Us and ubm training course anterior and posterior imaging

1. Ultrasound biomicroscopy
and Ultrasound training
course
Mohamed ELShafie
Assistant lecturer of ophthalmology
Kafr ELShiekh university

2. Pathophysiology of Blunt Ocular Trauma
If a large object hits the eye,
most of the impact is usually
taken by the orbital margin.
If a small object hits the eye, the
eye itself may take most of the
impact.

3.  There are four main mechanisms:
1- Coup (injury at the same point)
2- Contrecoup (injury at the opposite point)
3- Equatorial expansion
4- Global repositioning
Mechanism of Blunt Ocular Trauma

4.  Anterior segment
 Posterior segment
 Adnexa
 Orbit
Location of Injury

5. Anterior Segment
 Conjunctiva
 Cornea
 Iris & Ciliary body
 Lens & Zonules

6. Effects on the Cornea
Blood stained cornea
Corneal Abrasion
Corneal Edema

7. Effects on the Iris and Ciliary Body
Hyphema
Angle recession
Iridodialysis
Traumatic mydriasis
Cyclodialysis Cleft

8. Effects on the Lens and Zonules
• Traumatic cataract
• Vossius' Ring
• Lens Subluxation
• Lens Dislocation
• Anterior Capsule Rupture
• Posterior Capsule Rupture
• PCIOL Dislocation

9. Posterior Segment
 Vitreous
 Retina
 Choroid
 Optic nerve

10. Effects on the Vitreous
 Posterior vitreous detachment
• Vitreous hemorrhage

11. Effects on the Retina
 Rhegmatogenous retinal detachment
• Commotio retinae
• Retinal Hge
• Retinal Tear without detachment
• Retinal Dialysis

12. Effect on the Optic Nerve
 Optic nerve avulsion

13.  Non invasive
 Out patient…
Ultrasonsogarphy
in evaluation of a case with blunt trauma

15. *Difficult clinical examination.
* Uncooperative patient.
* To assess the extent of intraocular
injuries.
Need for ultrasound

16. Orientations of the B-scan Probe
• Axial:
Lesion in relation to lens &optic nerve .
•Transverse:
Lateral extent, 6 clock hours .
•Longitudinal:
AP extent,1 clock hour.

18. Measured in decibels
Higher gain –
Display weaker echoslike
vitreous opacities
Lower gain
Stronger echoes
(retina and sclera)
Better resolution
Gain

19. Dot like lesions:
vitreous floaters, vitreous
hge, vitreous exudates.
Membranous lesions:
vitreous membranes, PVD,
RD
Mass lesions:
choroidalor retinal tumors
Echotexture of Lesion

20. Ultrasound Biomicroscopy
High frequency ultrasound
(50-100MHZ)
Images with high resolution
(50 um)
Depth of penetration
(5mm)
Can image through opaque
cornea
Coupling media: Fluid
Patient position: Supine
Skilled examiner
Time consuming

21. Orientations of the UBM probe
• Transverse section
Lateral extent
• Radial section

22. Examination Technique of UBM:
• Patient is lying down in supine position
• Monitor is at comfortable height
• Hand controller is in accessible position.
• Eye cup of suitable size separate the two lids, filled with saline solution.

28. Examples from our cases by
B-scan Ultrasound

29. Male patient of 45 years old was exposed to
blunt trauma 2 years ago .. Clinical
examination show traumatic cataract
B-scan US show rupture of posterior
capsule which cant be detected by clinical
examination

30. A case with Vit. Hge that couldn't be detected
clinically due to corneal oedema

31. A case with RD
Retinal break could be localized only by US

32. A case with PVD
Mobility of PVD is more than RD.
PVD becomes more prominent in higher gain settings

33. A case with retinal tear without
detachment

34. A case with posterior lens dislocation

35. A case with PCIOL dislocation

36. A case with optic nerve avulsion
Retinal step sign from an edematous retina to bare sclera.

37. Examples from our cases by
UBM

38. 25 years old man exposed to blunt trauma ..
Clinically slit lamp showed corneal oedema,
which mask visaulization of the anterior
segment
UBM examination showed subluxated lens
with vitreous prolapsed in AC.

39. A case with iridodialysis
separation of the iris root from its attachment to the ciliary body

40. A cases with hyphema

41. A 6-year-old child with traumatic cataract.
UBM evaluation was useful in detecting zonular
dialysis before surgery.

42. A case with angle recession that couldn't
be detected clinically
Tear in the ciliary body itself, between the circular and the longitudinal fibers

43. A case with cyclodialysis cleft
Separation of the ciliary body from the scleral spur resulting in cleft

44. A case with PCIOL dislocation

46.  Structural abnormalities
Guide to treatment
Follow up after treatment
A new method for gonioscopy and
quantitative angle measurement