Search

Importance: Ocular symptoms represent approximately 2% to 3% of all emergency department (ED) visits. These disease processes may progress to permanent vision loss if not diagnosed and treated quickly. Use of ocular point-of-care ultrasonography (POCUS) may be effective for early and accurate detection of ocular disease., Objective: To perform a large-scale, multicenter study to determine the utility of POCUS for diagnosing retinal detachment, vitreous hemorrhage, and vitreous detachment in the ED., Design, Setting, and Participants: A prospective diagnostic study was conducted at 2 academic EDs and 2 county hospital EDs from February 3, 2016, to April 30, 2018. Patients who were eligible for inclusion were older than 18 years; were English- or Spanish-speaking; presented to the ED with ocular symptoms with concern for retinal detachment, vitreous hemorrhage, or vitreous detachment; and underwent an ophthalmologic consultation that included POCUS. Patients with ocular trauma or suspicion for globe rupture were excluded. The accuracy of the ultrasonographic diagnosis was compared with the criterion standard of the final diagnosis of an ophthalmologist who was masked to the POCUS findings. Seventy-five unique emergency medicine attending physicians, resident physicians, and physician assistants performed ocular ultrasonography., Exposure: Point-of-care ultrasonography performed by an emergency medicine attending physician, resident physician, or physician assistant., Main Outcomes and Measures: Sensitivity and specificity of POCUS in identifying retinal detachment, vitreous hemorrhage, and vitreous detachment in patients presenting to the ED with ocular symptoms., Results: Two hundred twenty-five patients were enrolled. Of these, the mean age was 51 years (range, 18-91 years) and 135 (60.0%) were men; ophthalmologists diagnosed 47 (20.8%) with retinal detachment, 54 (24.0%) with vitreous hemorrhage, and 34 (15.1%) with vitreous detachment. Point-of-care ultrasonography had an overall sensitivity of 96.9% (95% CI, 80.6%-99.6%) and specificity of 88.1% (95% CI, 81.8%-92.4%) for diagnosis of retinal detachment. For diagnosis of vitreous hemorrhage, the sensitivity of POCUS was 81.9% (95% CI, 63.0%-92.4%) and specificity was 82.3% (95% CI, 75.4%-87.5%). For vitreous detachment, the sensitivity was 42.5% (95% CI, 24.7%-62.4%) and specificity was 96.0% (95% CI, 91.2%-98.2%)., Conclusions and Relevance: These findings suggest that emergency medicine practitioners can use POCUS to accurately identify retinal detachment, vitreous hemorrhage, and vitreous detachment. Point-of-care ultrasonography is not intended to replace the role of the ophthalmologist for definitive diagnosis of these conditions, but it may serve as an adjunct to help emergency medicine practitioners improve care for patients with ocular symptoms.

Objectives: The objective of this study was to determine the test characteristics of point-of-care ultrasonography (POCUS) for the diagnosis of retinal tear (RT), retinal detachment (RD), posterior vitreous detachment (PVD), and vitreous hemorrhage (VH)., Design: A prospective observation study on a convenience sample of patients presenting to a tertiary care emergency general ophthalmology clinic was performed., Participants: Adult patients with acute flashes/floaters or new visual field defects were included (n = 62)., Methods: POCUS was performed by a study sonographer and compared with a retina specialist examination without sonography imaging. Sonographers were masked to clinical information. Follow-up was performed by a 6-week health records review. The primary outcome was the diagnosis of RD/RT, PVD, and VH. Analyses included descriptive statistics and test characteristics., Results: A total of 62 patients with a mean age of 60.8 years were enrolled; 62.9% were female. The mean time to scan required was 7.4 minutes. There was no change in diagnosis at 6 weeks. The sensitivities and specificities, respectively, are as follows: any pathology (n = 60) 88.3% (95% CI 86.8%-89.9%) and 50% (95% CI 2.7%-97.3%); RD (n = 6) 100% (95% CI 53.9%-100%) and 67.9% (95% CI 62.9%-67.9%); RD/RT (n = 23) 47.8% (95% CI 30.8%-62.2%) and 82.1% (95% CI 72.0%-90.6%); PVD (n = 47) 80.9% (95% CI 74.7%-88.0%) and 33.3% (95% CI 14.0%-55.7%); and VH (n = 14) 43.0% (95% CI 21.4%-58.0%) and 93.8% (95% CI 87.5%-98.2%)., Conclusions: Ocular POCUS detected all RDs but has limited use for the diagnosis of RTs. Patients with suspected acute ocular posterior pathology should be referred to ophthalmology independent of ocular POCUS., (Copyright © 2016 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.)

