High Resolution Ultrasound of the Peripheral Globe After Multiple Intravitreal Injections

Abstract

Purpose: : To detect and characterize any abnormalities that occur in the peripheral globe of patients who have undergone multiple intravitreal injections in one eye.

Methods: : High-resolution ultrasound (20MHz) was performed to evaluate the peripheral globe of both eyes in 10 patients who had received five or more intravitreal injections inferotemporally in one eye. The injected eye was the study eye while the fellow eye (with no history of intravitreal injection) served as a control. All eyes were evaluated using both transverse and longitudinal scans with a 20 MHz probe. Contact B-scan screening of the posterior segment using a 10 MHz probe was also performed.

Results: : Seven women and three men were evaluated for this study. All patients received at least 5 intravitreal injections (mean 6.3) and all were being treated for age-related macular degeneration. Seven of the patients had been treated with various agents over the course of treatmet. Three were treated wtih the same agent for all injections. A focal area of increase scleral thickening was noted at the injection site in one patient. No vitreoretinal or vitreociliary adhesions were noted in any patient. One ciliary body cyst was noted in a single patient and pars plana cysts were detected temporally in four patients. Two patients had single cysts temporally in the injected eye and two patients had bilateral cysts. Retinal detachment was not detected in any of the patients.

Conclusions: : Injection related complications after intravitreal injections are well known, but possible long-term structural changes to the globe have not been well studied. While conventional ultrasound is useful to evaluate the posterior segment, high-resolution ultrasound allows imaging of the peripheral globe yielding information about abnormalities that cannot be seen with a standard eye examination and imaging modalities. This small study suggests that the globe can tolerate multiple intravitreal injections without significant structural change.

Keywords: imaging/image analysis: clinical • imaging methods (CT, FA, ICG, MRI, OCT, RTA, SLO, ultrasound)