A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine. / We present the safety and efficacy of a novel transscleral sutured posterior chamber intraocular lens (TSSPCIOL) implantation approach utilizing 25 gauge vitrectomy and a foldable posterior chamber intraocular lens implant (AKREOS AO60, Bausch & Lomb). 80 consecutive eyes that underwent single surgeon TSSPCIOL implantation between October 2008 and July 2012 at a referral‐based retina institution were analyzed for best spectacle‐corrected visual acuity (BCVA) and safety indicators. Postoperative complications included retinal detachment in 2 eyes (2.5%), Irvine‐Gass cystoid macular edema in 3 eyes (3.75%), with 2 of those cases occurring late, persistent postoperative corneal edema in 1 eye (1.25%), hyphema in 2 eyes (2.5%) and 1 case of postoperative vitreous hemorrhage with spontaneous clearing. The modified external approach with AKREOS® TSSPCIOL placement with 25 gauge vitrectomy has relatively few complications, improves visual acuity in patients requiring TSSPCIOL, and offers several advantages over traditional anterior chamber or conventional scleral sutured techniques.

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Les ultrasons (US) thérapeutiques sont devenus un sujet d'intérêt croissant en ophtalmologie. Les ultrasons focalisés de haute intensité (HIFU) pour le traitement du glaucome et pour la délivrance de médicaments dans l'oeil sont les deux principaux domaines de recherche dans ce domaine. Cette thèse traite des deux sujets en deux parties distinctes : l'administration de médicaments ou drug delivery par d'ultrasons (USDD) à travers la sclère et la caractérisation par rayonnement infrarouge (IR) d'un dispositif HIFU ophtalmique pour le traitement du glaucome. Bien que plus perméable que la cornée, l'administration de médicaments efficace à travers la sclère reste un réel challenge. Dans ce travail, nous avons évalué l'effet d'une propagation d'us en mode pulsé sur l'administration de médicaments à travers la sclère. Parmi les mécanismes sous-jacents, la cavitation semble être un contributeur à une USDD renforcée. L'activité maximale de cavitation sous-jacente à une émission d'ultrasons en mode pulsé peut donc être une méthodologie viable pour l'amélioration de l'administration de médicaments à travers l'oeil. Dans la deuxième partie de la thèse, une nouvelle méthode de caractérisation ultrasonore de terrain a été développée pour un dispositif HIFU multi-éléments. Ce dispositif médical développé par Eyetechcare est destiné au traitement du glaucome réfractaire (Rillieux -la-pape, France). Une alternative basée sur la thermographie par infra-rouge a été développée pour une évaluation rapide et qualitative de la distribution d'intensité émise spécifiquement par ce dispositif à haute fréquence (19-21 mhz) constitué de multiéléments à focalisation en ligne. Cette méthodologie permettra de caractériser les sondes de thérapie à l'échelle industrielle / Therapeutic ultrasound has become a topic of growing interest in ophthalmology. High intensity focused ultrasound (HIFU) for the treatment of glaucoma and ultrasound (US) drug delivery are the two main areas of research in this field. This work addresses these domains in two separate parts: transscleral ultrasound drug delivery (USDD), and infrared (IR) field characterization of an ophthalmic HIFU device for glaucoma treatment. The sclera is a promising pathway for ocular drug delivery, since transscleral administration can address both the anterior and posterior segments of the eye. Due to the low permeability however, efficient drug delivery is challenging. In this study, HIFU was investigated as a potential modality for an enhanced transscleral drug delivery (in vitro). Among US effects, cavitation was shown to be the major contributor to an enhanced USDD. A pulsed US protocol designed to maximum cavitation activity may therefore be a viable method for enhancing ocular drug delivery. In the second part, a new method of ultrasonic field characterization was developed for a multi-element HIFU device. This system is designed and produced for glaucoma treatment by Eyetechcare Company (Rillieux-la-Pape, France). The traditional hydrophone method for field characterization was prohibitively slow on an industrial scale. An alternative modality for rapid qualitative assessment of the intensity distribution based on infra-red (IR) thermography was developed specific to this high frequency (19-21 MHz) device with line-focus US radiators. The second part of the study was aimed to expand the application of a R&D technique for ultrasonic field characterization to an industrial scale

Therapeutic ultrasound has become a topic of growing interest in ophthalmology. High intensity focused ultrasound (HIFU) for the treatment of glaucoma and ultrasound (US) drug delivery are the two main areas of research in this field. This work addresses these domains in two separate parts: transscleral ultrasound drug delivery (USDD), and infrared (IR) field characterization of an ophthalmic HIFU device for glaucoma treatment. The sclera is a promising pathway for ocular drug delivery, since transscleral administration can address both the anterior and posterior segments of the eye. Due to the low permeability however, efficient drug delivery is challenging. In this study, HIFU was investigated as a potential modality for an enhanced transscleral drug delivery (in vitro). Among US effects, cavitation was shown to be the major contributor to an enhanced USDD. A pulsed US protocol designed to maximum cavitation activity may therefore be a viable method for enhancing ocular drug delivery. In the second part, a new method of ultrasonic field characterization was developed for a multi-element HIFU device. This system is designed and produced for glaucoma treatment by Eyetechcare Company (Rillieux-la-Pape, France). The traditional hydrophone method for field characterization was prohibitively slow on an industrial scale. An alternative modality for rapid qualitative assessment of the intensity distribution based on infra-red (IR) thermography was developed specific to this high frequency (19-21 MHz) device with line-focus US radiators. The second part of the study was aimed to expand the application of a R&D technique for ultrasonic field characterization to an industrial scale