Objective: To find the reliability of ocular ultrasonography (USG) for pre-surgical evaluation in various vitreo-retinal conditions., Method: In a retrospective study, a chart review of patients who underwent preoperative USG for various vitreoretinal conditions was done. We correlated findings of preoperative USG with intraoperative findings., Results: 131 of 130 patients were included. Various ocular pathologies included trauma, diabetic vitreous hemorrhage, endophthalmitis, and other causes of vitreous hemorrhage. We found overall sensitivity and specificity of 92.31% and 98.31% for identification of rhegmatogenous retinal detachment, and 96.2% and 100% for posterior vitreous detachment, respectively, whereas it was 100% for vitreous hemorrhage, preretinal bleed, and vitreous exudates. In eyes with trauma, sensitivity and specificity of USG for identifying the status of retina was least (90.9% and 97.7%)., Conclusion: Our study highlighted that the reliability of USG findings was least in cases of trauma, hence requiring special care while reporting.

Background: Retinal detachment is a true medical emergency. It is a time-critical, vision-threatening disease often first evaluated in the Emergency Department (ED). Diagnosis can be extremely challenging and confused with other ocular pathology. Several entities can mimic retinal detachment, including posterior vitreous detachment and vitreous hemorrhage. Ocular ultrasound can assist the emergency physician in evaluating intraocular pathology, and it is especially useful in situations where fundoscopic examination is technically difficult or impossible. Accurate and rapid diagnosis of retinal detachment can lead to urgent consultation and increase the likelihood of timely vision-sparing treatment., Objectives: This case demonstrates both the utility of ocular ultrasound in the accurate and timely diagnosis of retinal detachment and potential pitfalls in the evaluation of intraocular pathology in the ED., Case Report: A 38-year-old woman presented with acute onset of bilateral visual loss that was concerning for retinal detachment. Rapid evaluation of the intraocular space was performed using bedside ocular ultrasound. Bedside ocular ultrasound correctly diagnosed retinal detachment in the right eye. Posterior vitreous detachment in the left eye was incorrectly diagnosed as retinal detachment., Conclusion: This case illustrates the importance of bedside ocular ultrasound and highlights some of the pitfalls that can occur when evaluating for retinal detachment. Following is a discussion regarding methods to distinguish retinal detachment from vitreous hemorrhage and posterior vitreous detachment., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Purpose: To assess the diagnostic value of ultrasonography in the detection of vitreo-retinal pathologies., Material and Methods: This prospective study included all patients from retina department in Eye Clinic University Clinical Center Tuzla first time referred and examined by a single experienced vitreo-retinal surgeon in period from January 2011 to January 2012. Complete ophthalmic examination and ultrasonography-standardized echography were performed to all patients for detection and confirmation of vitreo-retinal pathology., Results: Study included 146 eyes from 122 patients. 58 (39.7%) eyes had poor posterior segment visualization, 21 (14.4%) eyes due to dense cataracts and 37 (25.3%) eyes due to different vitreous opacities. 88 (60.3%) eyes had good or partial posterior eye segment visualization, where 67 (45.9%) eyes had proliferative vitreo-retinopathy and 55 (37.7%) eyes had tractional retinal detachment. Most common causes for referral to vitreo-retinal surgeon were ocular complications of diabetes mellitus 94 (64.4%), ocular trauma 18 (12.3%), rhegmatogenous retinal detachment 16 (10.9%) and intraocular inflammation 9 (6.2%). Ultrasonography confirmed suspected diagnosis and operative management plan in 120 (82.2%) eyes, sublassified previously established diagnosis in 19 (13%) eyes and helped further operative planning and established completely new diagnosis and changed initial management plan in 7 (4.8%) eyes. The final clinical diagnosis confirmed the ultrasonography findings in 142 from 146 (97.3%) eyes., Conclusion: Ultrasonography is useful part of ophthalmic examination for detection, evaluation and follow up of different vitreo-retinal pathologies.

