Using Ultrasound Biomicroscopy Research Articles

The Imaging Characteristics of Lens Subluxation on the Ultrasound Biomicroscopy.

Background To evaluate the imaging characteristics of the lens subluxation with the use of ultrasound biomicroscopy. Methods From October 2018 to September 2019, 55 eyes diagnosed with lens subluxation were enrolled in the group. All patients underwent detailed eye examination and panoramic ultrasound biomicroscopy. Results The most common sites of lens suspensory ligament injury were superior temporal side (32.73%) and superior nasal side (23.63%). The most common range of subluxation in all patients was 30°. Comparing the measurement indicators of all patients, ciliary body thickness (CBT) in affected eyes was smaller than that in healthy eyes (0.79 ± 0.21, 1.04 ± 0.16), the distance between ciliary process and crystal equator increased (1.91 ± 0.70, 1.17 ± 0.32), and iris-ciliary processes distance (ICPD) increased (1.04 ± 0.51, 0.80 ± 0.17) (P < 0.05). The range of subluxation in patients with lens subluxation was positively correlated with the distance between ciliary processes and the crystal equator. Conclusions The ultrasound biological microscope has a good application significance in the diagnosis of lens subluxation. From this study, we suggest that the three indexes of CBT, ICPD, and the distance between the ciliary process and crystal equator are of high reference value in ultrasound biomicroscopy among patients with lens subluxation.

Evaluation of Lacrimal Sac Diameter in Different Age groups Using Ultrasound Biomicroscopy

Background: Chronic dacryocystitis is the most frequent disorder in the lacrimal drainage system. The disease has been considered to be strongly associated with obstruction of the lacrimal duct, which creates a fertile environment for bacterial colonization and promotes lacrimal sac inflammation. Objective: The aim of this work was to evaluate lacrimal sac diameter in different age groups using ultrasound biomicroscopy (UBM). Patients and Methods: Twenty-four eyes of 24 normal individuals. They were divided according to age into 3 groups; group A: age ranging between 30 and 40 years, group B: age ranging between 40 and 50 years and group C: age above 50 years. Lacrimal sac diameter was assessed. Ocular examination and special tests were done for lacrimal drainage system (regurge test and fluorescein dye disappearance test) with imaging of lacrimal passages by ultrasound biomicroscopy. Results: All patients had no symptoms of epiphora, negative both regurge test and dye disappearance test and clear contents of the lacrimal sac. There was no statistically significant difference between groups regarding either longitudinal or horizontal lacrimal sac diameter. Conclusion: UBM can be used for imaging and measuring lacrimal passages and thus can be useful as an adjunctive to clinical examination and surgical planning in cases with lacrimal system diseases.

Repeatability and Reliability of Quantified Ultrasound Biomicroscopy Image Analysis of the Ciliary Body at the Pars Plicata

Most of the ciliary body and ciliary processes of the eye cannot be directly visualized in vivo because of the posterior location of the pars plicata to the posterior chamber and iris. However, ciliary anatomy can be effectively imaged using ultrasound biomicroscopy (UBM) by placing the probe close to the limbus, perpendicular to this structure. Previous studies measuring ciliary body parameters in meridian UBM images found that these parameters were measured with poor reliability and repeatability. This study evaluates the intra-observer reliability and inter-observer agreement of a standardized protocol for measuring six ciliary parameters in transverse or quadrant UBM images that capture an entire row of ciliary processes. All six ciliary parameters have high intra-observer reliability, with ciliary body thickness, ciliary process length and ciliary process density measurements being the most consistent for each observer. The coefficient of variation for each observer ranged from 1.4%–15%. Inter-observer agreement was also high for all six parameters, with an intra-class correlation coefficient >0.8. Utilizing transverse UBM images of the pars plicata allows for consistent quantitative analysis in control subjects.

