Efficacy and safety of ultrasound cycloplasty as the first treatment in glaucoma for eyes with functional vision: A 1-year prospective study

Abstract

Objective

Ultrasound cycloplasty (UCP) is a non-invasive treatment traditionally used for advanced glaucoma. However, its potential as the first surgical option for moderate glaucoma with functional vision has not been thoroughly investigated. This study aimed to assess the effectiveness and safety of UCP as the initial surgery for glaucoma with residual visual function.

Methods

This prospective study included 117 glaucoma patients (63 males, 54 females; mean age 48.3 ​± ​17.2 years) with various glaucoma subtypes and best-corrected visual acuity (BCVA) better than 1.30 logMAR who underwent UCP as their first treatment. The primary outcomes were the surgical success rates at 12 months for both qualified and complete success. Qualified success was defined as a ≥20% reduction in intraocular pressure (IOP) from baseline, IOP between 6 and 21 mmHg, and no additional glaucoma surgery, achieved with or without anti-glaucoma medication. Complete success was defined by the same criteria, but achieved without any anti-glaucoma medications. Secondary outcomes included mean IOP, BCVA, and postoperative complications.

Results

The qualified success rate of UCP as the first treatment was 71.8% at 12 months, with a complete success rate (medication-free) of 27.4%. Subgroup analysis revealed that PACG had the highest qualified success rate (84.8%), followed by POAG (73.0%) and NVG (66.7%). Patients with ≤0.30 logMAR achieved the highest rate (80.0%), followed by those with 0.30-0.50 logMAR (75.0%), 0.50-1.00 logMAR (66.7%), and 1.00-1.30 logMAR (63.6%). The overall mean BCVA showed minimal change from 0.62 ​± ​0.42 logMAR at baseline to 0.63 ​± ​0.43 logMAR at 1 year. Patients experienced initial visual acuity decline in the early postoperative period, which gradually recovered after 1 week. Only 2.6% (3/117) of patients experienced a clinically significant visual decline of more than 2 lines at 12-month follow-up. No severe complications were observed.

Conclusions

UCP can be an effective and safe option as the first surgical treatment for glaucoma patients with visual function. UCP significantly reduces IOP over 12 months without causing significant visual acuity decline or severe complications.