Elsevier

Survey of Ophthalmology

Volume 56, Issue 5, September–October 2011, Pages 433-450
Survey of Ophthalmology

Diagnostic and Surgical Techniques
Ultrasound Biomicroscopy in Glaucoma

https://doi.org/10.1016/j.survophthal.2011.04.004Get rights and content

Abstract

Ultrasound biomicroscopy (UBM) is a high-resolution ultrasound technique that allows noninvasive in vivo imaging of structural details of the anterior ocular segment at near light microscopic resolution and provides detailed assessment of anterior segment structures, including those obscured by normal anatomic and pathologic relations. We summarize UBM applications in glaucoma. In some cases UBM elucidates the mechanism of elevated intraocular pressure by showing the relationship between the peripheral iris and the trabecular meshwork. It can be used to study the causes of secondary glaucoma, for example, the pigment dispersion syndrome, lens-induced glaucomas, ciliary block, cysts, and solid tumors of the anterior segment. It can also assess the effects of various interventions such as laser iridotomy, trabeculectomy, and non-penetrating drainage surgery. Precise quantitative evaluation of the anterior chamber angle structures can help in diagnosis and management of various pathologies related to glaucoma.

Section snippets

Principle

UBM uses a scan transducer with a high frequency. The transducer frequency of conventional diagnostic ultrasound instruments is in the range of 7.5–10 MHz. With the advent of polyvinylidene fluoride in 1990s, transducer membranes could be made sufficiently thin to support frequencies of 100 MHz (wavelength: 15 μm) and above. This brought about the development of the UBM instrument with a transducer frequency of approximately 50 MHz.74, 75, 76

UBM provides much higher image resolution

Examination of the Anterior Chamber Angle

With the UBM the angle structures (iris, ciliary body, and scleral spur) can be recognized easily. The scleral spur is the only constant landmark and is the key to analyzing angle pathology.37 The scleral spur can be identified in the region where the radio-opaque shadow of the sclera merges with the relatively radiolucent shadow of the cornea.

Biometry of the Anterior Segment

With the UBM one can determine the corneal thickness, anterior chamber depth, posterior chamber depth, IOL thickness, iris thickness, ciliary body

Conclusion

Ultrasound biomicroscopy has revolutionized the evaluation of the anterior segment of the eye. The structures surrounding the posterior chamber that were difficult to examine clinically are now being imaged and assessed in detail. The qualitative and quantitative evaluation using this technology has contributed to our understanding of the pathophysiology of angle-closure glaucoma, pigmentary glaucoma, secondary glaucoma, and a variety of other anterior segment disorders. The use of this

Method of Literature Search

Searcheds were performed in PubMed and included Medline and additional citations for articles dating from 1980 through May 2010. PubMed automatically identifies the MESH terms associated with the search and uses an “OR” strategy unless a specific “AND” command is provided. We used the following search terms: qualitative ultrasound biomicroscopy, secondary glaucoma mechanism, functional status of filtering surgery, uveitic glaucoma, quantitative assessment of angle structure. In addition, once

Disclosure

The authors reported no proprietary or commercial interest in any product mentioned or concept discussed in this article.

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