High‐intensity focused ultrasound treatment for open angle glaucoma

Summary Many physical methods have been proposed to destroy the ciliary body, resulting in coagulation necrosis following heating (laser) or freezing (cryotherapy). These methods have two major drawbacks: they are nonselective for the target tissue and have an unpredictable dose–effect relationship. To overcome these drawbacks and take advantage of recent breakthroughs in the field of high‐intensity focused ultrasound (HIFU) technology, a new device was developed to achieve a selective coagulation of the ciliary body while sparing the adjacent structures. This device is a ring‐shaped probe with six miniaturized HIFU transducers. Experimental studies have shown a selective coagulation of the treated ciliary processes. Four clinical studies have been conducted. The first one was a pilot study designed to evaluate the safety in a small number of eyes with refractory and advanced glaucoma. The two other studies were multicenter studies designed to evaluate the efficacy and safety in eyes with open‐angle glaucoma and less advanced disease, but still refractory to filtering surgery. Since these studies have demonstrated a nice tolerability, a fourth study was conducted in patients with early glaucoma naïve of any previous filtering surgery.