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Research Paper | Radiology and Medical Imaging Sciences | India | Volume 11 Issue 9, September 2022
Pattern of Pathologies on B-Mode Ocular Ultrasound: An Observational Study
Dr. Tariq Ahmad Bhat | Dr. Musadiq Adil Sheikh [2] | Dr. Mohammad Farooq Mir | Dr. Feroze A Shaheen | Dr. Tariq Ahmad Gojwari
Abstract: The superficial location of the eye, its cystic composition, and the advent of high-frequency ultrasound make sonography ideal for imaging the eye. Ultrasonic imaging of the eye has been undergoing progressive development for over a half century. Ocular B-mode ultrasonography (USG) is an essential adjuvant for evaluation of ocular diseases. This is not unconnected with the anatomic accessibility of the eye. The cystic nature of the eye also made it a good candidate for sonographic evaluation, a modality that is based on high frequency sound waves. But the beauty of ocular ultrasonography is its role as a substitute to ophthalmoscopy or as an ancillary to some ophthalmoscopic limitations. Direct visualization of the retro-bulbar pathologic lesions with ophthalmoscope is also not possible even with clear media. This therefore calls for a substitutive imaging modality like B-scan ocular ultrasonography that will readily characterize most ocular lesions. These lesions range from lens pathology to posterior eye segment pathologies. Materials & Methods: The study was conducted in the Department of Radiodiagnosis and Imaging, Sher-I-Kashmir Institute of Medical Sciences (SKIMS), Medical College and Hospital Srinagar, on patients referred from the Department of Ophthalmology, SKIMS Medical College and Hospital Srinagar. It was a cross-sectional study performed at SKIMS Medical College and Hospital. Diagnostic ultrasound was performed using a high resolution and high-frequency probe on the affected eye. A data collection sheet was used to record the ultrasound findings. Ocular findings were stratified by sex, age group and affected eye. Findings were presented in the form of tables, charts and graphs. The study was conducted over a period of one and a half year in the Department of Radiodiagnosis and Imaging on all patients referred for Ocular Ultra sound. Diagnostic ultrasound was performed with a high frequency (10MHz) linear transducer. The examination was performed in brightness (B-mode) with the patient in the supine position and the eyes closed, slightly resting the transducer on both eyelids, after application of 4% topical lignocaine and coupling gel. Axial images were acquired from the lower to the upper limits of the entire globe followed by sagittal images from the nasal to the temporal side. All patients referred for ocular ultrasound were recruited into the study after consenting to the study and meeting the inclusion criteria. The principal investigator interviewed the patient and document the patient?s biodata and presenting complaints in the data collection tool. Diagnostic ultrasound was then performed on the affected eye by an experienced ocular sonographer and the principal investigator and images displaying pathology were acquired and printed. Specific diagnoses were made according to criteria set out in Diagnostic Imaging of the Eye. Results: Majority of the age distribution of the study population belonged to the 30?49-year age group i. e., 56 (51.88 %) followed by 11?29-year age group i. e., 19 (17.92 %) and >50 years i. e., 19 (17.92%). There were 12 (11.32%) patients who aged between 1-10 years. There were 66 (64.85%) males and 39 (37.15%) females in our study. Right eye involvement was observed in 49 (46.67%) patients, 42 (40%) patients had left eye involvement and 14 (13.33%) had bilateral eye involvement. On ultrasonography, retinal detachment was the most common finding in 28 (26.66%) followed by vitreous hemorrhage in 24 (22.85%), vitreous detachment in 18 (17.14%). Most common symptom at presentation was decreased vision followed by leukocoria in 42.57%, trauma in 20.43%, pain and redness in 15.71%, discharge in 3.78% and exophthalmos in 4.32% patients. The study demonstrated that at least half of the ocular pathologies result in diminution of vision and hence the importance of ultrasound as a diagnostic tool in the evaluation of ocular pathologies. The low volume of patients with orbital pathologies is due to referring clinicians preferring CT scan of the orbits over ultrasound for evaluation of the orbit. Vitreous hemorrhage was the USG finding observed in 16 males and 8 females, vitreous detachments in 13 and 5 males and females respectively, retinal detachments in 17 and 11 males and females respectively, retinal metastasis and slow flow vascular malformation were not seen in any male patient but in 1 female patient each. Vitreous hemorrhage and vitreous detachment were significantly more common in 30?49-year group. Vitreous hemorrhage accounted for 57.1% (p 0.05). The distribution of sonographic diagnoses for males and females were not significantly different. Conclusion: Ultrasonography is readily available, simple, cost effective, non-ionizing, non-invasive and a reliable imaging modality for posterior segment ocular pathologies. It readily establishes the diagnosis in significant number of cases. The superficial location of the eye, its cystic composition, and the advent of high-frequency ultrasound make sonography an ideal imaging modality for imaging of the eye. It has a higher spatial and temporal resolution compared to both CT and MRI for the diagnosis of ocular pathologies. It superseded the accuracy of ophthalmoscopic diagnosis with significant difference (p-value < 0.0001). Even though for most orbital pathologies, it needs additional investigations (CT, MRI, histopathology) for confirming the diagnosis, ultrasound proves a useful imaging tool and correlates very well with the final diagnosis.
Keywords: Ocular, Ultrasound, Imaging, Pathology
Edition: Volume 11 Issue 9, September 2022,
Pages: 778 - 785