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Ultrasound Biomicroscopy (UBM) for Preoperative Assessment of Traumatic Cataract Surgery

Ultrasound Biomicroscopy (UBM) for Preoperative Assessment of Traumatic Cataract Surgery Matthew Gewirtz, MD Tatiana Forofonova, MD Suqin Guo, MD Supported in part by an Unrestricted Grant from Research to Prevent Blindness, Inc. and The Lions Eye Research Foundation of New Jersey Setting

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Ultrasound Biomicroscopy (UBM) for Preoperative Assessment of Traumatic Cataract Surgery

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  1. Ultrasound Biomicroscopy (UBM) for Preoperative Assessment of Traumatic Cataract Surgery Matthew Gewirtz, MD Tatiana Forofonova, MD Suqin Guo, MD Supported in part by an Unrestricted Grant from Research to Prevent Blindness, Inc. and The Lions Eye Research Foundation of New Jersey

  2. Setting Institute of Ophthalmology and Visual Science UMDNJ – New Jersey Medical School Newark, NJ

  3. Purpose To assess the ocular anatomy with UBM prior to traumatic cataract surgery for appropriate preoperative planning

  4. Methods • Twelve patients who sustained closed eye trauma and underwent UBM examination between January 2003 and January 2006 were evaluated retrospectively • Clinical indications for UBM test were: cataract, foreign body, hyphema, corneal opacities, angle recession, hypotony • UBM with high frequency ultrasound (50 MHz) with high resolution was used to obtain the images

  5. Methods • The probe was positioned in the eyecup in the axial position and in 12, 3,6 and 9 o’clock meridians to evaluate anterior part of the eye, then the probe was moved back in the same meridians to evaluate ciliary body and peripheral retina • UBM was evaluated for cornea ( FB, scars), AC depth and contents of the AC, AC angle, lens, its position and capsules, iris-lens contact

  6. Methods • Special attention was paid to zonules, iris-zonules distance, iris-lens contact • Lens zonules were measured as whether they were present or disorganized

  7. Results CDC-Cyclodialysis Cleft. ID-Iridodialysis, CS-Corneal Scar *-Dislocated Lens

  8. Results • Nine of twelve patients (75%) had zonule abnormalities • Seven of nine patients (78%) with zonule abnormalities had a deeper anterior chamber • Four of nine patients (44%) with zonule abnormalities had a dislocated lens • Another common finding of interest was cyclodialysis cleft (6 of 12 pts)

  9. Cornea Irregular Iris No Iris-Lens Contact No Zonules

  10. Disrupted Zonules

  11. Normal Zonules

  12. Cyclodialysis Cleft

  13. Conclusion • We concur with the recommendation that UBM is very helpful after a traumatic globe injury • It can reliably visualize vital ocular structures which cannot be seen on clinical exam • Can determine whether zonule defects are present and the extent

  14. Conclusion • Our review showed another possible indicator of zonule abnormalities • Anterior chamber depth • Clinicians without UBM can use the A-Scan to screen patients which could benefit from UBM examination

  15. Conclusion • Helpful to know the area of zonule disruption • Mostly occurred superior and temporal in our review • McWhae, et al • 90.5% of the defects involve the superior 180 degrees • This is significant as this is where many surgical incisions occur

  16. Conclusion • In addition to zonule abnormalities, UBM can accurately visualize • Angle recession • Cyclodialysis • Peripheral Anterior Synechiae formation • Iridodialysis

  17. Conclusion • With the data collected from UBM • Adequate preoperative planning • Patient can be given all the information needed to give a proper informed consent • Have a realistic idea of outcomes

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