TREATMENT OF REFRACTORY GLAUCOMA WITH HIG H-INTENSITY FOCUSED ULTRASOUND

The efficacy of therapeutic ultrasound was retrospectively assessed in 456 patients who presented with uncontrolled glaucoma refractory to m aximal medical therapy and filtration surgery from April 1987 to Janua ry 1992. Treatment was performed under local anesthesia in ambulatory outpatients. Therapeutic ultrasound induced local destruction of the c iliary epithelium and a thickening of the sclera. A 47% decrease in in traocular pressure (IOP) was obtained from the mean preoperative (33.8 mmHg) and the mean postoperative (18.2 mm Hg) values. After a 33-mont h mean follow-up, 65% of treated eyes had an IOP less than or egal to 20 mmHg. Therapeutic ultrasound was effective in most of the glaucomas , especially in open angle, closed angle, aphakic, pseudophakic and po st-silicone oil glaucoma. The main complications were immediate ocular hypertension and corneoscleral alterations. Phtysis bulbi occurred in 5.7% of the eyes. The therapeutic interest of ultrasound were compare d with those of the other cyclodestruction techniques.