Value of ultrasound biomicroscopy for ciliodestructive procedures

Ciliodestructive procedures are commonly performed by the transscleral approach because ciliary processes are seldom visible. Thus the ablative energy is directed toward an "invisible" target whose position can only be estimated on the basis of experimental data. Ultrasound biomicroscopy has been recently introduced in ophthalmologic practice. This high-frequency ultrasound B-scan method gives real-time images of the subsurface structures of the anterior portion of the living eye at microscopic resolution. Ultrasound biomicroscopy perfectly visualizes the ciliary body and its surrounding structures and is a promising complementary tool for ciliodestructive procedures. The system has been used to image early and late ciliary body alterations after transscleral cyclophotocoagulation, to establish the position of the ciliary body to ensure correct laser probe placement, to locate ciliary body residuals for retreatment, and to rule out scleral damage after the procedure. An apparatus has been designed for simultaneous contact cyclophotocoagulation and ultrasound biomicroscopy analysis. A prospective randomized clinical trial is now needed to clarify the influence of ultrasound biomicroscopy on the success rate of ciliodestructive procedures.