Background: Retinal detachment is an ocular emergency posing diagnostic difficulty for the emergency practitioner. Direct fundoscopy and visual field testing are difficult to perform and do not completely rule out retinal detachment. Ophthalmologists use ocular ultrasound to enhance their clinical acumen in detecting retinal detachments (RD), and bedside ultrasound capability is readily available to many emergency practitioners (EP)., Study Objective: Our study sought to assess whether ocular ultrasound would be a helpful adjunct for the diagnosis of RD for the practicing EP., Methods: This was a prospective observational study with a convenience sample of patients. As part of a general course on emergency ultrasonography, practitioners received a 30-min training session on ocular ultrasound before beginning the study. Trained practitioners submitted ultrasound scans with interpretation on patients with signs and symptoms consistent with retinal detachment., Results: Thirty-one of the 72 practitioners trained submitted ocular ultrasound reports on patients presenting to the Emergency Department with concerns for retinal detachments. EPs achieved a 97% sensitivity (95% confidence interval [CI] 82-100%) and 92% specificity (95% CI 82-97%) on 92 examinations (29 retinal detachments). Disc edema and vitreous hemorrhage accounted for false positives, and a subacute retinal detachment accounted for the only false negative., Conclusion: These data show that trained emergency practitioners can use ocular ultrasound as an adjunct to their clinical assessment for retinal detachment., (Copyright © 2011 Elsevier Inc. All rights reserved.)

The study was done to find out pathologic processes in ophthalmic patients in different age group to understand the use, role and limitations of ultrasonography in the diagnosis of ocular pathology in this locality. A prospective study was done on total 143 patients from September 2004 to January 2006 who attended Centre for Nuclear Medicine & Ultrasound, Mymensingh for ultrasound evaluation of eye. Total 100 (69.93%, n=100) cases were male and 43 (30.06%, n=43) cases were female. The age ranges were 2 months to 80 years. A variety of ocular pathology was diagnosed with the help of high resolution ultrasound (HRUS) with unique ultrasound appearance. Bulk of the referral patients had history of ocular trauma (38.46 %, n= 38) and most commonly detected pathology in these group are vitreous hemorrhage (34.44%, n=34) and cataract formation (28.28%, n=28). Almost all of the patients did not have conclusive diagnosis clinically and by conventional means available before ultrasonography were performed. High resolution sonography may be used as a valuable tool for evaluation of ophthalmic pathology as a well suited, noninvasive method, and only practical imaging modality for assessing those cases particularly when light conducting media are opaque.

