B-scan ultrasonography and optical coherence tomography (O.C.T.) in epiretinal macular membranes: pre- and post-operative evaluation

PURPOSE: This study was designed to evaluate B-scan ultrasonography and optical coherence tomography in the pre- and post-operative morphologic evaluation of idiopathic epiretinal macular membranes. METHODS: Fifteen eyes were examined using B-scan ultrasonography and optical coherence tomography before and after surgical excision of the epiretinal macular membranes. RESULTS: Ultrasonography prior to surgery allowed an excellent evaluation of both the peripheral and the posterior vitreous and showed the membrane. The thickening of the retina and the retinal folds were equally visualised by either method. An improved observation of the macular oedema was obtained by the optical coherence tomography as well as the type of membrane adhesion. After surgery, both methods were able to detect membrane remnants. A better visualisation of retinal thickness and cystoid macular oedema was obtained by optical coherence tomography rather than ultrasonography. Serous sub-foveal retinal detachment was only revealed by optical coherence tomography. DISCUSSION: Ultrasonography is indispensable in case of media opacity or of optical inaccessibility of the posterior pole. Moreover, it allows an excellent global analysis of the anterior and posterior vitreous, which is very useful for the surgeon. The membrane is always showed by ultrasonography, but not always by optical coherence tomography in case of diffuse adherence. Both methods can detect the membrane and a cystoid macular edema. However, retinal analysis with the optical coherence tomography is more precise. It can even detect cysts of the macular oedema or serous sub-foveal retinal detachment. CONCLUSION: B-scan ultrasonography and optical coherence tomography give complementary information in pre- and post-operative examination of epiretinal macular membranes.     

眼B超诊断早期视网膜裂孔

目的 探讨利用眼B超技术早期发现视网膜裂孔的临床价值.方法 收集2008年9月至2009年5月期间采用全方位纵向扫描B超探查首诊发现的可疑视网膜干性裂孔68只眼,经三面镜散瞳眼底检查进一步明确诊断.分析B超判断早期视网膜裂孔的正确性,及其图像特征.确诊为裂孔者行激光封孔术,术后一月随访裂孔封闭情况.结果 B超可疑视网膜裂孔 68只眼中,经眼底检查确诊视网膜裂孔44只眼,阳性率66%.其中有突发性视糊、闪光主诉者24只眼(55%),近视屈光度≥-6D者14只眼(32%).裂孔均为马蹄形,大多位于赤道部之前(63只眼,占93%),颞上象限多见(23只眼,占50%).B超表现为周边部球壁前中粗短弧形或短带状回声,带宽类似视网膜厚度或略粗,游离端多见玻璃体后脱离的细带状回声与之牵引.非裂孔24只眼(35%),病变处可见积血机化、变性区或玻璃体混浊黏连.所有裂孔均即刻行激光封孔术,2例因裂孔过于周边和视网膜下积液转行巩膜冷冻外加压手术.术后一月复查,所有术眼裂孔封闭良好,视网膜平伏.结论 全方位纵向扫描眼B超探查,有助于早期发现周边部视网膜裂孔,对其及时激光治疗和预防孔源性视网膜脱离具有重要价值.     

B-scan ultrasonography following open globe repair

Purpose

To examine the accuracy and predictive ability of B-scan ultrasonography in the post-repair assessment of an open globe injury.

Methods

In all, 965 open globe injuries treated at the Massachusetts Eye and Ear Infirmary between 1 January 2000 and 1 June 2010 were retrospectively reviewed. A total of 427 ultrasound reports on 210 patients were analyzed. Ultrasound reports were examined for the following characteristics: vitreous hemorrhage, vitreous tag, retinal tear, RD (including subcategories total RD, partial RD, closed funnel RD, open funnel RD, and chronic RD), vitreous traction, vitreous debris, serous choroidal detachment, hemorrhagic choroidal detachment, kissing choroidal detachment, dislocated crystalline lens, dislocated intraocular lens (IOL), disrupted crystalline lens, intraocular foreign body (IOFB), intraocular air, irregular posterior globe contour, disorganized posterior intraocular contents, posterior vitreous detachment, choroidal vs retinal detachment, vitreal membranes, and choroidal thickening. The main outcome measure was visual outcome at final follow-up.

