[Treatment of refractory glaucoma with high density focused ultrasonics]

The efficacy of therapeutic ultrasound was retrospectively assessed in 456 patients who presented with uncontrolled glaucoma refractory to maximal medical therapy and filtration surgery from April 1987 to January 1992. Treatment was performed under local anaesthesia in ambulatory outpatients. Therapeutic ultrasound induced local destruction of the ciliary epithelium and a thickening of the sclera. A 47% decrease in intraocular pressure (IOP) was obtained from the mean preoperative (33.8 mmHg) and the mean postoperative (18.2 mm Hg) values. After a 33-month 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 post-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 compared with those of the other cyclodestruction techniques.