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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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ALAA EL DORGHAMY
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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ALAA EL DORGHAMY
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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ALAA EL DORGHAMY
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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
CAPSULEALAA EL DORGHAMY
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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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ALAA EL DORGHAMY
WHY CLINICAL
EXAMINATION?
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THANK YOU
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