Qualitative ultrasound biomicroscopy in glaucoma

Background: UBM is a high?resolution ultrasound technique which allows non?invasive, in vivo imaging of the anterior segment and iridocorneal angle. Purpose: This video is compilation of short video clips and images which gives description on identification of angle closure due to pupillary block, peripheral anterior synechiae, iris bombe, plateau iris, supra ciliary effusion, and malignant glaucoma. It also shows video demonstrating partially and fully patent iridotomy and features of trabeculectomy bleb. Synopsis: This video summarizes importance of UBM application in angle closure glaucoma to understand its pathophysiology by showing the relationship between the peripheral iris, trabecular meshwork and ciliary processes. Highlights: UBM provides two?dimensional, grayscale images of the angle structures and allows identification of non?pupillary block mechanism in angle closure glaucoma, which can be recorded for qualitative and quantitative analyses.

Quantitative ultrasound biomicroscopy of iridocorneal angle

Background: Ultrasound biomicroscopy (UBM) is a high?resolution ultrasound technique, which allows noninvasive, in vivo imaging of the ocular anterior segment structures. Purpose: This video gives a description of the identification of the iridocorneal angle structures in the cross?sectional view in a radial scan through a typical ciliary process and a guide toward measuring the angle parameters. Synopsis: UBM provides two?dimensional, grayscale images of the iridocorneal angle. The real?time image is displayed on a video monitor and can be recorded for qualitative and quantitative analysis. The angle parameters can be measured by in?built calipers in the machine software and manipulated by the examiner. Highlights: This video demonstrates UBM caliper positions as displayed on the monitor and marked by the examiner for the measurement of various anterior segment parameters of the eye.

Qualitative ultrasound biomicroscopy of the normal anterior segment

Background: Ultrasound biomicroscopy (UBM) is a high?resolution ultrasound technique that allows noninvasive, in vivo imaging of the ocular anterior segment structures. Before interpreting the UBM images of the diseased eyes, it is essential to understand the structures seen in the UBM image of the normal eye. Purpose: This video is a compilation of short video clips that gives description of identification of the anterior segment structures in the axial scan, a cross?sectional view through the anterior chamber angle region of a normal subject in a radial scan, and identification of ciliary processes in the transverse scan. Synopsis: UBM provides two?dimensional, grayscale images of the various anterior segment structures and allows all these structures to be imaged simultaneously, in their normal state, as they occur in the living eye. The real?time image is displayed on a video monitor and can be recorded for qualitative and quantitative analysis. Highlights: The video gives an overview of identification of normal anterior segment structures on UBM.

Management of intrascleral chestnut burr spines under ultrasound biomicroscopy guidance

Purpose: To explore the efficacy of ultrasound biomicroscopy (UBM) as a tool for detecting and localizing intrascleral chestnut burr spines. Methods: Individuals who were diagnosed with definitive or suspected intrascleral chestnut burr injuries between 2019 and 2020 were retrospectively reviewed. All patients underwent UBM to detect potential intrascleral spines. UBM imaging features were recorded and analyzed. Intrascleral spines were removed based upon UBM?guided localization. Patient clinical profiles, management, and treatment outcomes were recorded. Results: A total of 10 eyes (10 patients; 6 males, 4 females) were diagnosed with intrascleral spines over the study period, with an average patient age of 55 years (range: 39–71). Three of these 10 eyes exhibited involvement of the palpebrae and cornea, whereas three exhibited corneal involvement, and the remaining four patients exhibited only intrascleral spine injuries owing to their having undergone previous intracorneal spine extraction procedures. UBM features consistent with chestnut burr spines manifest a hyperechoic spot with a shadow. UBM enabled the precise localization of these spines and thus ensured their successful removal via a single surgery. During follow?up, two patients experienced vitreous hemorrhage due to a penetrating injury into the ciliary body that was gradually absorbed. All patients with eye irritation and red eyes progressed favorably, and no surgical complications were recorded. Conclusion: A retained scleral chestnut burr spine should be suspected if a patient complains of persistent eye irritation following intracorneal spine removal. UBM may be a valuable tool for detecting spines retained in the sclera, enabling the successful removal thereof.