Results

Among 427 B-scan reports, there were a total of 57 retinal detachments, 19 retinal tears, 18 vitreous traction, 59 serous choroidal detachments, 47 hemorrhagic choroidal detachments, and 10 kissing choroidal detachments. Of patients with multiple studies, 26% developed retinal detachments or retinal tears on subsequent scans. Ultrasound had 100% positive predictive value for diagnosing retinal detachment and IOFB. The diagnoses of retinal detachment, disorganized posterior contents, hemorrhagic choroidal detachment, kissing choroidal detachment, and irregular posterior contour were associated with worse visual acuity at final follow-up. Disorganized posterior contents correlated with particularly poor outcomes.

Conclusions

B-scan ultrasonography is a proven, cost-effective imaging modality in the management of an open globe injury. This tool can offer both diagnostic and prognostic information, useful for both surgical planning and further medical management.     

B超在穿孔性眼外伤辅助诊断中的作用

目的分析B型超声观察穿孔性眼外伤眼球中后段及眶内病变的意义。方法对临床确诊为眼球穿孔伤者,进行B超检查,观察玻璃体腔及球后的影像学变化。结果对129例（129眼）角巩膜穿孔伤,分别为锐器伤,细小异物击伤,钝物击伤,爆炸伤及原凶不明的外伤。B超探查发现轻微玻璃体浑浊73例,占56．59％;单纯玻璃体积血浑浊12例,占9．30％;眶内异物25例,占19．38％;玻璃体积血合并脉络膜脱离6例,占4．65％;玻璃体积血合并视网膜脱离6例,占4．65％;玻璃体积血合并视网膜脱离及脉络膜脱离7例,占5．43％。结论眼球穿孔伤多数伴有外伤性虹膜睫状体炎、外伤性白内障或玻璃体积血等影响眼底检查的因素,B超就成为了解这类患者眼球后段及眶内病变的重要检查方法,为临床诊断及下一步治疗提供重要的依据。     

彩色多普勒在脉络膜脱离型视网膜脱离的临床应用

目的 评价B型超声及彩色多谱勒血流成像(CDH)对脉络膜脱离型视网膜脱离的诊断价值.方法 16例脉络膜脱离型视网膜脱离患者,分别行常规B超并叠加CDH诊断,结合临床治疗及手术反馈信息,证实超声诊断准确性.结果 经手术验证,B超结合CDFI诊断脉络膜脱离型视网膜脱离符合率96.85%,B超及CDFI影像具有特征性表现.结论 应用B超结合CDFI,显著提高了对脉络膜脱离犁视网膜脱离的诊断准确性,并较精细的显示内眼情况.     

B型超声在眼挫伤诊断中的应用

目的探讨B型超声检查在眼后段挫伤诊断中的临床价值。方法对58例（65眼）眼后段挫伤进行眼部B型超声检查,并对其眼底表现与B超检查结果进行比较分析。结果眼底表现：黄斑水肿26眼（40．0％）、视网膜出血及视网膜下出血17眼（26．2％）、黄斑区色素紊乱9眼（13．8％）、玻璃体积血8眼（12．3％）、视盘水肿7眼（10．8％）、视网膜脱离3眼（4．6％）等。B型超声的阳性发现率：玻璃体积血、视网膜脱离均为100．0％,视盘水肿85．7％,视网膜出血及视网膜下出血84．2％,黄斑水肿69．2％,对黄斑色素紊乱不能显示。结论B型超声对眼后段挫伤是一种安全、有效的检查方法,对玻璃体积血、视网膜脱离、视盘水肿、视网膜大量出血、黄斑水肿等诊断具有重要价值。     

