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S. Y. Hu, G. W. Zaidman; Correlation Between Ultrasound Biomicroscopy (UBM) and Intraoperative Findings in Patients With Congenital Corneal Opacities (CCO). Invest. Ophthalmol. Vis. Sci. 2010;51(13):5668.
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Diagnosing and treating infants with congenital corneal opacities in Peter’s anomaly, sclerocorena, congenital glaucoma and hereditary corneal dystrophies can be challenging. The young age of the patient and their poor cooperation makes it difficult to assess the extent of their anterior segment pathology by biomicroscopy alone. UBM is a non-invasive technique that can offer detailed anterior segment images while children are undergoing ocular exams under anesthesia. Our aim is to investigate the accuracy and usefulness of UBM in the management and preoperative planning of children with congenital corneal opacities.
15 eyes of 9 children were examined by a single experienced operator using an ultrasound biomicroscope (VuMax). All eyes examined had CCO preventing direct visualization of the anterior segment. 13 eyes then underwent penetrating keratoplasty (PKP). The intraoperative findings were compared to the preoperative findings on the UBM.
In the 9 children, ages 2 weeks to 21 months, there were 5 eyes with congenital glaucoma (CG), 2 eyes with congenital hereditary endothelial dystrophy (CHED), 5 with Peters Anomaly (PA), 2 with sclerocornea and 1 with an anterior corneal staphyloma. In PA, UBM revealed synechiae and a normal lens in 4 eyes but showed a cataract and synechiae in 1 eye, refining the diagnosis of PA to Type I and Type II respectively. In other eyes, UBM helped diagnose 2 cases of aphakia, 1 focal cataract, 2 dense cataracts, 1 dislocated cataract, and 2 misplaced tube shunts. The pre-operative data enabled preparation for intraocular lens implant and vitrectomy prior to surgery. It also provided a basis for the surgeon to advise families about visual prognosis. Overall, the UBM findings changed the diagnosis and surgical plan in 7 patients. In all 13 eyes that underwent PKP, findings seen on the pre-op UBM were confirmed intraoperatively.
UBM is an invaluable tool in the preoperative assessment of children with congenital corneal opacities. It helps to clarify the diagnosis, enables better surgical planning and assists in counseling families regarding prognosis prior to surgery.
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