Ultrasound biomicroscopy of sclerotomy sites after conventional and sutureless (23, 25 G) pars plana vitrectomy

Purpose To evaluate postoperative outcomes of transconjunctival sutureless pars plana vitrectomy (PPV), using ultrasound biomicroscopy (UBM), conventional PPV, and transconjunctival sutureless vitrectomy (TSV) sclerotomy sites were compared using UBM. Patients and methods A total of 30 patients underwent complete ophthalmological examination. Conventional PPV was performed following the same surgical techniques, and all TSV procedures were performed by one surgeon. The 20-, 23-, and 25-G vitrectomy systems were used, with 10 patients in each gauge. UBM examination was performed after 1–30 days following surgery to locate and document the sclerotomy sites. Results The 20, 23, and 25 G sclerotomies showed no statistical difference in site diameter at UBM. All patients had at least two diameters of the incision measured, and all wounds were constructed obliquely. The mean size of 20 G sclerotomy was 375.40±83.70 µm (range, 280.4–695 µm) and coefficient of variation was 0.21. The mean size of 23 and 25 G sclerotomy was 315.5±56.8 µm (range, 253.2–362.5 µm; coefficient of variation=0.26; P&lt;0.556). Conclusion Postoperative UBM examination allowed the evaluation of the wound architecture and showed no statistical difference between conventional 20 G and TSV 23, 25 G sclerotomies.

Bilateral multiple iridociliary cysts causing secondary pigment dispersion.

Primary epithelial iris cysts are benign innocuous lesions, which are mostly bilateral and asymptomatic in nature. They can lead to creeping angle closure, when the angle progressively narrows due to age-associated changes. This photoessay, herewith, signifies the dual importance of identifying minute bumpy elevations in the iris by a thorough slit lamp examination as well as the use of ultrasound biomicroscopy in patients presenting with creeping angle closure, frequently misdiagnosed in the primary angle closure disease spectrum.

Analysis of bleb morphology after CLASS with ultrasound biomicroscopy and clinical grading scale.

Filtration in the area subjected to CO2 laser-assisted sclerectomy surgery (CLASS) is described using ultrasound biomicroscopy (UBM) and the clinical grading scale to evaluate the mechanism of intraocular pressure (IOP) reduction. Twenty-eight patients with open-angle glaucoma underwent CLASS. The Indiana Bleb Appearance Grading Scale evaluation was performed 1 month after surgery to determine bleb height, extent, vascularity, and leakage. UBM was used to describe and measure the surgical area. Bleb morphology, the size of the scleral lake, scleral route, and trabeculodescemetic membrane (TDM) thickness were examined. One month after CLASS, IOP significantly decreased from 20.46 ± 3.92 mmHg to 12.71 ± 2.99 mmHg, and the anterior chamber depth significantly more shallow, from 2.75 ± 0.36 mm to 2.61 ± 0.33 mm(p < 0.05). Shallow uplift occurred in 71.43% of the blebs, and 64.29% of the blebs were within 1 to 2 h; 82.15% showed mild or moderate vascular hyperemia, and the Seidel test was negative. UBM showed that all eyes had an intact TDM, with a mean thickness of 99.3 ± 22.2 μm; 21 eyes (75%) had L-type (low reflective). The scleral lake anteroposterior length, height, and transversal length were 2.247 ± 1.831 mm, 0.520 ± 0.234 mm, and 3.312 ± 0.423 mm, respectively. The TDM thickness and postoperative IOP were positively correlated, and the size of the scleral lake was not correlated with IOP reduction. Four eyes (14.29%) exhibited cyclodialysis. UBM examination indicated the aqueous humor drainage route. In the early stage after CLASS, subconjunctival and choroidal drainage routes might be the major mechanism underlying IOP reduction. Mild and moderate congestion of bleb blood vessels warrant attention to avoid early bleb scarring.

Surgical site characteristics after CLASS followed by ultrasound biomicroscopy and clinical grading scale: a 2-year follow-up.

This study describes the imaging of the filtering area in CO2 laser-assisted sclerectomy surgery (CLASS) using ultrasound biomicroscopy (UBM) combined with the Indiana Bleb Appearance Grading Scale (IBAGS) and evaluates the mechanism by which CLASS lowers the intraocular pressure (IOP). Twenty-eight cases (28 eyes) of primary open-angle glaucoma that could not be controlled by drugs underwent CLASS. At 1, 3, 6, 12, 18, and 24 months after surgery, IBAGS was used to evaluate the external morphology of the filtering blebs, and UBM was used to describe and measure their internal structure. During the early period after CLASS, most cases showed diffuse filtering blebs with a serious degree of congestion. At the end of follow-up, most cases did not present filtering blebs. All patients showed an intact and thin trabeculodescemetic membrane (TDM) with an average thickness of 0.094 ± 0.017 mm. The scleral reservoir size gradually decreased over time and tended to stabilize after 18 months. At 3 and 6 months after surgery, 53.57% of the patients had abnormalities in the TDM area, and after laser goniopuncture treatment, the scleral reservoir became slightly larger and the IOP decreased. The TDM thickness was not correlated with postoperative IOP, and the scleral reservoir size was negatively correlated with IOP. During the early phase after CLASS, the subconjunctival and suprachoroidal pathways may be the main mechanisms lowering IOP; over time, internal drainage pathways such as the intrascleral, trabecular-meshwork, and suprachoroidal pathways play greater roles in lowering IOP.

