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Ultrasound ciliary plasty treatment in glaucoma secondary to Axenfeld-Rieger syndrome

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Session Details

Session Title: Presented Poster Session: Glaucoma

Venue: Poster Village: Pod 2

First Author: : S.Barros PORTUGAL

Co Author(s): :                  

Abstract Details

Purpose:

Axenfeld-Rieger syndrome(ARS) is associated with glaucoma in 50%of cases, whose majority will require surgery. Ultrasound ciliary plasty(UCP) is a recent non-invasive treatment for refractory open-angle glaucoma with good safety profile and IOP reduction from 26-36% at 12months. We evaluated the safety and efficacy of UCP in a patient with ARS.

Setting:

Department of Ophthalmology, Hospital Garcia de Orta

Methods:

Ultrasonic coagulation of the ciliary body is a brand new technique designed to deliver high intensity focused ultrasound (HIFU) to this structure, by a miniaturized annular second generation probe in order to perform the UCP. HIFU device (EyeOP 1– EYE TECH CARE – France) is a ring-shaped probe containing six piezoelectric elements, inserted in a positioning cone. Each of the six transducers is a segment of a 10.2mm radius cylinder with a 4,5mm width and a 7 mm length (surface area of about 35mm²). Relevant clinical data and complete ophthalmological evaluation with anterior segment photos were obtained. Literature was reviewed.

Results:

Women, 30years old, with the diagnosis of ARS and congenital glaucoma came to our department accompanied by her mother. She was currently on treatment with latanoprost 0,005% once daily, timolol 0,5% plus dorzolamide 2% twice daily, brimonidine 0,1% and acetazolamide 500mg twice daily. No history of previous glaucoma surgery. OS was her only eye (OD was eviscerated during childhood due to severe penetrating trauma). Consecutive observation for three months revealed best corrected visual acuity of 0,1 OS and IOP ranging from 26-31mmHG (Goldmann aplanation tonometry). Cup-to-disc ratio was 0,9. Consent was obtained to perform UCP under general anesthesia.

Conclusions:

Reduction of IOP in the range of 20% was achieved. No complications during surgery or side-effects during follow up were reported. UCP acts mainly through aqueous humour (AH) inflow reduction following thermic necrosis of ciliary epithelium but an increase of the suprachoroidal and transcleral AH outflow has also been hypothesized. Ultrasound Ciliary Plasty seemed to be a safe and effective method to reduce IOP in the short-term of this patient with ARS. The single step procedure is fast (less than 5 minutes) and easy to perform, without major concerns. Longer follow-up will clarify the need of additional interventions.

Financial Disclosure:

NONE

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