Value of high-frequency ultrasound biomicroscopy in uveitis

PURPOSE

To determine the use of high-frequency ultrasound biomicroscopy (UBM) in the assessment of inflammatory lesions of the iris, ciliary body, pars plana and peripheral vitreous, and in particular to determine the proportion of cases for which UBM contributed significant additional, hitherto inaccessible, information.

METHODS

Charts of patients seen in the uveitis clinic at University Eye Hospital from November 1994 to September 1999 for whom a UBM investigation had been performed were analysed. UBM was performed in a standard manner, using a Humphrey UBM 840 system. The clinical relevance of the UBM findings was determined for the whole series and for the following six subgroups of patients arbitrarily established according to the type and location of pathology: hypotony, pseudophakic uveitis, iris and ciliary body pathology excluding hypotony, pars plana pathology, scleritis and Toxocara uveitis. Findings were classified as positive when they confirmed a suspected diagnosis of lesional process or when they gave essential information. Findings were classified as essential when they led to the diagnosis or when they modified therapeutic intervention.

RESULTS

During the study period 111 eyes of 77 patients were included. UBM findings contributed essential information that allowed a diagnosis to be reached or that influenced treatment in 43% of cases. It yielded positive findings in 91% of cases, enabling assessment of morphological changes in the iris, ciliary body, and retroiridal and peripheral vitreous induced by intraocular inflammatory or pseudo-inflammatory disorders. Specific UBM signs, present in all patients, were identified in Toxocara uveitis. The groups of patients that benefited most from UBM examination were those with hypotony (83% essential findings) and opaque media (100% essential findings).

CONCLUSION

For uveitis patients with an inflammatory process situated in the iris/ciliary body/pars plana/retroiridal vitreous areas, UBM was of great clinical value and improved the management in a significant manner.

Ultrasound biomicroscopic imaging in intermediate uveitis

BACKGROUND

Clinical examination of the region of the eye mainly affected in patients with intermediate uveitis is difficult and often hampered by media opacities. In that perspective ultrasound biomicroscopy (UBM) promises to be a valuable additional diagnostic tool.

METHODS

UBM was performed at a sound frequency of 50 MHz on 26 eyes of 13 patients with intermediate uveitis in order to determine configuration of pars plana, peripheral retina, and vitreous. Findings of ophthalmoscopy with scleral indentation and UBM were compared.

RESULTS

In 18 of 26 eyes pathological structures such as membraneous or fluffy vitreous condensations were identified by UBM. Among these UBM revealed pathological findings which were not visible on funduscopy in nine eyes. Most importantly, vitreoretinal adhesions with traction on the retina were imaged in four eyes. However, in three eyes vitreous opacities being visible on funduscopy were not identified by UBM.

CONCLUSION

UBM seems to be a valuable diagnostic technique for the evaluation of patients with intermediate uveitis. Longitudinal studies will have to determine the relevance of UBM findings for the individual clinical course and their influence on therapeutic decisions.

Ultrasound biomicroscopy in pars planitis

PURPOSE

To report the diagnosis of pars planitis on the basis of ultrasound biomicroscopy images.

METHODS

The Humphrey ultrasound biomicroscope was used for examination of the right eye of a 17-year-old boy, referred to our clinic because of blurred vision. The lens showed a posterior subcapsular cataract precluding fundus visualization.

RESULTS

Ultrasound biomicroscopy showed a homogeneous mass of medium reflectivity over the pars plana. Lensectomy and vitrectomy confirmed the diagnosis.

CONCLUSION

This brief case report points out the utility of ultrasound biomicroscopy in diagnosing pars planitis in cases of media opacities.

Grading of pars planitis by ultrasound biomicroscopy--echographic and clinical study

OBJECTIVE

To determine the value of high frequency ultrasound biomicroscopy (UBM) in the assessment of pars planitis, and in particular to correlate UBM findings and ophthalmoscopy findings.

METHODS

All patients with pars planitis were identified from the uveitis database of the Department of Ophthalmology, University of Aberdeen. Fifteen consecutive patients (age 14-52 years) underwent complete ophthalmological examination. UBM was performed at a sound frequency of 50 MHz on 17 eyes of 10 patients to determine the extent of disease. UBM findings were evaluated by two investigators in a blinded fashion and graded from 0 to 3 according to the following grading criteria: 0=no cells, 1=mild cells, 2=marked cells, 3=organization of cells. Opthalmoscopy findings were also graded using the same criteria. UBM and ophthalmoscopy findings were independently graded and compared.

RESULTS

We found a good inter-observer correlation for the UBM grading of pars planitis (rho=0.86). There was no significant difference in the grading of pars planitis by indirect ophthalmoscopy as compared to grading by UBM (P>0.05).

CONCLUSION

UBM appears to be a valuable and reliable diagnostic technique for the evaluation of patients with pars planitis and may be useful especially in patients with media opacities to diagnose and/or monitor efficacy of treatment.

Ultrasound biomicroscopy in the diagnosis and management of pars planitis caused by caterpillar hairs

PURPOSE

To report the use of ultrasound biomicroscopy in the detection of caterpillar hairs in the pars plana in a patient with unilateral pars planitis.

METHOD

Ultrasound biomicroscopic imaging of the anterior segment of the eye.

RESULTS

Ultrasound biomicroscopy located a hair in the posterior chamber at the first visit and five more in the pars plana 1 month later. This finding was confirmed intraoperatively.

CONCLUSION

Ultrasound biomicroscopy is useful in the diagnosis and management of unilateral pars planitis of uncertain cause.

Review for Disease of the Year Clinical Features and Ocular Imaging in Intermediate Uveitis and Pars Planitis

Intermediate uveitis is a relatively common form of intraocular inflammation that can be seen at any age. The vitreous is the primary site of inflammation; and the presence of snowballs or snowbank defines its subtype, pars planitis. Since it is a clinical diagnosis, it is important to recognize the typical clinical features and associated ocular complications. Recent advances in ocular imaging have made significant contributions to the clinical appraisal and studies of intermediate uveitis. This narrative review includes clinical signs, ocular complications, and ocular imaging of intermediate uveitis and pars planitis.