Does anisometropia affect the ciliary muscle thickness? An ultrasound biomicroscopy study.

To compare the ciliary muscle thickness (CMT) of the normal fellow eye to that of the amblyopic eye using ultrasound biomicroscopy (UBM) in patients with unilateral anisometropic amblyopia. Thirty patients with unilateral anisometropic amblyopia were involved. The patients were divided into two groups: 19 hyperopic and 11 myopic. Axial length (AL) was measured with optic biometry and anterior chamber depth (ACD), iris area, and CMT were measured with UBM. The mean age was 34.10 ± 6.61years. The mean spherical difference between two eyes was 2.59 diopter (D) in hyperopic patients and 3.77D in myopic patients. In the hyperopic patients, nasal CMT1(nCMT), temporal CMT1(tCMT), tCMT2, and tCMT3 values were statistically thinner in amblyopic eyes than healthy eyes (p = 0.036, p = 0.003, p = 0.023, p = 0.005, respectively). ACD values were statistically lower in amblyopic eyes (2.78 ± 0.26mm) than healthy eyes (2.90 ± 0.21mm) (p < 0.001). In the myopic patients, nCMT1, nCMT2, nCMT3, tCMT1, tCMT2, and tCMT3 values were statistically thicker in amblyopic eyes than healthy eyes (p = 0.003, p = 0.003, p = 0.005, p = 0.003, p = 0.003, p = 0.019, respectively). ACD values were statistically higher in amblyopic eyes (3.20 ± 0.30mm) than healthy eyes (3.06 ± 0.29mm) (p = 0.004). Also, there was no significant difference in the iris area between the amblyopic and normal eyes of the myopic and hyperopic patients (p > 0.05). Amblyopic eyes in patients with unilateral myopic anisometropia have thicker CMT and deeper ACD than healthy eyes. Conversely, amblyopic eyes in patients with unilateral hyperopic anisometropia have thinner CMT and shorter ACD than healthy eyes. There is a positive correlation between AL and CMT.

Real-time intraoperative ultrasound biomicroscopy for determining graft orientation during Descemet's membrane endothelial keratoplasty.

To evaluate the intraoperative use of ultrasound biomicroscopy (UBM) during Descemet's membrane endothelial keratoplasty (DMEK) to determine graft's orientation. Prospective interventional study of eight eyes of seven patients who underwent DMEK. Following the identification of correct graft orientation using 'Blue cannula tip' sign during DMEK surgery, UBM was used to ascertain graft's orientation. The rate of successful DMEK graft orientation determined by the UBM was registered and verified postoperatively by anterior segment-optical coherence tomography (OCT). Intra- and postoperative complications, postoperative clearance of the cornea, corrected distance visual acuity and endothelial cell loss were also noted. The study included five males and two females aged 54-82years with corneal oedema due to Pseudophakic bullous keratopathy (n=5), Fuchs' endothelial dystrophy (n=2). In all cases, the technique allowed proper determination of the graft's orientation. In one case, 'blue cannula tip' sign showed correct orientation while UBM identified an upside-down graft. The graft was inverted in the anterior chamber using fluid jets, and repeat 'blue cannula tip' sign and UBM examination both showed correct orientation. In all cases, postoperative anterior segment-OCT demonstrated correct graft orientation. Use of intraoperative UBM to determine graft orientation during DMEK correlated with proper graft orientation, as was verified postoperatively by anterior segment-OCT. The use of UBM can be particularly helpful in cases of poor graft visibility due to opaque corneal stroma, pigment or blood in the anterior chamber during surgery, or when the blue tint of the graft fades rapidly, which may preclude proper determination of graft's orientation.