Ultrasound biomicroscopy as a tool in the evaluation and management of ocular hypotony in uveitis

Purpose: Chronic uveitis can lead to hypotony that may result in severe visual impairment. We highlight the use of ultrasound biomicroscopy (UBM) as an imaging tool to decide the modality of therapy and management of uveitic hypotony. Methods: This was a retrospective hospital?based interventional case?series study that included a total of 36 eyes of 25 patients with uveitic hypotony seen between January 1997 and January 2020. Results: Thirty?six eyes of 25 patients with uveitic ocular hypotony were included. Unilateral involvement was seen in 56%. The median age of presentation was 21 years with a median follow?up of 21.5 months. Anterior uveitis was noted in 13.88%, intermediate uveitis in 52.77%, and panuveitis in 33.33% eyes. UBM findings commonly noted were pars plana membranes, supraciliary effusion, blunted ciliary process, and ciliary body traction. Other findings included ciliochoroidal detachment and ciliary body edema. Moreover, 22.2% eyes were managed with medical therapy alone, whereas 77.8% eyes received both medical and surgical intervention based on UBM findings. Furthermore, 66.7% eyes showed improvement in intraocular pressure, 13.9% eyes maintained the same IOP, whereas 19.4% eyes had worsening of IOP at final follow?up. Conclusion: We found UBM as a useful imaging tool in evaluating and judiciously deciding the mode of management of uveitic hypotony.

Ciclodiálisis postraumática, desafío diagnóstico y terapéutico. Reporte de caso y revisión de literatura / Post-traumatic cyclodialysis, diagnostic and therapeutic challenge. Case report and literature review

Presentamos el caso de un paciente con ciclodiálisis postraumática difícil de localizar, incluso con ultrabiomicroscopia (UMB) repetida. El objetivo es informar del diagnóstico de una ciclodiálisis pequeña de difícil visualización y con presentación atípica. Paciente con ciclodiálisis postraumática crónica de 1 hora de reloj, con visualización difícil tanto por examen clínico como por imagen (UBM), a pesar de las evaluaciones repetidas. Inicialmente se realizó el tratamiento médico, sin embargo, no se logró el cierre espontáneo y ni la localización exacta. El seguimiento riguroso basado en la sospecha clínica permitió finalmente su ubicación y reparación quirúrgica exitosa. La ciclodiálisis es una condición rara y la mayoría de los oftalmólogos tratan solo unos pocos casos, no existe un protocolo estandarizado y tanto el diagnóstico como el manejo pueden ser difíciles. La gonioscopia sigue siendo el método diagnóstico de elección, y ciertas ayudas de diagnóstico como la UBM y posiblemente la tomografía de coherencia óptica pueden mejorar la sensibilidad de detección, aunque en algunos casos solo la sospecha clínica y el monitoreo riguroso pueden conducir a un diagnóstico preciso y un tratamiento adecuado.

We present the case of a patient with post-traumatic cyclodialysis difficult to locate, even with repetitive ultrabiomicroscopy (BMU). Our objective is to inform the diagnosis of a small cyclodialysis that is difficult to visualize and with an atypical presentation. Patient with chronic post-traumatic cyclodialysis of 1 clock hour, with difficult visualization by both clinical examination and imaging (UBM), despite repeated evaluations. Medical management was undertaken initially, however, no spontaneous closure and no exact localization were achieved. Rigorous follow up based on clinical suspicion allowed finally for its location and successful surgical repair. Cyclodialysis is a rare condition, and most ophthalmologists treat only a few cases, there is no standardized protocol and both diagnosis and management can be difficult. Gonioscopy remains the diagnostic method of choice, and certain diagnostic aids such as UBM and possibly optical coherence tomography (OCT) can improve detection sensitivity, although in some cases only clinical suspicion and rigorous monitoring can lead to accurate diagnosis and proper treatment

Contrastive analysis of corneal horizontal diameter measurement by five instruments / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To analyze the correlation and consistency of five corneal diameter measurements.<p>METHODS: Totally 25 cases(50 eyes)who underwent ICL implantation in West China Hospital. The preoperative horizontal corneal diameter was measured using measuring caliper, SIRIUS anterior eye assay system, IOL Master500, anterior segment OCT and UBM. <p>RESULTS: The mean WTW distances were 11.54±0.30 mm as obtained with measuring caliper, 11.77±0.33mm with SIRIUS anterior eye assay system, 11.98±0.33mm with IOL Master500, 11.63±0.35mm with anterior segment OCT and 11.53±0.34mm with UBM. No statistical difference was found between measuring caliper and UBM, measuring caliper and anterior segment OCT, UBM and anterior segment OCT. The linear correlation analysis found significant correlation between the measurements of the five measurements. The Bland-Altman analysis for the measuring caliper and SIRIUS, measuring caliper and UBM, measuring caliper and anterior segment OCT found that the absolute values of 95% LOA upper and lower limits were less than 0.5mm.<p>CONCLUSION: The results of the four kinds of corneal horizontal diameter measurements can be interchanged including SIRIUS, UBM, anterior segment OCT and measuring caliper. IOL Master500 results are the largest, that cannot be used as a diagnostic basis for measuring the size of corneal horizontal diameter. The results of other measurement equipment should be combined with clinical practice.

