Role of diagnostic endoscopy in posterior segment evaluation for definitive prognostication in eyes with corneal opacification
Abstract Purpose Direct visualization of the posterior segment is not possible with conventional imaging techniques in eyes with corneal opacification. This study evaluated the efficacy of video-endoscopy in visualising and hence prognosticating the visual outcomes in such eyes . Design Prospective...
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Veröffentlicht in: | American journal of ophthalmology 2017-04, Vol.176, p.9-14 |
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Zusammenfassung: | Abstract Purpose Direct visualization of the posterior segment is not possible with conventional imaging techniques in eyes with corneal opacification. This study evaluated the efficacy of video-endoscopy in visualising and hence prognosticating the visual outcomes in such eyes . Design Prospective non-comparative consecutive interventional case series. Methods This study included 64 eyes of 64 patients with corneal opacification who underwent diagnostic ophthalmic endoscopy procedure from March 2014 to May 2016. All eyes also underwent conventional B –scan ultrasonography as part of their comprehensive ocular examination. The findings that were noted during endoscopy included the optic disc characteristics, anatomical integrity of retina and condition of the retinal blood vessels. The principal outcome measure was the determination of whether the results of the video endoscopy helped in establishment of or brought a change in the management plan; accordingly they were classified either as “contributory” or “non-contributory. Results The video endoscopy findings were classified as “contributory” in 62 of 64 eyes. The remaining 2 eyes had vitreous haemorrhage; endoscopic vitrectomy was done in them to detect an inoperable retinal detachment in one eye. With the help of the stereoscopic picture of the fundus provided by the endoscope, a poor visual prognosis in 17 eyes with retinal detachment and 22 with attached retina was determined. Additionally in eyes which had an attached retina on ultrasound B scan, the endoscope helped in detecting a glaucomatous disc in 10 of those eyes and 7 of them had glaucomatous optic atrophy. In 3 patients ultrasound did not detect a retinal detachment (false negative). And 1 eye with detached retina on ultrasound did not have a retinal detachment actually (false positive). Thus an ultrasound had a sensitivity of 88.4% and a specificity of 97.3% in detecting RD as compared to an endoscopic evaluation. Based on the endoscopic findings 34 of 64 (53%) eyes were identified with having some visual prognosis and underwent subsequent vision restoring procedures. This included 10 (16%) patients who directly underwent a corneal procedure and 24 (37.5 %) patients with endoscopic vitreo-retinal procedures initially before undergoing a corneal procedures . Endoscopy helped in identifying poor prognosis in 30 of 64(46.8%) eyes and a further invasive procedures could be avoided. The endoscopy procedure in itself did not lead to any complica |
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ISSN: | 0002-9394 1879-1891 |
DOI: | 10.1016/j.ajo.2016.12.018 |