Subject(s)
Diabetic Retinopathy/therapy , Glucocorticoids/adverse effects , Laser Coagulation , Macular Edema/therapy , Triamcinolone Acetonide/adverse effects , Vitreous Body/drug effects , Vitreous Detachment/chemically induced , Combined Modality Therapy , Diabetic Retinopathy/drug therapy , Diabetic Retinopathy/surgery , Fluorescein Angiography , Glucocorticoids/therapeutic use , Humans , Injections , Macular Edema/drug therapy , Macular Edema/surgery , Tomography, Optical Coherence , Triamcinolone Acetonide/therapeutic use , Visual Acuity/physiology , Vitreous Detachment/diagnosisABSTRACT
OBJECTIVE: To evaluate the performance characteristics of B-scan ultrasonography (US) as a diagnostic test for the detection of retinal tears in acute symptomatic age-related posterior vitreous detachment (PVD). DESIGN: Evaluation of a diagnostic test through a cross-sectional study with prospective data collection. The study intended to meet the 14 items proposed by the Quality Assessment of Diagnostic Accuracy Studies panel. PARTICIPANTS: Two hundred thirty-nine patients with acute-onset age-related PVD were consecutively enrolled in a nonreferral hospital. TESTING: Comprehensive eye examination including vitreous and retinal biomicroscopy was performed on an emergency basis followed by blind B-scan kinetic US. Sensitivity, specificity and predictive values of the index test (B-scan US) were analyzed and compared with the standard reference (baseline examination). In cases of disagreement between both diagnostic methods, a new gold standard was established based on the findings of subsequent directed indirect ophthalmoscopy based on the echographic findings. Positive and negative likelihood ratios and a likelihood nomogram with pretest and posttest odds of retinal tears were calculated for B-scan US. MAIN OUTCOME MEASURES: Index test performance for the detection of retinal tears secondary to age-related PVD. RESULTS: Both diagnostic methods performed comparably. The sensitivity of B-scan US for detection of retinal tears was 96% and that of baseline examination was 89%. Both methods had similar negative predictive values of 99%. B-scan US specificity was 98%. The estimated pretest and posttest probability for a positive B-scan US were 10.8% and 89%, respectively. CONCLUSIONS: Proper B-scan kinetic US is a noninvasive and accurate diagnostic method for the detection of retinal tears that can be reliably used in no view or small pupil cases with symptomatic PVD. FINANCIAL DISCLOSURE(S): The authors have no proprietary or commercial interest in any of the materials discussed in this article.