A Simple Modified Way of Glueless, Sutureless Scleral Fixation of an IOL: A Retrospective Case Series

To evaluate the outcome and viability of a modified self-sealing scleral pocket technique for scleral fixation of an intraocular lens (IOL). Retrospective interventional case series. A retrospective, interventional case series in which 81 eyes underwent this modified technique, performed in the previous 4 years. Cases included a dislocated IOL and an absent posterior capsule or subluxated cataract. Two diagonally opposed paralimbal, curved self-sealing scleral pockets were made 3mm away from the limbus along with a vitrectomy. A multipiece IOL was used, and the haptics were fixed under the scleral pockets inside a linear scleral tunnel underneath the superficial scleral flap. The conjunctiva was opposed by using cautery. Postoperatively, anterior segment optical coherence tomography (AS-OCT) was performed in order to detect intrascleral hyper-reflective cross-section of the haptics and optic tilt. The optic position was re-evaluated using ultrasound biomicroscopy (UBM). Main outcomes were mean pre- and postoperative best corrected visual acuity (BCVA), postoperative astigmatism. Postoperative AS-OCT was performed to detect the position of the haptics and optics. UBM was done to recheck any optic tilt. Mean pre- and postoperative BCVA were LogMAR 1.2 ± 0.59 and LogMAR 0.47 ± 0.3 (P < 0.001). Mean postoperative astigmatism was 1.27 ± 1.02 Dcyl. In AS-OCT, an intrascleral hyper-reflective shadow signified stable haptics without any optic tilt. UBM also showed a stable position of the IOL optic without any tilt. This modified, simple way of scleral fixation of an IOL decreases the duration of surgery with minimal complication.

Validation of ultrasound biomicroscopy for the assessment of xenogeneic testis tissue grafts and cell implants in recipient mice.

Subcutaneous grafting/implantation of neonatal testis tissue/cells from diverse donor species into recipient mice can be used as an in vivo model to study testis development, spermatogenesis, and steroidogenesis. Ultrasound biomicroscopy (UBM) allows obtaining high definition cross-sectional images of tissues at microscopic resolutions. The present study was designed to (a) validate the use of UBM for non-invasive monitoring of grafts/implants overtime and to (b) correlate UBM findings with the morphological attributes of recovered grafts/implants. Testis tissue fragments (~14mm3 , each) and cell aggregates (100×106 cells, each) obtained from 1-week-old donor piglets (n=30) were grafted/implanted under the back skin of immunodeficient mice (n=6) in eight analogous sites per mouse. Three-dimensional transcutaneous Doppler UBM was performed, and a randomly selected graft and its corresponding implant were recovered at 2, 4, 6, and 8weeks. Graft/implant weight (P=.04) and physical height (P=.03) increased overtime. The dynamics of physical length and volume increases over time differed between tissue grafts and cell implants (P=.02 and 0.01 for sample type*time interactions, respectively). UBM-estimated volume was correlated with the post-recovery weight and volume of the grafts/implants (r=0.98 and r=0.99, respectively; P<.001). Pre- and post-recovery length and height of the grafts/implants were positively and strongly correlated (r=0.50, P=.01; r=0.70, P=.001) and so were the areas covered by cordal, non-cordal, or fluid-filled cavities between UBM and histology (r=0.87, P<.001). UBM findings correlated with physical attributes of the grafts/implants, validating its use as a non-invasive high-fidelity tool to quantify the developmental changes in ectopic testis tissue grafts and cell implants, potentially leading to a reduction in the number of recipient mice needed for similar experiments.

Evaluation of functional outcome and stability of sutureless scleral tunnel fixated IOLs in children with ectopia lentis.

To evaluate functional outcome of sutureless scleral tunnel intraocular lens (SSTIOL) in children with crystalline lens subluxation of more than 7 clock hours. A prospective interventional study was conducted consisting of 45 eyes of 44 children in age group 6-18y having >7 clock hours of lens subluxation who underwent lensectomy-vitrectomy followed by SSTIOL implantation. Primary outcome was improvement in best corrected visual acuity (BCVA) and secondary outcomes were assessment of intraocular lens (IOL) tilt using ultrasound biomicroscopy (UBM), mean change in astigmatism at last follow-up of 1y and associated complications. The mean preoperative and postoperative BCVA was 1.05±0.28 and 0.64±0.45 (logMAR) respectively (P=0.001) at last follow-up. The mean astigmatism preoperatively and postoperatively was -4.17±2.69 D and -1.86±1.25 D respectively (P=0.011). Significant IOL tilt (>5 degrees) was present in 5 cases. The mean percentage endothelial loss was 3.65%±1.92%. The most serious complication encountered was retinal detachment seen in 2 cases. SSTIOL implantation provides efficient visual rehabilitation in children provided there is stringent case selection. We recommend caution in children having white-to-white distance >12 mm and presence of peripheral retinal degenerations.

