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

Year: 2025

Type: article

Abstract: 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. 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 outcome was the surgical success rate at the 12-month, defined as an intraocular pressure (IOP) reduction of ≥ 20% from baseline and >5 mmHg without additional glaucoma surgery. Secondary outcomes included mean IOP, BCVA, and postoperative complications. 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 better baseline visual acuity (≤0.30 logMAR) achieved higher qualified success rates (80.0%) compared to those with poorer visual acuity. 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. 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. What is already known on this topic Previous studies on ultrasound cycloplasty (UCP) have focused on its efficacy in advanced glaucoma patients with poor vision. The long-term safety profile of UCP as a first surgical treatment in early-stage glaucoma patients with good visual acuity remains understudied. What this study adds This prospective study of 117 patients with both primary and secondary glaucoma subtypes and BCVA better than 1.30 logMAR demonstrates that UCP is an effective and safe first surgical treatment, achieving a 71.8% 1-year qualified success rate and 27.4% complete success (medication-free) rate without severe complications. No patients lost light perception during follow-up, and only 3 patients (2.6%) experienced visual acuity deterioration of more than 2 lines at 12 months. Survival analysis revealed that secondary glaucoma and eyes with poorer baseline vision had less stable IOP control over the 12-month period compared to primary glaucoma and eyes with better vision. How this study might affect research, practice or policy This study highlights UCP's potential as a promising, minimally invasive first surgical treatment for early to moderate glaucoma patients with functional vision across various subtypes. However, secondary glaucoma and eyes with poor vision may require closer follow-up due to lower expected success rates. The findings may encourage UCP's adoption as a primary surgical option, reducing medication burden and preserving visual function. Synopsis/Precis: This prospective study demonstrates the efficacy and safety of ultrasound cycloplasty as the first surgical treatment for various glaucoma subtypes in patients with functional vision, achieving a 75.2% 1-year qualified success rate and 27.4% complete success rate (medication-free) with stable visual acuity maintained in 114 of 117 patients (97.4%), no loss of light perception, and no severe complications.

Source: Advances in Ophthalmology Practice and Research

DOI: 10.1016/j.aopr.2025.10.001