UBM (ultrasound biomicroscopy) is a high-frequency ultrasound imaging technique that can generate images of ocular structures with resolutions approaching light microscopy to a depth of 4-5mm. It has three main components: a transducer, signal processor, and articulated arm. UBM uses immersion technique with fluid to image the cornea as a multilayered structure and measure anterior chamber depth, angle, iris thickness, and iridolenticular contact distance. It can be used to assess corneal and scleral diseases, tumors, glaucoma, trauma, and IOL complications by providing detailed images of angle structures, iris behavior, and IOL position.

1. ULTRASOUND
BIOMICROSCOPY
(UBM)
CHOLAKKAL MUHAMED RAFEEQ
1966

2. What is UBM ?
It Is a method of high frequency ultrasound
imaging used to generate images
approaching light microscopic resolution
up to a depth of 4–5 mm from the surface.

3. Instruments
 There are 3 main components of the system:
 1. The transducer
 2. Signal processor and
 3. A articulated arm to steady the scanning head and provide precise motion
control.

4. UBM MACHINE

5. TECHNIQUE
 Technique used for examination is the immersiontechnique using a fluid standoff
 An eye cup permits evaluation avoiding distortion caused by the eyelids and
permits the use of a coupling solution.
 The procedure is done in the supine position under topical anesthesia
 The eyecup is used to separate the lids and is filled with 1% methylcellulose or
normal saline.
 The transducer is immersed in the solution and placed directly over the part to be
scanned.
 As the arm can be tilted as well as rotated in the horizontal plane, various sections
of the same area can be scanned.
 The cornea and anterior segment can be easily studied, and the conjunctiva,
sclera and peripheral retina up to the limits of rotation of the eye in various
directions.

6. UBM OF NORMAL OCULAR STRUCTURE
 The cornea is seen as a multilayered structure with a highly reflective epithelium,
 1. The cornea is seen as a multilayered structure, with a highly
 high reflective line consisting of the endothelium and Descemet’s
 membrane.
 2. UBM can measure
 1. ACD (Anterior chamber depth)
 2. anterior chamber angle
 3. Iris thickness
 4. iridolenticular contact distance.
 3. The ciliarybody, ciliaryprocesses and the ciliarysulcus are well distinguished on
UBM. The anterior lens surface can be seen, as well as the anterior zonules.

7. USES OF UBM
❑ CORNEAL AND SCLERAL DISEASES
1. The UBM performed in opaque corneas can be helpful in deciding the
prognosis and planning surgery in eyes undergoing keratoplasty.
2. “Virtual gonioscopy” in these instances gives an idea of angle details. The lens
status can also be assessed.
3. Depth of involvement in scleral and episcleral inflammation can help in
diagnosis and evaluatingresponse to treatment.

8. A)UBM image of Edematous cornea
B) Corneal dystrophy

9. ❑ TUMORS :
1. Cystic lesions of the cornea, iris and ciliary body
Iris tumors and nevi
Small ciliary body tumors as well as cysts, which can mimic tumors are best
assessed on UBM
2. The UBM is useful in defining the posterior extent of ciliary body tumors as well
as the anterior extent of peripheral choroidal tumors

11. ❑ GLAUCOMA :
1. UBM can image all the angle components, iris, and ciliary body complex.
2. It is also possible to study the behavior of the iris and angle under various conditions of
illumination
3. Angle-closure can occur at four anatomic levels;
1. the iris (pupillaryblock),
2. the ciliarybody (plateau iris),
3. the lens (phacomorphic glaucoma)
4. The anterior vitreous face (malignant glaucoma).
Narrow angle of the ciliary body

12. ❑ MALIGNANT GLAUCOMA :
➢ UBM - able to demonstrate anterior rotation of the ciliary processes to
make a diagnosis of malignant glaucoma.
➢ UBM helps in deciding the course of management at an early stage.

13. ❑ TRAUMA :
UBM can demonstrate anterior segment foreign bodies, cyclodialysis
clefts, zonular damage and angle recession

14.  Iridodialysis :separation of the iris root from its attachment to the
anterior ciliary body

15.  Cyclodialysis: Detachment of the ciliary body from its insertion
at the scleral spur

16. ❑ INTRAOCULAR LENS COMPLICATION :
1. The UBM is useful in studying various IOL complications.
2. Optic and haptic locations can be assessed accurately by looking for a strong echo at
their interface plane.
3. This ability to image the IOL helps in determining whether structural changes induced by
the IOL are responsible for postoperative complications.
4. These can be due to retained cortex or contact of the IOL haptic with the iris or ciliary
body.

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