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CLINICAL OPHTHALMIC

ULTRASOUND

ALAA EL DORGHAMY

PROFESSOR OF OPTHALMOLGY

FACULTY OF MEDICINE TANTA UNIVERSITY

MEMBER OF INTERNATIONAL SOCIETY FOR

OPHTHALMIC ULTRASOUND (SIDUO)

EXAMINATIONN WITH B SCAN

ULTRASONOGRAPHY

THREE STEPS

CLINICAL DATA

SYSTEMATIC ULTRASONIC EXAMINATION

DATA RECORDING LIKE OPHTHALMIC SHEET

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FOLLOWS ALL THE LOWS OF SOUND

PROPAGATION

REFLECTION

REFRACTION

ATTENUATION

THE INSTRUMENT

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HEIGHT &BRIGHTNESS

* SOUND BEAM ANGLE

* INTERFACE BETWEEN

TISSUES

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* INTERFACE BETWEEN TISSUES

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ADVANTAGECAN PASS THROUGH OPAQUE MEDIA &

RETURN THROUGH THE TRANSDUCER TO THE

DISPLAY

THE SAME TRANSDUCER TO SEND &RECEIVE

SO THERE IS A DEAD ZONE DUE TO

INTERFERENCE BETWEEN THE PROPAGATED

ECHOES&RECEIVED ECHOES

DISADVANTAGE

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SO ABOUT ANTERIOR 7 MM OF THE

GLOBE(CORNEA,AC&LENS) COULD

NOT BE EVALUATED BY REGULAR B

SCAN WITH CONTACT TECHNIQUE

SO ULTAROUD BIOMICROSCOPY (UBM)

MAY BE HELPFUL

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* SOUND BEAM CHARACTERISTICS

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SHAPE

WIDTH

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B SCAN (TWO DIMENSIONS)

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STANDARDIZED A SCAN

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A SCAN(BIOMETRY)

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A SCAN ONE DIMENSION

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A-SCAN =AMPLITUDE

B-SCAN =BRIGTHNESS

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0000011111111111111111011111110000000000000111111111111111100000000111111

11111111111111110000000000000000001101010101000000001001010101010110000

0011111111111111111011111110000000000000111111111111111100000000111111111

11111111111110000000000000000001101010101000000001001010101010110000001

1111111111111111011111110000000000000111111111111111100000000111111111111

11111111110000000000000000001101010101000000001001010101010110000001111

1111111111111011111110000000000000111111111111111100000000111111111111111

11111110000000000000000001101010101000000001001010101010110000001111111

1111111111011111110000000000000111111111111111100000000111111111111111111

11110000000000000000001101010101000000001001010101010110000001111111111

1111111011111110000000000000111111111111111100000000111111111111111111111

10000000000000000001101010101000000001001010101010110000001111111111111

1111011111110000000000000111111111111111100000000111111111111111111111100

00000000000000001101010101000000001001010101010110000001111111111111111

1011111110000000000000111111111111111100000000111111111111111111111100000

00000000000001101010101000000001001010101010110

A SCAN

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B SCAN

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EXAMINATION TECHNIQUES

* CONTACT TECHNIQUE

* IMMERSION TECHNIQUE

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CONTACT TECHNIQUE

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IMMERSION TECHNIQUE

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WHERE IS THE LESION

&

WHAT IS THE LESION?

IMMERSION TECHNIQUE

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CONTACT TECHNIQUE

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POSTERIOR SEGMENT

EVALUATION

B-SCAN SCREENING TECHNIQUE

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A-SCAN B-SCAN

BASIC SCREENING EXAMINATION

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CONTACT TECHNIQUE

* AXIAL

* LONGITUDINAL

* TRANSVERSE

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AXIAL SCAN

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TRANSVERSE SCAN AT 12 O,CLOCK

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LONGITUDINAL SCAN AT 12 O,CLOCK

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TRANSVERSE SCAN AT 12 O,CLOCK

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LONGITUDINAL SCAN AT 12 O,CLOCK

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TRANSVERSE SCAN AT 6 O,CLOCK

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EVALUATION OF THE MACULA

LONGITUDINAL MACULAR SCANALAA EL DORGHAMY

EVALUATION OF THE MACULA

LONGITUDINAL MACULAR SCANALAA EL DORGHAMY

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ALAA EL DORGHAMY

1- WHER IS THE LESION? (TOPOGRAPHIC

EXAMINATION).

2-WHAT IS THE LESION? (QUNTITIVE&KINETIC

TOPOGRAPHY).