Purpose: To describe the ultrasonographic characteristics and treatment outcomes of surgery in vitreous hemorrhage (VH) associated with idiopathic polypoidal choroidal vasculopathy (IPCV)., Design: Retrospective interventional and observational case series., Methods: Clinical, ultrasound, and surgical data of 10 consecutive patients operated for VH due to IPCV in a tertiary eye institute was studied by chart review. Data were analyzed to determine the clinical features, ultrasonographic characteristics, and surgical outcomes. An additional five patients with IPCV without VH were evaluated by ultrasound in various stages of the disease., Results: Between January 1998 and March 2005, 10 eyes of 10 patients underwent vitreous surgery for VH associated with IPCV. Characteristic ultrasonographic features that helped the diagnosis preoperatively included focal choroidal thickening without excavation or acoustic hollowing with associated low reflective echoes of dispersed VH, or diffuse choroidal thickening and low-intensity echoes of dispersed hemorrhage on either side of the retinal spike, often without vitreous detachment spike. Oral corticosteroids were provided preoperatively to patients with associated exudative retinal detachment. Indocyanine green angiography (ICGA) confirmed IPCV postoperatively. Focal lesions were treated with laser photocoagulation. Anatomical success was seen in nine of 10 eyes. Visual acuity improved in five of 10 eyes but was limited by macular pathology in other five eyes. The most common complication was iatrogenic tears. Some eyes had recurrent IPCV lesions in follow-up., Conclusions: Characteristic ultrasonographic features could identify IPCV in eyes with VH. Anatomical and visual outcomes of our management approach were encouraging and need further study.

Introduction: Ultrasonographic techniques are commonly used for the imaging of various tissue structures and organs, including the eyeball and orbit. The non-invasive ultrasound imaging is safe for the patient and may be repeated after a short time unlike in the case of other radiological techniques. In pediatric ophthalmology, ultrasonography plays a major role as an auxiliary examination for the diagnosis of various intraocular diseases, pathologies of the retina and choroid, and retrobulbar conditions. Ultrasonography is of major importance in diagnosing eye disorders associated with opacity preventing visual inspection of the posterior eye segment., Methods: Among ultrasonographic techniques in pediatric ophthalmology the most frequently used are B-scan, A-scan, and Doppler ultrasonography. Because of the resolution of ultrasonographic methods in comparison to radiological techniques, they play an important role in monitoring the dynamics of pathological processes in retinopathy of prematurity (ROP). Other radiological methods such as CT, MRI or subtractive angiography do not offer a detailed view of retinal attachment or vitreo-retinal proliferation., Conclusion: Ultrasonography as an auxiliary examination at subsequent stages of ROP helps to document the changes and in case of corneal opacity connected with progression of vitreo-retinal abnormalities is the basis for the diagnosis.

Purpose: To report that an avulsed retinal vessel may appear as a tractional retinal detachment on echographic evaluation., Methods: Case report., Results: A 57-year-old diabetic woman presented with a nonclearing vitreous hemorrhage of 2 months duration in the left eye. Echography was consistent with a localized tractional retinal detachment on longitudinal sections; transverse sections demonstrated a pinpoint opacity in the vitreous cavity. Intraoperatively, an avulsed retinal vessel was noted in the area of echographic abnormality., Conclusion: An avulsed retinal vessel may mimic tractional retinal detachment on echography. Although trained ophthalmic echographers routinely perform both longitudinal and transverse sections during an echographic evaluation, less skilled observers must be aware of the importance of performing both longitudinal and transverse sections for accurate echographic diagnosis.

Purpose: To discuss and possibly explain the ultrasonic lighthouse effect, a metaphor suggested for an artifact-like phenomenon sometimes found by B-scan in eyes having had intra-ocular perfluorocarbon and/or silicone oil injected as part of vitreoretinal surgery., Method: Analysis of the ultrasonic findings with a view to the specific gravities of the above injected substances. Compared to water, perfluorocarbon has a higher and silicone oil a lower gravity; they are heavy and light, respectively., Results: The elicited lighthouse effect may appear localized or 'mobile'. When evoked only from specific positions on the globe, most likely it is explained by a lens-like accumulation of material trapped at the vitreous base just under the transducer. When mobile it depends on head position; there is a gravitational shift in position of the material, as evident in particular when becoming visible in the anterior chamber., Conclusions: In case reports in literature slit-lamp verified anterior segment perfluorocarbon remnants have caused acoustic disturbances of a similar nature. In this study we found evidence that also silicone oil can underlie the acoustic lighthouse effect.