Clinical Usefulness of UBM in the Sitting Position in Anterior Chamber Depth and Angle Measurements

PURPOSE: We compared the measurements of anterior chamber depth (ACD) and anterior chamber angle (ACA) using ultrasound biomicroscopy (UBM) in the sitting position compared with IOL Master(R), Pentacam(R), and Spectralis optical coherence tomography (OCT) to evaluate the clinical usefulness of UBM in the sitting position. METHODS: We evaluated 92 eyes in 47 healthy adults. ACD was measured by IOL Master(R), Pentacam(R), and UBM. ACA was measured using Pentacam(R), UBM, and Spectralis OCT. UBM was performed in the sitting position using bag/balloon technology. Measured values were compared statistically. RESULTS: ACD measured by IOL Master(R), Pentacam(R), and UBM was 3.57 +/- 0.32 microm, 3.64 +/- 0.33 microm and 3.51 +/- 0.32 microm, respectively. UBM measurements of ACD were significantly shallower than with the other methods (p 0.8, p 0.05). There was strong correlation between UBM and Spectralis OCT (r = 0.957) but moderate correlation between Pentacam(R) and UBM and Pentacam(R) and Spectralis OCT (r = 0.557, 0.571, respectively, p < 0.05). Specifically, ACA of the superior quadrant showed a low correlation between Pentacam(R) and UBM and Pentacam(R) and Spectralis OCT (r = 0.257, 0.295, respectively). CONCLUSIONS: ACD measured by UBM in the sitting position was shallower compared to the other methods; however, ACD measured by IOL Master(R), Pentacam(R), and UBM showed significant correlations among the methods. The mean ACA measured by Pentacam(R), UBM, and Spectralis OCT showed no significant differences. Due to the high correlation of ACA measurements between UBM and Spectralis OCT in the present study, UBM is expected to be a good tool for measuring anterior segment parameters.

Application of ultrasound biomicroscopy in open-globe injury / 眼科研究

Background Open-globe injury of zone Ⅱ is a severe eyeball wound in the sclera area near 5mm from the corneal limbus.To accurately evaluate the local tissue structure after the wounding is very important for lessening the complications of eye injury.Ultrasound biomicroscope (UBM) has been proven useful in examining eyeball wall and vitreous at the wound in order to offer the useful information about whether secondary operation is needed for the injured eyes and when is the optimal timing for surgery.Objective The present study is to explore the clinical application of UBM in open-globe injury of zone Ⅱ. Methods This is an observational study of clinical cases.UBM examination was performed on 38 eyes of 38 cases received emergency repair surgery of open-scleral injury.The restore status of sclera,ciliary body and vitreous of injuried zone (zone Ⅱ) were evaluated under the UBM in 3-5 days after the operation.The comprehensive results of UBM,B-scan and ophthalmoscope examinations were analyzed to determine the further treatment.The oral informed consent was obtained from each subject before this trial.Results Vitreous surgery were performed on 15 cases,and all wounds were found by UBM and were proven in the surgery.The other 23 cases were followed up in out-patient department and no obvious complications were found.Conclusion UBM is a valuable and atraumatic examination for open-globe injury of zone Ⅱ.It offers important and appraisal information about ocular injury.

Clinical Significance of Ultrasound Biomicroscopy in Early Stage of Traumatic Hyphema

PURPOSE: To evaluate the clinical significance of angle-opening distance 500 (AOD500) using ultrasound biomicroscopy (UBM) in the early stage of traumatic hyphema. METHODS: The participants of this study were 46 hospitalized traumatic hyphema patients. We measured the quantity of initial blood clotting using a slit-lamp and the range of angle recession, AOD500 using UBM and then reviewed the relationship between the two. RESULTS: The difference of AOD500 in the traumatic and the non-traumatic eye measured by UBM at admission increased significantly in the wider recessed angle group (p=0.008), but did not increase at a statistically significantly level in the larger initial blood clot grade group (> or =Grade 2). CONCLUSIONS: These results suggest that the measurement of the angle-opening distance of both eyes using UBM will aid in evaluating the range of angle recession in patients in the early stage of traumatic hyphema.