玻璃体不全后脱离所致视网膜病变的光学相干断层扫描观察

目的分析玻璃体不全后脱离的光学相干断层扫描(optical coherence tomography,OCT)图像特征,探讨玻璃体不全后脱离与所引发的玻璃体视网膜病变的关系。方法对81例(86只眼)玻璃体不全后脱离患者进行眼科常规检查、B型超声检查和OCT检查,并对所获得的OCT图像进行分析,观察玻璃体视网膜界面的异常图像特征。结果27只眼显示特发性玻璃体黄斑牵引综合征;25只眼显示特发性黄斑前膜;25只眼显示后界膜牵拉导致特发性黄斑板层裂孔及全层黄斑裂孔形成;9只眼显示玻璃体后界膜与黄斑部及视盘周视网膜神经上皮层多处牵拉粘连。结论OCT能够直观的显示玻璃体不全后脱离与所引发的黄斑部视网膜病变的进展变化,并可进行定量、定性分析与鉴别诊断。     

B型超声波检查在眼外伤诊断中的应用

目的 评价Ｂ超检查在眼外伤诊断中的价值。方法 对３５０例眼外伤Ｂ超检查的结果进行分析。结果 ３５０眼中阳性表现错综复杂,其中玻璃体病变３２６眼,外伤性视网膜脱离６０眼,眼内异物３５眼等。结论 Ｂ超扫描对眼外伤的检查具有重要意义,尤其在屈光间质浑浊或疑有眼内异物时更是简便有效而必不可少的,明显优于光学检查及传统的Ｘ线定位法。     

B超检查眼球穿孔伤患者球内各种强回声的分析及鉴别

目的：分析B超对眼球穿孔伤中出现的各种强回声信号的诊断价值。 方法：对临床确诊为眼球穿孔伤患者,进行B超检查,观察晶状体、玻璃体腔及球壁、球后的影像学表现。 结果：眼球穿孔伤经B超检查球内出现强回声的患者176例176眼中,玻璃体积血146例,晶状体脱位4例,球内异物（包含球壁异物）105例,玻璃体腔内气泡1例,视网膜脱离34例,脉络膜脱离23例,后巩膜破裂9例。每例患者都同时合并以上两种或两种以上体征,每例患者的 B超均表现有强回声信号。对以上病例出现的各种强回声信号总结如下：（1）浓稠的玻璃体积血;（2）球内异物;（3）脱位的晶状体;（4）玻璃体腔内气泡。 结论：眼球穿孔伤由于前房出血,白内障、玻璃体积血或因眼睑肿胀,患者不合作,使眼后段检查很难进行,B超给眼科医生提供了极大的帮助。 B 超对视网膜脱离、球内异物、后巩膜裂伤、出血性脉络膜脱离等都十分敏感,并有特异性的影像。复杂的眼球穿孔伤球内常会出现一些易混淆的强回声信号,B超检查可以对这些声像进行鉴别,这是其他检查方法难以替代的。     

Ultrasonic examination in severe diabetic eye disease.

B-scan ultrasound of the posterior segment is reported in 154 patients with severe diabetic eye disease. Epiretinal fibrosis, vitreous haemorrhage, vitreous detachment, and retinal detachment were frequently diagnosed. The ultrasonic findings are discussed in relation to the pathological changes in the vitreous in proliferative diabetic retinopathy.     

B-scan ultrasonography of retinal detachments

Characteristic ultrasonsographic patterns of retinal detachment in a variety of clinical circumstances are demonstrated and discussed. Uncomplicated retinal detachment consists of ultrasonically detected retinal detachment without associated pathology in the vitreous, subretinal space, or choroid. The simultaneous detection of lesions in one or more of these areas may be a source of diagnostic confusion. Acoustic diagnostic criteria for differentiation of associated conditions in complicated retinal detachments are demonstrated and discussed. High resolution A-scan and B-scan ultrasonography provides a method for detection and diagnosis of retinal detachment, associated ocular pathology, and simulating conditions.     

