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Umiya Agraval, Wilma Kincaid, Sanjay Mantry, Kanna Ramaesh; Predicting Anterior Segment Surgical Anatomy: Application of Ultrasound Biomicroscopy (UBM) in Surgical Intervention. Invest. Ophthalmol. Vis. Sci. 2014;55(13):4847.
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Difficulty in assessing the integrity of the anterior segment structures due to poor visibility can make surgery unpredictable. Planning reconstructive surgery of the anterior segment in the presence of an opaque cornea, corneal oedema, poorly dilated pupils, previous surgery or trauma can be a surgical challenge. A clear surgical anatomy is essential for planning anterior segment surgery. In this study we report the correlation between high resolution Ultrasound Biomicroscopy (UBM) findings with that of surgical findings.
In total 12 eyes, underwent a UBM prior to surgical intervention, to assess and identify the anterior segment abnormalities where delineating surgical anatomy is not otherwise possible. UBM was performed according to standard protocols; scans were performed in all meridians. The structures and functions of interest are to specifically identify the status of posterior capsule, zonular integrity, depth of corneal scarring and mechanism of acute glaucoma of unknown aetiology. Correlations between UBM and surgery were noted intra-operatively.
We found a very high degree of correlation between UBM and surgical findings. Identification of the integrity of the posterior capsule and zonules allowed appropriate intra-ocular lens implantation. The depth of corneal scarring helped to define the type of corneal graft surgery. In the cases of complex secondary acute glaucoma associated with severe corneal oedema, the mechanisms and the dynamics of the iris correlated with the predication made from the UBM.
The use of UBM has been identified as a safe and effective imaging tool to assess the anatomy and pathology of the anterior segment, including cornea, iridocorneal angle, anterior chamber, iris, ciliary body and lens. However, its use for complex cases with poor visibility is often under utilised. The UBM images correlated well with surgical findings of complex anterior segment surgical pathological anatomy. UBM is particularly useful in the surgical planning and management of complex glaucoma that presents with significant corneal oedema. The diagnostic role is of UBM is valuable and we recommend its use prior to surgical intervention for complex cases of which visualisation of structures is compromised.
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