High-intensity focused ultrasound in the treatment of glaucoma: a narrative review

Introduction: Ultrasound Cyclo-Plasty (UCP) using High-Intensity Focused Ultrasound (HIFU) is a recently developed cyclodestructive procedure. It can be applied to the target area, avoiding any effect on surrounding tissues. This review aims to present the actual role of HIFU in the management of glaucoma patients. Areas covered: The PubMed database was consulted in November2020. The search terms used were: ‘high intensity focused ultrasound treatment,’ ‘cyclo-ablation’‘cyclo-destruction’‘cyclo-plasty.’ Relevant aspects about UCP are discussed in this review, particularly the probe development, the histological effects, and the mechanism of action. Furthermore, UCP indications are reported. Besides, technical limitations are evident, such as mild adverse events, severe adverse events, and long-termoutcomes, including reducing hypotensive medications, additional glaucoma surgery, and comparison with other cyclodestructive techniques. Finally, future perspectives about HIFU applications and improvements are reported. Expert opinion: Ultrasound Cyclo-Plasty(UCP) procedure is simple to perform and can be applied to almost all glaucoma types and eyes. It can be considered asafe and effective procedure. However, its mechanism of action is not entirely understood, resulting in different IOP lowering. Nevertheless, focalized and selective ciliary body coagulation with HIFU opened the possibility of anew therapeutic approach against glaucoma disease.