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Meira Neudorfer, Adiel Barak, Aya Barzelay, Ari leshno; Diagnosis of pars plana retinoschisis using ultrasound biomicroscopy. Invest. Ophthalmol. Vis. Sci. 2018;59(9):1504.
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© ARVO (1962-2015); The Authors (2016-present)
Differential diagnosis of retinoschisis (RS) from retinal detachment (RD) can be challenging, especially when the lesion is very anterior. Advances in ultrasound biomicroscopy (UBM) enable high-quality visualization of even the most peripheral retinal areas. We describe new UBM findings in RS that can help establish diagnosis.
Medical records of subjects diagnosed with RS and RD who underwent UBM examinations prior to any intervention were retrospectively collected. Clinical data and UBM, US B-scan and SD-OCT images were obtained. The US B-scans and UBM examinations were performed with the Aviso S instrument (Quantel Medical, Clermont-Ferrand, France) at 10 and 50 MHz, respectively. All images were obtained on the same day. They were evaluated for detachment shape (e.g., flat membranous, dome or irregular) by the US B-scan, and for the presence of intra-retinal pillars, retinal layer splits and intra-retinal cysts by UBM.
A total of 48 eyes of 48 patients were eligible for analysis, of which 25 were diagnosed as RS and 23 as RD. In 23 cases, the lesion had a flat membranous shape on the US B-scan which was distributed almost equally between the RD (n=11, 47.8%) and RS (12, 52.2%) groups. All the dome-shaped cases (n=13) were in the RS group, and all the irregular-shaped cases (n=11) were in the RD group. A retinal layer split was the most common finding on UBM in the RS group (72%), followed by intraretinal pillars (64%) and intraretinal cysts (36%). These findings were absent in all the cases in the RD group (P<0.001). In a subgroup analysis of the flat membranous-shaped cases, only retinal layer splits and intraretinal pillars remained significant (P<0.001 and P=0.002, respectively)
Advances in UBM enable good quality high-resolution imaging of even the most peripheral retinal areas. The three herein described lesion types as observed by UBM were present only in RS cases. Identification of these lesions might help distinguish RS from RD in difficult cases when the morphology is not distinctive (e.g., flat membranous shape), and especially when the anterior retinal areas cannot be demonstrated adequately by other imaging modalities.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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