B-scan ultrasonography following open globe repair

Abstract

Purpose: To examine the accuracy and predictive ability of B-scan ultrasonography in the post-repair assessment of an open globe injury.

Methods: In all, 965 open globe injuries treated at the Massachusetts Eye and Ear Infirmary between 1 January 2000 and 1 June 2010 were retrospectively reviewed. A total of 427 ultrasound reports on 210 patients were analyzed. Ultrasound reports were examined for the following characteristics: vitreous hemorrhage, vitreous tag, retinal tear, RD (including subcategories total RD, partial RD, closed funnel RD, open funnel RD, and chronic RD), vitreous traction, vitreous debris, serous choroidal detachment, hemorrhagic choroidal detachment, kissing choroidal detachment, dislocated crystalline lens, dislocated intraocular lens (IOL), disrupted crystalline lens, intraocular foreign body (IOFB), intraocular air, irregular posterior globe contour, disorganized posterior intraocular contents, posterior vitreous detachment, choroidal vs retinal detachment, vitreal membranes, and choroidal thickening. The main outcome measure was visual outcome at final follow-up.

Results: Among 427 B-scan reports, there were a total of 57 retinal detachments, 19 retinal tears, 18 vitreous traction, 59 serous choroidal detachments, 47 hemorrhagic choroidal detachments, and 10 kissing choroidal detachments. Of patients with multiple studies, 26% developed retinal detachments or retinal tears on subsequent scans. Ultrasound had 100% positive predictive value for diagnosing retinal detachment and IOFB. The diagnoses of retinal detachment, disorganized posterior contents, hemorrhagic choroidal detachment, kissing choroidal detachment, and irregular posterior contour were associated with worse visual acuity at final follow-up. Disorganized posterior contents correlated with particularly poor outcomes.

Conclusions: B-scan ultrasonography is a proven, cost-effective imaging modality in the management of an open globe injury. This tool can offer both diagnostic and prognostic information, useful for both surgical planning and further medical management.

Figure 1

Ultrasonography examples in ocular trauma. (a) A 71-year-old man with a ruptured globe in a motor vehicle accident. The wound involved zones II and III. B-scan performed 20 days after operation showed loose and membranous vitreous debris, flattening of the globe, and diffuse choroidal thickening with bulging of the optic nerve into the eye suggestive of hypotony. At 2 months after operation, the patient had light perception vision with phthisis. (b) A 14-year-old female who sustained a BB to the eye with retained intraocular FB. B-scan 24 days after the repair and removal of the BB showed a V-shaped membrane, nonmobile, diffusely thickened with cystic components, attaching at the optic nerve, suggestive of a total open funnel retinal detachment. This was verified and repaired 1 week later with PPV/retinectomy/laser and oil. She ultimately developed LP vision and pain and received a retrobulbar chlorpromazine injection for pain. (c) A 76-year-old man with a blunt rupture of his globe resulting in a ruptured extracapsular cataract extraction wound, limbal laceration, and uveal extrusion. B-scan 2 days after the repair showed large dome-shaped membranous elevations containing nonmobile moderate reflective debris with anterior attachment suggestive of non-kissing hemorrhagic choroidal detachments. An overlaying membrane off the base of the choroidal detachment is suggestive of a retinal detachment. After 6 weeks, B-scan showed shallow choroidal detachment, and total retinal detachment. He then underwent scleral buckle, lensectomy, PPV, laser and gas 6 weeks later. Final vision was LP. (d) A 57-year-old man with a blunt rupture resulting in a zone II and III scleral rupture. B-scan 5 weeks later showed diffusely thickened, nonmobile, V-shaped membrane with a point of attachment at the optic nerve, representing a total funnel retinal detachment. After 2 months, the patient had no light perception vision with phthisis.