Comparison of Measurement of Anterior Segment Parameters Between Scheimpflug Camera and Ultrasound Biomicroscopy

PURPOSE: To evaluate the clinical reliability of Pentacam(R) by comparing anterior chamber parameters measured by Oculus Pentacam system (Oculus Inc., Germany) and Hi-scan ultrasound biomicroscopy (OPTIKON 2000, Rome, Italy) in primary angle closure (PAC) and normal patients. METHODS: A prospective study was performed from June 2006 to January 2007. Fifty-one eyes in 26 primary angle-closure patients and 39 eyes in 20 normal control patients, for a total of 90 eyes of 46 patients were recruited from glaucoma out-patient clinics. The correlation and agreement of both measurements of anterior chamber depth and anterior chamber angle measured by UBM and Pentacam(R) were calculated. Sensitivity and specificity of each tool were also compared and the diagnostic value of angle closure was examined. RESULTS: Anterior chamber depth measured by UBM and Pentacam(R) showed strong correlation in the normal control group (r=0.821) and PAC group (r=0.957). Anterior chamber angle showed moderate correlation in the normal control group (r=0.523) and PAC group (r=0.456) while good agreement was also observed. In diagnosing angle closure, anterior chamber measurements appear similar in UBM and Pentacam(R) using the ROC curve (AUC of UBM, 0.942; AUC of Pentacam(R), 0.931). CONCLUSIONS: Pentacam(R) shows high to moderate correlation of anterior chamber measurements and good agreement compared with UBM. Pentacam(R) shows similar ability in diagnosing angle closure compared with UBM and thus is expected to be a good tool in diagnosing angle closure.

A Case Report on the Change of the Refractive Power After a Blunt Trauma

PURPOSE: To determine the pathogenesis of transient myopia after blunt eye trauma. METHODS: In one patient, the refraction of both eyes (the left eye was injured, but the right eye was not) was measured with an autorefractometer. The cycloplegic refraction was measured at the early stage of trauma and again 3 months after the blunt eye injury. The angle and depth of the anterior chamber, the ciliary body, and the choroids were examined by ultrasound biomicroscopy (UBM) over 3 months. The depth of the anterior chamber, the thickness of the lens, and the axial length were measured by A-scan ultrasonography in both eyes. During the 3 months after the injury, we made comparisons between the menifest and the cycloplegic refractions, the depths of anterior chambers, the thickness of the lenses, the axial lengths, and the UBM-determined appearances of the angles and depths of the anterior chambers, the ciliary bodies, and the choroids in both eyes. RESULTS: We suspect that the depth reduction in the anterior chamber, the increase in anterior to posterior lens diameter, and the edema in the ciliary body are all related to the change in the refractive power following the blunt trauma. CONCLUSIONS: Ultrasound biomicroscopy (UBM) and ultrasonography of the anterior segment in the eye may be helpful to diagnose and confirm changes in the refractive power that occur after trauma.

A Case Report on the Change of the Refractive Power After a Blunt Trauma

PURPOSE: To determine the pathogenesis of transient myopia after blunt eye trauma. METHODS: In one patient, the refraction of both eyes (the left eye was injured, but the right eye was not) was measured with an autorefractometer. The cycloplegic refraction was measured at the early stage of trauma and again 3 months after the blunt eye injury. The angle and depth of the anterior chamber, the ciliary body, and the choroids were examined by ultrasound biomicroscopy (UBM) over 3 months. The depth of the anterior chamber, the thickness of the lens, and the axial length were measured by A-scan ultrasonography in both eyes. During the 3 months after the injury, we made comparisons between the menifest and the cycloplegic refractions, the depths of anterior chambers, the thickness of the lenses, the axial lengths, and the UBM-determined appearances of the angles and depths of the anterior chambers, the ciliary bodies, and the choroids in both eyes. RESULTS: We suspect that the depth reduction in the anterior chamber, the increase in anterior to posterior lens diameter, and the edema in the ciliary body are all related to the change in the refractive power following the blunt trauma. CONCLUSIONS: Ultrasound biomicroscopy (UBM) and ultrasonography of the anterior segment in the eye may be helpful to diagnose and confirm changes in the refractive power that occur after trauma.

Changes in Ciliary Sulcus Size, Anterior Chamber Depth and Angle during Accommodation using Ultrasound Biomicroscopy

PURPOSE: To evaluate changes in the ciliary sulcus size, anterior chamber depth (ACD) and anterior chamber angle (ACA) during accommodation using an ultrasound biomicroscope (UBM). METHODS: Twenty-seven eyes of 27 healthy subjects were studied. We examined refractive error and intraocular pressure, measured the horizontal distance of the ciliary sulcus, ACD, and ACA at distant fixation and near fixation using a UBM (50 MHz transducer, model P45 UBM plus, Paradigm(R), Kent, U. K.). RESULTS: The subjects included 16 males and 6 females. The mean age of the subjects was 20.5 years (age range, 19-22 years), and mean spherical equivalent was -2.86+/-1.67 diopters. At distant fixation, horizontal ciliary sulcus size was 11.75+/-0.56 mm, ACD was 3.15+/-0.17 mm, and ACA was 38.5+/-4.2 . At near fixation, horizontal ciliary sulcus size was 11.34+/-0.65 mm, ACD was 2.92+/-0.15 mm, and ACA was 44.5+/-5.7 . CONCLUSIONS: During accommodation, horizontal ciliary sulcus size and ACD significantly decreased and ACA increased in the patients.

