Review

Authors: Vasile Potop, Valeria Coviltir, Speranţa Schmitzer...

Ultrasound biomicroscopy (UBM) is an important tool in the diagnosis, evaluation and follow up of glaucoma patients. Even if we are dealing with a primary angle closure glaucoma (PACG) or a primary open angle glaucoma (POAG) patient, the mechanism of angle closure can be revealed by performing an UBM. The device can help differentiate between the two types of glaucoma even in patients with opaque corneas when gonioscopy cannot be performed. Knowing the type of glaucoma is vital, especially regarding an individualized treatment, since each patient is unique and needs to be treated accordingly, in order to prevent glaucomatous optic neuropathy and visual field loss. : AC = anterior chamber, ICE = iridocorneal endothelial syndrome, IOP = intraocular pressure, NTG = normal tension glaucoma, PACG = primary angle closure glaucoma, PC = posterior chamber, PEX = pseudoexfoliation syndrome, POAG = primary open angle glaucoma, UBM = ultrasound biomicroscopy.

Topics: Glaucoma, Angle-Closure; Glaucoma, Open-Angle; Humans; Intraocular Pressure; Microscopy, Acoustic; Tonometry, Ocular; Visual Fields

PubMed: 34179574
DOI: 10.22336/rjo.2021.24

Review

Authors: Alberto Diniz Filho, Sebastião Cronemberger, Rafael Vidal Mérula...

The term plateau iris was first coined in 1958 to describe the iris configuration of a patient. Two years later the concept of plateau iris was published. In 1977, the plateau iris configuration was classically defined as presurgical changes of an eye with a relative normal central anterior chamber depth, flat iris by conventional biomicroscopy, but displaying an extremely narrow or closed angle on gonioscopic examination. On the other hand, the plateau iris syndrome was defined as an acute glaucoma crisis in one eye with a relative normal central anterior chamber depth and patent iridotomy on direct examination, presenting angle closure confirmed by gonioscopic examination after mydriasis. In 1992, the anatomic aspects of plateau iris were studied using ultrasound biomicroscopy. Finally, plateau iris has been considered an anatomic variant of iris structure in which the iris periphery angulates sharply forward from its insertion point and then again angulates sharply and centrally backward, along with an anterior positioning of the ciliary processes seen on ultrasound biomicroscopy. The clinical treatment of plateau iris syndrome is carried out with topical use of pilocarpine. However, the definitive treatment should be fulfilled by performing an argon laser peripheral iridoplasty.

Topics: Gonioscopy; Humans; Iris Diseases; Laser Therapy; Microscopy, Acoustic; Miotics; Pilocarpine; Syndrome

PubMed: 19039479
DOI: 10.1590/s0004-27492008000500029

Authors: Francesco Pichi, Khalid Qadha, Khaled Almasri...

BACKGROUND/OBJECTIVE

To describe the ultrasound biomicroscopy (UBM) diagnostic features in patients suspected of experiencing chronic inflammation due to phacoantigenic uveitis SUBJECTS/METHODS: This single-center study enrolled patients referred to the Uveitis Department of Cleveland Clinic Abu Dhabi for chronic anterior uveitis and traumatic cataract. Patients' demographics, causes and dates of the inciting traumatic event, and ophthalmic findings were recorded. 20-MHz UBM assessment of the status of the anterior capsule and the crystalline lens was performed. Then, cataract surgery was performed using a single technique. Comparison of the anterior capsule and lens status by clinical, UBM, and intraoperative evaluation.

RESULTS

Forty eyes with phacoantigenic uveitis were considered. The slit-lamp examination could identify interruption of the anterior capsule in 20% of the eyes and liquefied sinking lens material in 10%. An intra-operative defect in the anterior capsule was documented in 87.5% of eyes. UBM imaging showed anterior capsule irregularity in 63.3% of eyes and confirmed the presence of anterior capsule defects in 47.5% and lens matter herniating into the anterior chamber in 15%. Hypoechogenic lacunae within the cataractous lens were detected in 12.5% of eyes. For UBM, sensitivity and specificity values were 82.86% (95% CI: 66.35-93.44) and 100% (95% CI: 47.82-100), respectively. Positive and negative predictive values for UBM were 100% (95% CI: 88.06-100) and 45.45% (95% CI: 28.69-63.32), respectively. The overall diagnostic accuracy of UBM was 85% [95% CI: 70.16-94.29].

CONCLUSION

Ultrasound Biomicroscopy (UBM) is essential for assessing suspected anterior capsule ruptures in phacoantigenic uveitis cases.