急性视网膜坏死的临床分析

目的探讨急性视网膜坏死病因及治疗。方法就2例特殊类型急性视网膜坏死病例对本病进行分析。结果病例1,左眼抗青光眼术后第1天视物不见,荧光素眼底血管造影提示急性视网膜坏死。B超显示：局限性视网膜隆起。给予抗病毒及糖皮质激素治疗。后葡萄膜炎症明显,血管闭塞,视网膜脱离。病例2,发热昏迷患者,颈项强直,脑膜刺激症阳性,行脑脊液检查,颅脑磁共振成像检查后考虑病毒性脑炎,经抗病毒、糖皮质激素治疗,意识逐渐好转后发现双眼视物不见,眼底屈光间质欠清,后极部视网膜水肿,似有隆起,并可见散在黄白色病灶,B超提示视网膜脱离。针对2例特殊急性视网膜坏死病例临床表现、不良预后,减少临床误诊及漏诊病例,认识该病治疗。结论及时发现病情,早期足量、足疗程抗病毒治疗、预防性光凝、把握玻璃体手术时机是减少并发症有效手段。     

Vitreous haemorrhage without obvious cause: national survey of management practices

AIM: We undertook a national survey to establish the management of dense vitreous haemorrhage without obvious cause. METHODS DESIGN: Cross-sectional anonymous self-reporting survey of ophthalmic practitioners within three target groups: vitreoretinal specialists (VRS), nonvitreoretinal specialists (NVRS), and associate specialists (AS). INTERVENTION: Presentation of the hypothetical scenario of a patient presenting with recent onset (fresh) vitreous haemorrhage with no retinal view and no apparent cause on history taken at presentation. OUTCOME MEASURES: The relative importance assigned by respondents to eight examination techniques at presentation. The proportion of respondents stating that they would review patients and perform B-scan examination at or prior to 2 weeks after presentation. The stated time to surgical intervention by VRS, and the time to referral by NVRS and AS. RESULTS: VRS ranked B-scan examination higher than AS (P<0.001). A total of 98.1% of VRS indicated that they would next review patients within 2 weeks of presentation, this figure fell to 86.5% for NVRS and 47% for AS (P<0.001). A 98.1% of VRS indicated that they would next perform B-scan ultrasound within 2 weeks of presentation, this figure fell to 88.9% for NVRS and 70.6% for AS (P<0.001). The mean time to surgical intervention by VRS was 9.5 weeks without retinal tear demonstrated on B-scan, 1.7 weeks with retinal tear demonstrated on B-scan and 1 week with retinal detachment demonstrated on B-scan. The mean time to referral by NVRS was 6.7 weeks and by AS was 11.9 weeks. CONCLUSIONS: Vitreoretinal specialists considered B-scan the most important examination tool, and typically perform B-scan early and frequently after presentation. Non-VR ophthalmologists (particularly associate specialists) review patients and perform B-scan ultrasound later and less often than vitreoretinal specialists. We recommend early referral to VR specialists, as reported referral even in uncomplicated cases would often be outside the timeframe within which VR specialists would typically choose to operate.     

孔源性视网膜脱离中玻璃体后脱离的诊断评价

目的 对孔源性视网膜脱离(RRD)患者完全性玻璃体后脱离(PVD)的情况进行分析,研究RRD中PVD发生率以及不同诊断方法的准确性.方法 前瞻性病例系列研究.采用前置镜、超声、光学相干断层扫描(OCT)诊断PVD,与术中采用曲安奈德(TA)染色观察PVD进行比较.我院住院治疗RRD患者30例(30眼),所有患者术前行裂隙灯下前置镜眼底、超声和OCT检查玻璃体情况.玻璃体切除手术中采用TA辅助玻璃体染色作观察PVD的金标准,比较各种术前玻璃体检查方法对于诊断PVD的准确性和特异性.数据采用Kappa检验进行分析.结果 通过对不同检查方法对于诊断完全性PVD发生率进行比较,我们发现各种诊断方法间存在明显的差异,术中TA染色中发现完全性PVD发生率为10.0％;B超诊断完全性PVD发生率为76.7％,眼底检查诊断完全性PVD发生率为36.7％,OCT检查诊断完全性PVD发生率为13.3％,其中B超检查与术中发现的差异性最大.结论 在RRD中完全性PVD发生率较低.现有各种术前检查方法有其局限性,而术中TA染色,能够更好的显示玻璃体皮质残留.     