Objective: To evaluate the value of color Doppler ultrasonography (CDU) in the diagnosis of intraocular lesions., Methods: 82 cases of intraocular diseases were examined by high-resolution CDU (7.5 mHz), and the blood flow pattern was evaluated at the base of two-dimensional image., Results: CDU might show the blood flow of retinal vessels in all 21 cases of retinal detachment, no blood flow could be detected in 21 of 22 vitreous hemorrhages and/or membranes, and only in one case with diabetic proliferative retinopathy did fine blood flow be seen. Intratumor blood flow with branchy pattern could be detected in 17 of 18 cases with choroidal melanomas and 3 of 4 cases with choroidal metastatic carcinoma, and spectral analysis revealed high-resistance, simulating arterial blood flow waves. In 5 cases with choroidal hemangioma, intratumor blood flow with filled or sparkled pattern was detected, and the spectral analysis revealed both arterial and venous blood flow waves. No blood flow in the lesion was detected in simulating benign lesions i.e. 5 choroidal hemorrhages and 2 subretinal hemorrhages. In 3 cases (4 eyes) with persistent hyperplastic primary vitreous (PHPV), CDU showed band-shaped arterial blood flow coursing from optic nerve disc to the posterior surface of the lens in the vitreous cavity., Conclusion: CDU is helpful in the differential diagnosis among retinal detachment, vitreous hemorrhage, vitreous membrane, malignant choroidal melanoma, choroidal metastatic tumor, choroidal benign lesion or hemangioma, PHPV and lesions with white pupil.

Background: In several reports, early vitrectomy has been proposed for eyes with vitreous hemorrhage due to Terson syndrome as a means to hasten visual recovery. But the development of nuclear sclerosis and the neurologic problems arising from this disease encourage surgeons to wait for spontaneous resorption, especially with young patients. Although the formation of epiretinal membranes has been described, to the authors' knowledge retinal detachment with proliferative vitreoretinopathy in Terson syndrome never has been observed., Methods: The authors report five eyes from four patients with Terson syndrome due to spontaneous aneurysm rupture, in whom retinal detachment with proliferative vitreoretinopathy developed., Results: The early onset and the severe clinical course of proliferative vitreoretinopathy in these eyes showed parallels to traumatic proliferative vitreoretinopathy. The retina in all eyes could be reattached., Conclusion: The authors point out the necessity for accurate and close follow-up and early, extensive surgical treatment in Terson syndrome, especially in patients with a reduced general state of health.

The B-type echographic exam in retinal detachment shows in the most accurate way the detached retina. In the total detachments the aspect reproduced the V-image, because in the perpendicular section, the retinal folds join at the papilla. By the rotation of the transducer, when the oblique echographic section get close to the perpendicular section, it may be moved on the monitor like two heterogeneous planes or like a chistic echographic image in the vitreous. This show the importance of the chistic echographic image in the differential diagnosis of the retinal detachment.

The sonographic criteria for diagnosis of retinal detachment and vitreous membranes are well established, and in most cases a diagnosis can be made. However, in difficult cases, differentiation between the two may be difficult. In this study the use of high-resolution color flow Doppler was evaluated for differentiating between retinal detachments and vitreous membranes. Sonographic evaluation, including color flow Doppler, was performed in 25 symptomatic eyes. Seven eyes had areas of retinal detachment, all of which had detectable blood flow within at least a portion of the detached retina. Fifteen eyes had vitreous hemorrhages or membranes in which no flow was detected. Two diabetic patients with vitreous membranes and no retinal detachment did have flow detectable within the neovascular membranes. Another patient, who had a complete choroid detachment after surgery, demonstrated good flow within the area of detachment. It is concluded that in difficult cases high-resolution color flow Doppler can enable differentiation of an area of retinal detachment from a vitreous membrane in a patient without diabetes.