Topics: Humans; Microscopy, Acoustic; Female; Male; Middle Aged; Adult; Aged; Cataract; Uveitis, Anterior; Cataract Extraction; Young Adult; Lens, Crystalline; Phacoemulsification; Uveitis

PubMed: 39271823
DOI: 10.1038/s41433-024-03317-5

Authors: Sudha K Ganesh, Nivedita Nair, Divya Thatikonda...

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.

Topics: Adult; Humans; Intraocular Pressure; Microscopy, Acoustic; Ocular Hypotension; Retrospective Studies; Tonometry, Ocular; Uveitis; Vitrectomy; Young Adult

PubMed: 35086213
DOI: 10.4103/ijo.IJO_1313_21

Authors: Tarannum Mansoori

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.

VIDEO LINK

https://youtu.be/prsmGnR8jYc.

Topics: Humans; Ciliary Body; Eye Abnormalities; Glaucoma; Glaucoma, Angle-Closure; Iris; Iris Diseases; Microscopy, Acoustic; Pupil Disorders

PubMed: 37322722
DOI: 10.4103/IJO.IJO_153_23

Authors: Tarannum Mansoori

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.

VIDEO LINK

https://youtu.be/WTXMupYoyww.

Topics: Humans; Anterior Chamber; Anterior Eye Segment; Ciliary Body; Cross-Sectional Studies; Microscopy, Acoustic

PubMed: 37203007
DOI: 10.4103/IJO.IJO_3369_22

Authors: Xiaoli Li

The front part of the eye is exposed to the surface of the body, making it susceptible to injury. Blunt eye injuries often destroy the tissue structure in the anterior part of the eye. Often there is detachment of the iris root, separation of the ciliary body, the angle of retraction of the chamber, and complete dislocation or subluxation of the lens. Ordinary ocular ultrasound can penetrate into opaque tissue, but because of its low resolution, it can only show its outline, which is still very small for doctors in assisting diagnosis. Ultrasonic biomicroscopy is a very real-time analysis, will not be affected by the refraction space, and has great application value for ocular trauma. Based on this, this article proposes the ultrasound biomicroscope diagnosis analysis and fine nursing research of traumatic anterior chamber injury based on intelligent virtual reality technology. This article describes literature methods, experimental analysis methods, and other methods, in-depth study of the causes of traumatic anterior injuries, ultrasound biomicroscopy, and other theoretical knowledge, ultrasound biomicroscopy and microcontrol experiments for traumatic anterior injury design, and finally the causes of eye damage. This study compares the pairing results of ultrasound biomicroscopy biological measurements, analyzes the relationship between anterior bleeding level and anterior ocular injury, and analyzes the outcome and extent of service ophthalmology. The angle retreat accounted for 52.17% in grade I, 72.22% in grade II, and 60% in grade III. Anterior bleeding can cause single or complex iris root detachment, iris root detachment, ciliary body detachment, and angular leakage. The more the bleeding, the more serious the eye damage.

Topics: Anterior Chamber; Ciliary Body; Eye Injuries; Humans; Microscopy, Acoustic; Technology; Virtual Reality

PubMed: 34055276
DOI: 10.1155/2021/9930686

Review

Authors: Raul Martin

Current corneal assessment technologies make the process of corneal evaluation extremely fast and simple, and several devices and technologies show signs that help in identification of different diseases thereby, helping in diagnosis, management, and follow-up of patients. The purpose of this review is to present and update readers on the evaluation of cornea and ocular surface. This first part reviews a description of slit lamp biomicroscopy (SLB), endothelial specular microscopy, confocal microscopy, and ultrasound biomicroscopy examination techniques and the second part describes the corneal topography and tomography, providing up-to-date information on the clinical recommendations of these techniques in eye care practice. Although the SLB is a traditional technique, it is of paramount importance in clinical diagnosis and compulsory when an eye test is conducted in primary or specialist eye care practice. Different techniques allow the early diagnosis of many diseases, especially when clinical signs have not yet become apparent and visible with SLB. These techniques also allow for patient follow-up in several clinical conditions or diseases, facilitating clinical decisions and improving knowledge regarding the corneal anatomy.

Topics: Anterior Eye Segment; Cornea; Corneal Diseases; Corneal Topography; Humans; Microscopy, Acoustic; Microscopy, Confocal; Slit Lamp Microscopy

PubMed: 29380757
DOI: 10.4103/ijo.IJO_649_17

Authors: Ayse Yildiz Tas, Berk Abay, Orkun Muftuoglu...

