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Narine Viruni, Tin Yan Alvin Liu, Sarah Wang, Alice Yang Zhang, James T Handa; The Diagnostic Utility of Ultrasound in the Management of Severe Corneal Ulcers and Non-infectious Corneal Melt. Invest. Ophthalmol. Vis. Sci. 2018;59(9):4672. doi: https://doi.org/.
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Corneal ulcer and non-infectious corneal melt carry significant morbidity. Both may promote inflammation in the anterior chamber, raising concern for intraocular extension of infectious or inflammatory processes. In the absence of a clear view to the posterior segment, echography is frequently performed. The purpose of this study is to systemically describe ultrasound studies to determine how echography affects the management of severe corneal ulcers and non-infectious corneal melt.
The case logs of the Ophthalmic Ultrasound Division at the Wilmer Eye Institute were reviewed. Ultrasound studies performed for “vitreous opacity” were selected and patients with corneal ulcers and non-infectious corneal melt were included. Two retinal specialists performed the grading for the ultrasound studies in a masked fashion. Ultrasound studies with <10%, 10 to 40%, 50 to 90% and > 90% involvement of the posterior segment were graded as very low risk, low intermediate risk, high intermediate risk, and very high risk, respectively. Discrepancies between the two graders were reconciled during a second round of grading.
A total of 500 studies were reviewed. 34 of the 500 studies were performed on patients with corneal ulcers (45.1% male, median age 57 years (range 10-91)), and 8 studies on patients with corneal melts (62.5% male, median age 86 years (51-94)). Within the corneal ulcer group, 21 (61.8%) were found to have a positive corneal culture (28.6% gram positive, 23.8 % gram negative, 11.9% amoebic and 4.8% fungal).
Within the corneal melt group, anterior chamber inflammation does not seem to be a prominent feature, as none of the patients in this group had a hypopyon (Figure 1). Also, our data suggests that posterior segment inflammation is rare in this group, as none were graded to be in the very high risk group.Within the corneal ulcer group, 76% of the patients were graded as a very low risk group and only 5.9% as a very high risk group, suggesting extension of the infection into the posterior segment is uncommon. Within the very high risk group, the smallest corneal ulcer size was 5mm and the smallest hypopyon size was zero (Figure 2). Given these findings, there should be a low threshold for obtaining an ultrasound if the corneal ulcer size is larger than 5mm, with or without a hypopyon.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
Corneal melt subgroup analysis
Corneal ulcer subgroup analysis
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