Ciliary Sulcus Size according to Refractive Error using Ultrasound Biomicroscopy

PURPOSE: To evaluate the correlation between the size of ciliary sulcus and ocular measurements such as anterior chamber depth, axial length and limbus size, we measured anterior chamber depth, axial length, corneal thickness, corneal limbus size and ciliary sulcus size. We also evaluated the difference in ciliary sulcus size according to the refractive errors. METHODS: Forty eyes of twenty patients were subdivided into three groups after refraction: high myopia (>or= 6 diopter; 13 eyes), moderated myopia (>or= 3 diopter, < 6 diopter; 17 eyes), and low myopia (< 3 diopter; 10 eyes). We measured the anterior chamber depth using ultrasound biomicroscopy (UBM), and calculated the size of the ciliary sulcus by mapping method. We measured the axial length with ultrasonography, the size of limbus with calipers, and performed corneal topography. RESULTS: Vertical ciliary sulcus sizes were 12.2 +/- 0.6 mm, 12.2 +/- 0.5 mm, and 11.8 +/- 0.5 mm, while horizontal ciliary sulcus sizes were 11.8 +/- 0.6 mm, 11.9 +/- 0.4 mm, and 11.6 +/- 0.6 mm, in the high, moderate and low myopia groups, respectively. There were no significant differences between groups. Horizontal ciliary sulcus size was most positively correlated with anterior chamber depth among the ocular measurements(Pearson r=0.46). CONCLUSIONS: There were no significant correlations between ciliary sulcus size and anterior chamber depth, axial length and limbus size, and there were no differences in the ciliary sulcus size according to the refractive errors.

Ultrasound Biomicroscopic Evaluation of Ciliary Body and Choroidal Detachment after Panretinal Photocoagulation

PURPOSE: To clarify the ciliary body and choroidal detachment after panretinal photocoagulation and to inspect complications by ciliary body and choroidal detachment after panretinal photocoagulation. METHODS: A dynamic, in vivo examination using ultrasound biomicroscope (UBM) was performed on 12 eyes of 11 patients before, immediately after, and 3 and 7 days after panretinal photocoagulation. IOP measurement was performed on each occasions, and the spot size, and spot number of laser applications of each patient was measured. RESULTS: Three days after photocoagulation, ciliochoroidal detachment was observed in 6 of the 12 eyes, but none was observed at 7 days. The retinal surface area that had been treated was associated with the development of detachment. No significant IOP change according to the ciliochoroidal detachment was present. CONCLUSIONS: Although ciliochoroidal detachment was asymptomatic and transient in this study, potential hazards such as angle closure glaucoma necessitate careful attention in the planning of panretinal photocoagulation. UBM is a useful tool for the evaluation of ciliochoroidal detachment after photocoagulation.

Ultrasound Biomicroscopy of Sclerotomy Site

PURPOSE: Complications after pars plana vitrectomy are causes that courses heal the wound of sclerotomy site. It is difficult to diagnose abnormal finding at sclerotomy site because of its anatomical location. This study was aimed at assessing changes at the sclerotomy site using ultrasound biomicroscope (UBM) in eyes that underwent pars plana vitrectomy. METHODS: A dynamic in vivo examination using ultrasound biomicroscope (Model P45 UBM plus, Paradigm, U. K.) was performed on 120 sclerotomy sites of 40 eyes of 39 patients after pars plana vitrectomy. Average age was 52.56 years old, average post-operative period was 6.45 +/- 5.71months. RESULTS: In 120 sclerotomy site, vitreous incarceration, fibrovascular proliferation, scleromalacia was detected using UBM at 30%. Abnormal fidings of proliferative diabetic retinopathy group are more frequent than non-diabetic retinopathy group. After post-vitrectomy hemorrhage patient group is more abnormal finding. CONCLUSIONS: Ultrasound biomicroscope is a useful tool for the evaluation of sclerotomy site, which is difficult by ordinary method and is an invaluable tool in assessment of the patient before reoperation.