PURPOSE

To determine the clinical outcomes in patients after type 1 Boston keratoprosthesis surgery and the significance of ultrasound biomicroscopy imaging for postoperative follow-up.

METHODS

This retrospective analysis included 20 eyes of 19 patients who underwent corneal transplantation with type 1 Boston keratoprosthesis between April 2014 and December 2021. Data on patient demographics, preoperative diagnosis, visual acuity, and postoperative clinical findings were analyzed.

RESULTS

Type 1 Boston keratoprosthesis implantation resulted in intermediate- and long-term positive outcomes. However, blindness and other serious complications such as glaucoma, retroprosthetic membrane formation, endophthalmitis, or retinal detachment also occurred. The use of ultrasound biomicroscopy imaging allowed for better evaluation of the back of the titanium plate, anterior segment structures, and the relationship of the prosthesis with surrounding tissues, which provided valuable postoperative information.

CONCLUSION

Regular lifetime monitoring and treatment are necessary in patients who undergo Boston type 1 keratoprosthesis implantation for high-risk corneal transplantation. ultrasound biomicroscopy imaging can be a valuable imaging technique for the evaluation of patients with Boston type 1 keratoprosthesis, providing important information on anterior segment anatomy and potential complications. Further studies and consensus on postoperative follow-up protocols are required to optimize the management of patients with Boston type 1 keratoprosthesis.

Topics: Humans; Microscopy, Acoustic; Retrospective Studies; Male; Female; Middle Aged; Adult; Visual Acuity; Corneal Diseases; Prostheses and Implants; Treatment Outcome; Aged; Postoperative Complications; Corneal Transplantation; Postoperative Period; Prosthesis Implantation; Cornea; Young Adult; Artificial Organs; Adolescent

PubMed: 39109743
DOI: 10.5935/0004-2749.2023-0160

Observational Study

Authors: Abhidnya Surve, Rachna Meel, Neelam Pushker...

PURPOSE

To study the features of upper eyelid in healthy individual and different types of congenital ptosis in the Indian population using ultrasound biomicroscopy (UBM).

METHODS

This was a prospective observational study at a tertiary care center. Eyelid structure of healthy individuals with no eyelid abnormalities (n = 19); simple congenital ptosis (n = 33) cases; Marcus Gunn jaw-winking ptosis (MGJWP, n = 7) cases, and blepharophimosis-ptosis-epicanthus inversus syndrome (BPES, n = 20) cases were studied on a vertical UBM scan using 50-MHz probe. Lid-thickness, tarsal-thickness, orbicularis oculi and levator-Muller-orbital septum-conjunctival (LMSC) complex were measured in primary gaze. Comparison was made between four groups and results were statistically analyzed using ANOVA test. In normal individuals, LMSC measurements were repeated in down-gaze imaging.

RESULTS

Skin with subcutaneous tissue, LMSC complex and pre-aponeurotic fat-pad appeared echodense while orbicularis oculi and tarsus appeared echolucent. In primary gaze, mean thickness (± standard deviation) of the eyelid, tarsus, orbicularis oculi and LMSC, respectively, were: 1.612 ± 0.205, 0.907 ± 0.098, 0.336 ± 0.083, and 0.785 ± 0.135 mm in normal individual. LMSC showed 46.64% increase in thickness on down-gaze. The mean eyelid thickness and LMSC were thicker in MGJWP and BPES as compared to normal. In different types of congenital ptosis cases, various patterns of UBM imaging were observed.

CONCLUSION

UBM allows noninvasive imaging of eyelid structures with good anatomical correspondence in normal eyelids and study the structural alterations of eyelids in different types of congenital ptosis. UBM can be used to highlight the anatomical difference in normal eyelids that may help modify the surgery for better cosmetic outcomes. Furthermore, it has the potential to be used in preoperative evaluation and operative planning in certain types of acquired ptosis, which needs to be evaluated.

Topics: Adolescent; Adult; Asian People; Blepharophimosis; Blepharoptosis; Child; Eyelids; Female; Healthy Volunteers; Heart Defects, Congenital; Humans; India; Jaw Abnormalities; Male; Microscopy, Acoustic; Nervous System Diseases; Prospective Studies; Reflex, Abnormal; Skin Abnormalities; Urogenital Abnormalities; Young Adult

PubMed: 29480247
DOI: 10.4103/ijo.IJO_915_17