High-Intensity Focused Ultrasound Circular Cyclocoagulation in Glaucoma: A Step Forward for Cyclodestruction?

The ciliary body ablation is still considered as a last resort treatment to reduce the intraocular pressure (iop) in uncontrolled glaucoma. several ablation techniques have been proposed over the years,all presenting a high rate of complications,nonselectivity for the target organ,and unpredictable dose-effect relationship. these drawbacks limited the application of cyclodestructive procedures almost exclusively to refractory glaucoma. high-intensity focused ultrasound (hifu),proposed in the early 1980s and later abandoned because of the complexity and side effects of the procedure,was recently reconsidered in a new approach to destroy the ciliary body. ultrasound circular cyclocoagulation (uc3),by using miniaturized transducers embedded in a dedicated circular-shaped device,permits to selectively treat the ciliary body in a one-step,computer-assisted,and non-operator-dependent procedure. uc3 shows a high level of safety along with a predictable and sustained iop reduction in patients with refractory glaucoma. because of this,the indication of uc3 was recently extended also to naïve-to-surgery patients,thus reconsidering the role and timing of ciliary body ablation in the surgical management of glaucoma. this article provides a review of the most used cycloablative techniques with particular attention to uc3,summarizing the current knowledge about this procedure and future possible developments. © 2017 rodolfo mastropasqua et al.