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C. C. Chow, J. de la Cruz; Ultrasound Biomicroscopy as a Preoperative Tool for Surgical Planning in Patients With Congenital Corneal Opacities. Invest. Ophthalmol. Vis. Sci. 2009;50(13):3701.
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Congenital corneal opacities, including Peters' anomaly, sclerocornea, and congenital glaucoma are rare but often bilateral conditions in which disease severity and associated anterior segment findings vary widely. Childhood blindness can result from either corneal opacity or glaucoma, for which surgery is the mainstay of treatment. Unfortunately, anatomic features are often difficult, if not impossible, to assess by slit-lamp exam alone. Ultrasound biomicroscopy (UBM) is a well-established tool for examination of the anterior segment, in such disease states as glaucoma, ocular trauma, and iris tumors. Here we assess the utility of UBM as a preoperative tool in congenital corneal opacification.
Ultrasound biomicrosocopy was performed with a 35 Mhz Sonomed probe for preoperative evaluation of the anterior segment anatomy of infants with Peters' anomaly, sclerocornea, and congenital glaucoma.
UBM in a patient with bilateral Peters' anomaly revealed keratolenticular and iridocorneal adhesions. This led to the refinement of diagnosis of Peters' Type II, therefore directing management toward lens extraction and anterior vitrectomy prior to keratoplasty. Another patient with bilateral Peters' anomaly developed corneal opacity after a successful rotational autograft for about 5 months. UBM showed edema and scarring of graft, irregular iris formations, and peripheral anterior synechiae, which led to the use of a Boston keratoprosthesis Type I implant. UBM in a sclerocornea patient revealed a thick cornea, iridocorneal adhesions, and resorbed lens in both eyes, which led to the successful planning and implementation of a combined corneal transplant, vitrectomy, and Ahmed valve. Finally, UBM in a patient with congenital glaucoma status post a failed PKP revealed iridocorneal adhesions as well as a scarred angle, which also led to the selection of a Boston keratoprosthesis Type I implant.
UBM has proven to be an invaluable preoperative tool to detect anterior segment abnormalities associated with congenital corneal opacities and aids in preoperative planning of anterior segment surgeries.
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