Regeneration of testis tissue after ectopic implantation of porcine testis cell aggregates in mice: improved consistency of outcomes and in situ monitoring.

Ectopic implantation of donor testis cell aggregates in recipient mice results in de novo formation or regeneration of testis tissue and, as such, provides a unique invivo model for the study of testis development. However, currently the results are inconsistent and the efficiency of the model remains low. This study was designed to: (1) examine several factors that can potentially improve the consistency and efficiency of this model and (2) explore the use of ultrasound biomicroscopy (UBM) for the non-invasive invivo evaluation of implants. Testis cell aggregates, containing ~40% gonocytes, from 1-week-old donor piglets were implanted under the back skin of immunodeficient mice through skin incisions using gel matrices or through subcutaneous injection without using gel matrices. The addition of gel matrices led to inconsistent tissue development; gelatin had the greatest development, followed by collagen, whereas agarose resulted in poor development. The results also depended on the implanted cell numbers since implants with 100×106 cells were larger than those with 50×106 cells. The injection approach for cell implantation was less invasive and resulted in more consistent and efficient testis tissue development. UBM provided promising results as a means of non-invasive monitoring of implants.

Diagnosis of Peripheral Retinoschisis Using Ultrasound Biomicroscopy.

Retinal imaging can help differentiate retinoschisis (RS) from retinal detachment (RD). This study describes new sonographic features of RS using ultrasound biomicroscopy (UBM) and evaluates their diagnostic value. Medical records of subjects diagnosed with RS and RD who underwent imaging prior to intervention were reviewed. Images were evaluated for detachment shape ultrasound (US) B-mode, as well as presence of intraretinal pillars, retinal layers split, and intraretinal cysts on UBM. Of 48 eyes from 48 patients in the study, 25 were diagnosed as RS and 23 as RD. "Retinal layers split" was the most common UBM finding in the RS group (72%), followed by intraretinal pillars (64%) and intraretinal cysts (36%). No RD case exhibited these findings (P < .001). UBM might assist in difficult cases to differentiate between RS and RD by detection of the unique sonographic features of RS described herein. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:e196-e202.].

Observational study of intraocular lens tilt in sutureless intrascleral fixation versus standard transscleral suture fixation determined by ultrasound biomicroscopy

BackgroundThe position of the intraocular lens (IOL) is a major factor that affects the final visual acuity after cataract surgery. However, no prospective study has compared the IOL positions associated with the sutureless intrascleral technique and the standard transscleral suturing technique. The current study compared the IOL positions in the two techniques using ultrasound biomicroscopy (UBM) in vivo.MethodsTwenty-one eyes of 21 patients were included in this observational study conducted between February and May 2015. Eleven patients underwent the sutureless intrascleral technique, and 10 patients underwent transscleral fixation with suturing. Ophthalmologic examination and UBM were performed in all patients. Optic tilt was measured in relation to the iris plane. The haptic location was defined. Mann–Whitney test and multiple linear regression were used to analyze the vertical and horizontal gradients. Significant differences were considered when p ≤ 0.05.ResultsThe most common indication for scleral fixation was a complication during phacoemulsification (81.81% in the sutureless group and 60% in the suture group). The mean vertical and horizontal tilts were, respectively, 0.24 ± 0.21 and 0.25 ± 0.19 mm in the sutureless group and 0.14 ± 0.17 and 0.23 ± 0.16 mm in the suture group. No significant differences were seen in the vertical tilt and horizontal tilt (p = 0.888 and p = 0.148, respectively) between the groups. Gender (p = 0.835), age (p = 0.888), follow-up time (p = 0.915), and surgical duration (p = 0.094) were not associated with optic tilt. Of the 22 haptics in the sutureless group, 21 (95.45%) were in the intrascleral tunnel; of the 20 haptics in the suture group, 13 (65%) were posterior to the ciliary body, four (20%) anterior to the ciliary body, and three (15%) in the ciliary sulcus.ConclusionThis study showed that there are no significant differences in the IOL positions between the two techniques.

Ultrasound Biomicroscopy and High-Frequency Ultrasound for Evaluating Extramammary Paget Disease With Pathologic Correlation.