环扎加压术后玻璃体的短期改变

目的 分析环扎加压手术后玻璃体的短期改变。方法 采用超声和临床检查分析接受环扎加压术的76眼术前到术后短期内玻璃体的改变。结果41眼（53.9％）术后玻璃体内混浊物质增多。术前超声检查下后极区完全玻璃体后脱离（PVD）、部分PVD和无PVD者分别为20,34和22眼,而术后初次超声检查时则为46,26和4眼。结论在环扎加压术后,相当一部分眼术后短期内出现后极区PVD的范围迅速扩大。与黄斑中心凹周围相比,这种急性的PVD更多地首先发生于视盘区。     

孔源性视网膜脱离中玻璃体后脱离的诊断评价

Objective To investigate the prevalence of complete posterior vitreous detachment in rhegmatogenous retinal detachment （RRD） patients and to evaluate the following diagnostic tests： fundus examination， B-scan ultrasound and optical coherence tomography （OCT）. Methods Thirty patients （30 eyes） with RRD who underwent vitrectomy in Shanghai First People′s Hospital were included in this prospective case-series study. Patients received comprehensive ocular examinations that included fundus examination， B-scan ultrasound and OCT. TA stain （triamcinolone acetonide） was used to assist during the vitrectomy surgery as well as being the gold standard for PVD diagnosis. Data were analyzed using a Kappa test. Results The rate of detection for the prevalence of complete PVD was as follows： 10.0% by TA stain， 76.7% by B-scan， 36.7% by fundus examination and 13.3% by OCT. Different rates of PVD detection were found by the above examinations and， of these， the difference was most significant between B-scan and observation during surgery. Conclusion Observation during surgery with the help of TA is comparatively the most persuasive diagnostic method for PVD. Different examination methods can be selected for individual cases.     

高度近视眼中心凹脱离伴视网膜劈裂的形态学观察

目的观察高度近视眼中心凹脱离伴视网膜劈裂的形态学特征,并探讨高度近视眼玻璃体、黄斑及后巩膜葡萄肿三者间的关系。设计回顾性病例系列。研究对象29例(38眼)高度近视眼中心凹脱离伴视网膜劈裂的患者。方法所有患者均进行裂隙灯前置镜、三面镜、直接或间接检眼镜、B超及相干光断层扫描(OCT)检查,观察黄斑中心凹脱离及视网膜劈裂的形态及其与玻璃体以及后巩膜葡萄肿的关系。其中10眼行玻璃体手术。主要指标形态学特征。结果裂隙灯前置镜、三面镜检查见视网膜成微囊样改变并浅脱离,未见黄斑裂孔。B超显示后极部视网膜水肿或浅脱离0.5~2.0mm。所有38眼的OCT扫描均显示黄斑区神经上皮脱离;未显示黄斑裂孔;神经上皮层劈裂,表现为内层劈裂、外层劈裂和双层劈裂,劈裂的内外层视网膜之间可见桥柱样连接;3眼黄斑区未见劈裂,扫描至后巩膜葡萄肿边缘附近见视网膜劈裂;视网膜前存在低反射细光带(玻璃体后皮质),且与视网膜间存在点、线及片状粘连,相应粘连处视网膜被牵引。10眼玻璃体手术中见玻璃体液化、不完全后脱离,后极部玻璃体后皮质与视网膜粘连紧密,尽量剥除后皮质,术后视网膜均复位。结论OCT可清晰显示高度近视眼中心凹脱离伴视网膜劈裂的形态特征,来自玻璃体皮质的牵引及后巩膜葡萄肿因素是导致视网膜劈裂的主要原因。     

