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G. Yiu, A. S. Shah, M. T. Andreoli, L. Hart, S. Mukai, C. M. Andreoli; B-Scan Ultrasonography in the Evaluation of Intraocular Abnormalities After Open Globe Repair. Invest. Ophthalmol. Vis. Sci. 2010;51(13):6029.
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To evaluate the prognostic value of B-scan ultrasound findings after open globe repair (OGR).
55 patients who presented to the Massachusetts Eye & Ear Infirmary from 2001 to 2007 for OGR and had a B-scan within 7 days were identified. Patient charts were reviewed with respect to mechanism and location of globe injury, B-scan findings, and best-corrected visual acuity (BCVA) at presentation and up to 5 years post-operatively (median follow-up 242 days). The relationship of B-scan findings to final clinical outcome after OGR as measured by BCVA at the last visit was evaluated by logistic regression analysis.
Patients ranged from 2 to 94 years (median 45) with 78% male, and included both rupture (47%) and penetrating (53%) injuries involving Zone I in 56%, Zone II in 47% and Zone III in 16%. Mechanisms included fall (20%), projectile (13%), nail (15%), blunt trauma (18%), and others (34%). BCVA at presentation was ≤20/400 in 87%, 20/50-20/200 in 11%, and ≥20/40 in 2%. B-scan findings included retinal tear (11%), retinal detachment (25%), choroidal detachment (60%), vitreous abnormalities (71%), lens abnormalities (22%), and globe abnormalities (18%). These findings were further subcategorized: retinal detachment (64% partial, 36% total), choroidal detachment (64% serous, 36% hemorrhagic), vitreous abnormalities (28% "membrane" or "tag", 25% "traction", 85% "debris"), lens abnormalities (25% "dislocated", 75% "disrupted"), and globe abnormalities (30% "disturbed contents", 80% "irregular contour"). On follow-up, BCVA was ≤20/400 in 49%, 20/50-20/200 in 15%, and ≥20/40 in 36% of patients. While most B-scan findings including retinal or choroidal detachments, or vitreous, lens, or globe abnormalities were associated with poorer BCVA, only hemorrhagic choroidal detachments were statistically significant (P<0.005).
B-scan ultrasonography after OGR can provide additional details about the posterior segment not identified in OGR surgery or on pre-operative CT scan. Specific B-scan findings such as hemorrhagic choroidal detachments may have prognostic value on a patient’s long-term clinical outcome, and can help guide the planning of secondary surgical procedures. These results support the utility of early B-scan after open globe repair.
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