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Uveo-scleral outflow pathways after ultrasonic cyclocoagulation in refractory glaucoma: an anterior segment optical coherence tomography and in vivo confocal study
  1. Rodolfo Mastropasqua1,
  2. Luca Agnifili2,
  3. Vincenzo Fasanella2,
  4. Lisa Toto2,
  5. Lorenza Brescia2,
  6. Silvio Di Staso3,
  7. Emanuele Doronzo2,
  8. Giorgio Marchini1
  1. 1Ophthalmology Unit, Department of Neurological, Neuropsychological, Morphological and Movement Sciences, University of Verona, Verona, Italy
  2. 2Department of Medicine and Ageing Science, Ophthalmology Clinic, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
  3. 3Department of Surgical Science, Ophthalmic Clinic, University of L'Aquila, L'Aquila, Italy
  1. Correspondence to Dr Luca Agnifili, Ophthalmology Clinic, Via dei Vestini snc, Chieti 66100, Italy; l.agnifili{at}


Aims To evaluate, using anterior segment optical coherence tomography (AS-OCT) and in vivo confocal microscopy (IVCM), the uveo-scleral aqueous humour (AH) outflow pathways after ultrasonic circular cyclocoagulation (UCCC).

Methods Forty-four patients with refractory glaucoma underwent 4 or 6 s UCCC (group 1, 24 eyes; group 2, 20 eyes). UCCC was successful when the preoperative intraocular pressure (IOP) reduced by one-third. AS-OCT and IVCM were performed at baseline and at month 1 to evaluate the sclera and conjunctiva. The main outcomes were mean intra-scleral hyporeflective spaces area (MIHSA: mm2) at AS-OCT, mean density and area of conjunctival microcysts (MMD: cysts/mm2; MMA: µm2) at IVCM. The relations between MIHSA, MMA and MMD with IOP were analysed.

Results Mean baseline IOP was 26.9±2.8 mm Hg in group 1 and 27.5±4.0 in group 2. Intra-scleral hyporeflective spaces and microcysts were observed in both groups, without significant differences in MIHSA, MMA and MMD. At month 1, UCCC was successful in 63.6% of patients (41.6% in group 1, 80% in group 2), and IOP reduced to 18.8±3.2 (30.1%) and 17.1±2.7 mm Hg (38.7%), respectively (p<0.001). MIHSA showed a twofold and threefold increase in group 1 and 2 (p<0.05), with a significant difference between groups (p<0.05). MMA and MMD increased in both groups (p<0.05), with values higher in group 2 (p<0.05). Significant relations were found between MIHSA and IOP in both groups (p<0.01).

Conclusions UCCC induced anatomical modifications of sclera and conjunctiva, which suggested that the trans-scleral AH outflow enhancement is one of the possible mechanisms exploited by ultrasounds to reduce IOP.

  • Aqueous humour
  • Conjunctiva
  • Glaucoma
  • Sclera and Episclera
  • Treatment Surgery

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  • RM and LA contributed equally to this work and share primary authorship.

  • Contributors RM: writing the article; critical revision of the article. LA: conception and design; writing the article; critical revision of the article. VF: provision of patients; performing examinations; statistical contribution. LT: writing the article; performing examinations. LB: provision of patients; performing examinations; data collection. SDS: literature research; data collection. ED: literature research; critical revision of the article. GM: critical revision and final approval of the article.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval Institutional Review Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The present study contributed to clarifying the mechanism of action of ultrasonic cyclocoagulation in patients with refractory glaucoma. Particularly, we documented a scleral architecture rearrangement, which enhances trans-scleral aqueous humour drainage.

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