The purpose of this study was to investigate the performance of ultrasound biomicroscopy (UBM) and high-frequency ultrasound (HFUS) in the assessment of extramammary Paget disease (EMPD) and to correlate the imaging features with pathologic findings. In this retrospective study, we described the imaging features from UBM and HFUS based on 17 pathologically proven EMPD cases. The performance for visualizing layer involvement by UBM and HFUS was compared. Additionally, we checked the consistency between layer involvement of the lesions on UBM images and the pathologic results. Additionally, blood flow and the status of lymph nodes were investigated with HFUS. Ultrasound biomicroscopy revealed that all 17 lesions (100%) were hypoechoic and grew in a creeping form. The feature of layer involvement was shown in 10 lesions (58.8%) limited to the epidermis and 6 lesions (35.3%) involving the dermis, and the remaining lesion (5.9%) involved the full skin layers. Layer involvement was clearly displayed by UBM for all lesions (100%) but for only 5 lesions (29.4%) by HFUS (P < .001). Additionally, the layer involvement of 15 lesions (88.2%) on UBM was consistent with the pathologic results (κ = 0.746). High-frequency ultrasound revealed profuse blood flow in most lesions (64.7% [11 of 17]), and 1 case showed inguinal lymph node metastasis. Combined use of UBM and HFUS can provide key information on EMPD based on ultrasound features. Comparatively, UBM provides clearer morphologic information, whereas HFUS provides information on lymph node metastasis and blood flow.

Evaluation of the angle of the anterior chamber using ultrasound biomicroscopy, gonioscopy and a Van Herick examination

Abstract Objective To compare the measurement of the angle of the anterior chamber using ultrasound biomicroscopy (UBM), gonioscopy and the Van Herick examination. Methods An observational comparative study was carried out between 3 different methods for the estimation of the iridocorneal angle. A total of 30 subjects with open and closed angles were evaluated using UBM, gonioscopy and Van Herick. In the UBM and gonioscopy assessment all the quadrants were included in the analysis, and in the Van Herick examination the nasal and temporal quadrant were also analyzed. All the examinations included the assessment of both eyes under photo-optical and scotopic illumination conditions. These findings were compared with the kappa concordance test. Results There was no statistically significant difference between the 3 methods in the evaluation of the state of the iridocorneal angle. The consistency between UBM and gonioscopy was better (kappa 0.93) in relation to the estimation of the angle with Van Herick (kappa 0.83). Conclusions The UBM, gonioscopy and Van Herick examinations have comparable results, although gonioscopy in the first instance would be indicated as a routine test for identification of angular closure.

Value of ultrasound biomicroscopy in assessment of small masses at medial canthal region.

Conventional imaging techniques are not sensitive enough to reveal detailed structures of lacrimal drainage system (LDS) and its surrounding tissue (ST). Our study aimed to explore utility of ultrasound biomicroscopy (UBM) in assessment of small masses at the medial canthal region and compare performance of UBM with conventional imaging techniques. We prospectively recruited cases with small mass (long axis < 1cm) at the medial canthal region (upper LDS-located area) from June 2017 to October 2018. UBM ± color Doppler flow imaging (CDFI) and conventional imaging techniques (computed tomography, magnetic resonance imaging, and dacryocystography) were conducted by four independent practitioners. Results were analyzed against gold standards with Cohen's kappa test in three aspects including LDS patency, mass location, and presumptive diagnosis. Corresponding gold standards were syringe and dacryocystography, intraoperative findings, and pathological/empirical diagnosis. Seventy-two cases were recruited, including 20 cases of LDS lesions and 52 cases of ST lesions. Female (odds ratio 7.14) and age ≥ 37 (odds ratio 9.80) were risk factors for LDS lesion, and age range of 15-25 (odds ratio 9.17) was a risk factor for inflammatory ST lesion. In terms of LDS patency, UBM results were reliable for the detection of pre-saccal obstruction (kappa = 0.920), but were not reliable for intra-saccal and post-saccal obstruction (kappa = 0.106). In terms of mass location, the UBM (kappa = 0.766) performed better than conventional techniques (except for dacryocystography) to sort out ST lesions, with sensitivity of 93.8% and specificity of 83.3%. In terms of diagnosis, the UBM (kappa = 0.882) outweighed conventional techniques (except for magnetic resonance imaging) to distinguish cysts from nodules, with sensitivity of 93.8% and specificity of 94.4%. Notably, the UBM + CDFI achieved better performance than the UBM when screen out inflammatory lesions (kappa = 0.926 vs kappa = 0.689) and LDS-adjacent lesions (kappa = 0.815 vs kappa = 0.673), resulting in sensitivity of 91.7% and specificity of 100% for both testing items. If deep lesions (at the lacrimal sac-harbored area) were excluded, UBM reliability to detect inflammatory lesions (kappa = 0.915) and LDS-adjacent lesions (kappa = 0.770) improved, achieving sensitivity of 90.0% and 88.9%, and specificity of 100.0% and 92.7%, respectively. The UBM is a valuable tool to assess superficial masses at the medial canthal region regarding pre-saccal obstruction, mass location, and presumptive diagnosis. This work was registered on Chinese Clinical Trial Registry website with registration number ChiCTR1800018956 .

