No eyes presented with corneal decompensation, IOP of <5 mm Hg or phthisis.

The HIFU seems to be efficacious in patients with end-stage glaucoma. It offers a significant IOP reduction, most pronounced at 1 month after surgery, which lasts for over 12 months. The low complication rate, repeatability and good safety profile is important in the treatment of fragile eyes severely damaged by glaucoma.

The safety and efficacy of HIFU make it an option to be considered for treatment of end-stage glaucomatous eyes prone to complications of conventional surgery.