Diagnostic Ultrasound and Pars Plana Vitrectomy in Endophthalmitis

Purulentendophthalmitisistheinfectiousinflammationofeye.Whensevereendophtha鄄lmitisoccurs,vitreousbodyisofteninvolved,whichshowsopaqueandabscessformation.Whentheuveaandretinaareinvolved,theyshowswelling,ischemiaandexudates.Whenthelensisinvolved,itshowedopaqueanddegener鄄ated.Inclinical,mediaopacitiessuchastheex鄄udatesinanteriorchamber,cataractorcornealinfiltrationprecludetheophthalmoscopicevalua鄄tionofvitreousbody,whichmayaffectthedeci鄄sionofsurgery.B鄄scanultrasonographycanpro鄄videmuchin…     

老年人急性玻璃体后脱离的B超分析

目的 利用眼底检查和B型超声检查相结合,探讨观察急性PVD时的玻璃体和视网膜的情况.方法 通过2007年10月至2009年12月期间搜集老年人1周内有症状的急性PVD患者66人66只眼进行临床检查和分析,所有患眼均由间接检眼镜、VOLK90D详细检查视网膜和黄斑情况及B超作详细探测.结果 66只眼经B超检查发现完全性PVD56只眼,不完全性PVD10只眼.发现视网膜裂孔2只眼,未发现视网膜脱离.PVD的发生、发展与黄斑裂孔无明显相关性.结论 本组病例老年人PVD引起的视网膜裂孔发病率低(2/66),B超可作为探查PVD简单有效方法,而全面检查眼底可发现早期干性裂孔,及时诊断、及时光凝可令患眼得到良好预后.

Abstract：

Objective To observe vitreous and retinal changes at acute PVD by B-scan combined with fundus examination. Methods Sixty-six eyes with acute-onset of age-related PVD in one week were enrolled Comprehensive eye examination including vitreous and retinal biomicroscopy was perfonned followed by B-scan from October 2007 to December 2009. Results Fifty-six eyes were found with complete PVD and 10 eyes with partial PVD. Two eyes suspected with retinal tears were diagnosed after ffindus examination but missed in B scan. There was no sigiificant association between the presence of PVD and macular hole. Conclusions The incidence of retinal breaks in acute symptomatic age-related PVD is low in these cases (2/66). B-scan is a useful complementary in therapy and prognosis.     

The use of colour Doppler imaging in the diagnosis of retinal detachment

DESIGN: Prospective study. PURPOSE: To evaluate real-time duplex colour Doppler examination with colour and pulse Doppler ultrasonography (US) (colour Doppler imaging (CDI)) for detection of the retinal detachment from membranous structures in the posterior segment. MATERIALS AND METHODS: In 33 consecutive patients with ophthalmoscopically invisible eyes (34 eyes), CDI was performed to detect the presence or absence of retinal detachment. The diagnostic criterion for retinal detachment was whether or not spectral waveforms were detected in membranous structures with colour and pulse Doppler US. In all cases, the absence or presence of retinal detachment was confirmed by surgery. RESULTS: In 27 of 34 eyes, membranes and/or opacities were observed in the vitreous cavity with CDI. In 12 of these 27 eyes, blood flow in those structures was detected by CDI. In all of these 12 eyes, retinal detachment was confirmed at surgery, and in 14 of the 15 eyes in which blood flow was not detected by CDI, absence of retinal detachment was confirmed at surgery. When a diagnosis confirmed by surgery was used as the definitive finding, CDI had a sensitivity of 92.3%, specificity of 100%, positive predictive value of 100%, negative predictive value of 93.3%, and an accuracy in the detection of retinal detachment from membranes and/or opacities in the vitreous cavity of 96.3%. CONCLUSION: Real-time duplex colour Doppler examination with colour and pulse Doppler US (CDI) is a noninvasive method useful for the detection of retinal detachment from vitreous opacity and/or membrane in the posterior segment.