Ultrasound Biomicroscopy UBM for Preoperative Assessment of Traumatic Cataract Surgery

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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
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Setting

• Institute of Ophthalmology and Visual Science
• UMDNJ New Jersey Medical School
• Newark NJ

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Purpose

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

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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

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Methods

• The probe was positioned in the eyecup in the
  axial position and in 12 36 and 9 oclock
  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

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Methods

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

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Results
CDC-Cyclodialysis Cleft. ID-Iridodialysis
CS-Corneal Scar
-Dislocated Lens
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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)

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Cornea
Irregular Iris No Iris-Lens Contact No Zonules
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Disrupted Zonules
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Normal Zonules
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Cyclodialysis Cleft
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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

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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

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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

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Conclusion

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

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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