Kronik Oküler Hipotoni Tanı ve Tedavisinde Ultrason Biyomikroskopinin Yeri

Amaç: Kronik oküler hipotoni, çeşitli hastalıklara ikincil oluşan, uzun dönemde kalıcı değişikliklere yol açabilen bir durumdur. Ultrason biyomikroskopinin (UBM) kullanıma girmesiyle hipotoni mekanizmalarının daha doğru değerlendirilmesi mümkün hâle gelmiştir. Bu çalışmada, olgu serisi üzerinden kronik oküler hipotoninin tanısında ve izleminde UBM'nin yerinin gösterilmesi amaçlanmıştır. Gereç ve Yöntemler: Kliniğimizde 2005-2015 yılları arasında kronik hipotoni tanısıyla UBM yapılan hastalar retrospektif olarak değerlendirildi. Hastaların yaşı, cinsiyeti, primer hastalığı, görme keskinliği, göz içi basıncı, hipotoni süresi, UBM bulguları, hipotoni tedavisi ve tedavi sonuçları kaydedildi. Bulgular: 20 hastaya oküler hipotoni tanısıyla UBM görüntüleme yapıldığı belirlendi. Bu hastalardan filtran cerrahi sonrası fazla çalışan bleb nedenli hipotoni gelişenler ekarte edildikten sonra dosya bilgilerine ulaşılabilen 10 hastanın 12 gözü çalışmaya alındı. Hastaların 6 (%60)'sı kadın, 4 (%40)'ü erkekti. Ortalama tanı yaşı 58,5 (47-69) yıl'dı. Ortalama göz içi basıncı 4,25 mmHg (0-6 mmHg) idi. Hipotoni görülen gözlerin 8 (%66,6)'inde tanı kronik nonenfeksiyöz panüveit, 3'ünde (%25) regmatojen retina dekolmanı nedenli geçirilmiş pars plana vitrektomi (PPV) ameliyatı ve 1 (%8,4)'inde künt göz travması idi. UBM ile gözlerin 8 (%66)'inde siliyer cisim dekolmanı, 3 (%25)'ünde siliyer cisim atrofisi ve 1'inde(%8) siklitik membranlar izlendi. Bir (%8) hastada siliyer cisim normal görünümde idi. Sonuç: Oküler hipotoni hastalarında UBM, hipotoni mekanizmasının belirlenmesinde ve hastaların izlemlerinde yardımcı olan önemli bir değerlendirme yöntemidir.

Valoración del ángulo de la cámara anterior mediante biomicroscopia ultrasónica, gonioscopia y examen de Van Herick

ObjectiveTo compare the measurement of the angle of the anterior chamber using ultrasound biomicroscopy (UBM), gonioscopy and the Van Herick examination. MethodsAn observational comparative study was carried out between 3different methods for the estimation of the iridocorneal angle. A total of 30 subjects with open and closed angles were evaluated using UBM, gonioscopy and Van Herick. In the UBM and gonioscopy assessment all the quadrants were included in the analysis, and in the Van Herick examination the nasal and temporal quadrant were also analysed. All the examinations included the assessment of both eyes under photo-optical and scotopic illumination conditions. These findings were compared with the kappa concordance test. ResultsThere was no statistically significant difference between the 3methods in the evaluation of the state of the iridocorneal angle. The consistency between UBM and gonioscopy was better (kappa 0.93) in relation to the estimation of the angle with Van Herick (kappa 0.83). ConclusionsThe UBM, gonioscopy and Van Herick examinations have comparable results, although gonioscopy in the first instance would be indicated as a routine test for identification of angular closure.