AT THE END OF EXAMINATION WE SHOUD

ANSWER TWO MAIN QUESTIONS

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TECHNIQUES

TOPOGRAPHIC

Location

Extension

Shape

QUANTITATIVE1. Reflectivity estimate (spike height)

Structure ( internal architecture)

Sound attenuation (absorption)

2. Reflectivity measurement

(db comparison)

KINETICMobility (aftermovement)

Vascularity (blood flow)

Pupillary reaction

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TOPOGRAPHIC TECHNIQUE

* LOCATION

* EXTENSION

* SHAPE

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QUANTITATIVE TECHNIQUE

* REFLECTIVITY ESTIMATE (SPIKE HEIGHT)

STRUCTURE ( INTERNALARCHITECTURE)

SOUND ATTENUATION (ABSORPTION)

* REFLECTIVITY MEASUREMENT

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QUANTITATIVE TECHNIQUE

* REFLECTIVITY ESTIMATE (SPIKE HEIGHT)

STRUCTURE ( INTERNAL ARCHITECTURE)

SOUND ATTENUATION (ABSORPTION)

* REFLECTIVITY MEASUREMENT

(DB COMPARISON)

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KINETIC TECHNIQUE

* MOBILITY (AFTER MOVEMENT)

* VASCULARITY (BLOOD FLOW)

* PUPILLARY REACTION

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PUPILLARY REACTION

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* P = POSTERIOR (THE AREA JUST AS THE NERVE SHOWS )

* PE= POSTERIOR TO THE EQUATOR

* EP= EQUATOR POSTERIOR (JUST BEHIND THE EQUATOR)

* E= EQUATOR (A GOOD LANDMARK FOR THIS LABEL IS THE INSERTION OF A RECTUS MUSCLE)

* EA = ANTERIOR TO THE EQUATOR

* O= ORA

* CB = CILIARY BODY

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LENS AREA EXAMINATION

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DIFFICULT IN CASES OF OCULAR TRAUMA DUE TO

THE PRESENCE +OF:

* PAIN,TENDERNESS

* LID EDEMA

* CORNEAL ABRASIONS& WOUNDS

IMMERSION TECHNIQUE

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TO BYPASS MACHINE DISABILTY

TO EXAMINE LENS AREA

YOU CAN USE VITREOUS AS A COUPLING

FLUID

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CONTACT TECHNIQUE

* AXIAL

* LONGITUDINAL

* TRANSVERSE

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CONTACT B SCAN

AXIALLONGITUDINAL

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CONTACT B SCAN

AXIALLONGITUDINAL

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CONTACT B SCAN

AXIALLONGITUDINAL

CATARACTOUS LENS

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CONTACT B SCAN

AXIALLONGITUDINAL

SUBLUXATED LENS

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CONTACT B SCAN

AXIALLONGITUDINAL

INTUMESCENT CATARACT

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CONTACT B SCAN

AXIALLONGITUDINAL

OPACIFIED POSTERIOR CAPSULE

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CONTACT B SCAN

AXIALLONGITUDINAL

POSTERIOR SUBCAPSULAR CATARACT

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POSTERIOR DISLOCATED LENS

CONTACT B SCAN

AXIALLONGITUDINAL

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CONTACT B SCAN

LONGITUDINAL

RUPTURED POSTERIOR CAPSULE

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CONTACT B SCAN

LONGITUDINAL

CATARACT+ ENCIRCLING

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CONTACT B SCAN

AXIALLONGITUDINAL

POSTERIOR DISLOCATED LENS

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CONTACT B SCAN

LONGITUDINAL

INTUMSCENT CATARACT

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CONTACT B SCAN

LONGITUDINAL

CATARACTOUS

LENS&PERSISTANT HYALOID

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CONTACT B SCAN

LONGITUDINAL

DISLOCATED LENS

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CONTACT B SCAN

LONGITUDINAL

CATARACTOUS LENS &

CILOCHOROIDAL EDEMA

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CONTACT B SCAN

LONGITUDINAL

SUBLUXATED LENS

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CONTACT B SCAN

LONGITUDINAL

CATARACTOUS LENS WITH SMALL

NUCLEUS

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CONTACT B SCAN

LONGITUDINAL

HYPERMATURE

CATARACTALAA EL DORGHAMY

CONTACT B SCAN

LONGITUDINAL

INTRALENTICULAR FB

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CONTACT B SCAN

AXIALLONGITUDINAL

RUPTURED POSTERIOR

CAPSULE&POSTERIOR FB

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CONTACT B SCANLONGITUDINAL

OPACIFIED POSTERIOR

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CONTACT B SCAN

AXIALLONGITUDINAL

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CONTACT B SCAN

LONGITUDINAL

INTRALENTICULAR FB

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CONTACT B SCAN

LONGITUDINAL

CATARACTOUS LENS+ANTERIOR

HGE

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CONTACT B SCAN

LONGITUDINAL

INTRALENTICULAR FB

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CONTACT B SCAN

LONGITUDINAL

INTRALENTICULAR FB RELATED TO

POSTERIOR CAPSULE

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WHY CLINICAL

EXAMINATION?

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THANK YOU