B-Scan Ultrasonography to Screen for Retinal Tears in Acute Symptomatic Age-Related Posterior Vitreous Detachment

Objective To evaluate the performance characteristics of B-scan ultrasonography (US) as a diagnostic test for the detection of retinal tears in acute symptomatic age-related posterior vitreous detachment (PVD). Design Evaluation of a diagnostic test through a cross-sectional study with prospective data collection. The study intended to meet the 14 items proposed by the Quality Assessment of Diagnostic Accuracy Studies panel. Participants Two hundred thirty-nine patients with acute-onset age-related PVD were consecutively enrolled in a nonreferral hospital. Testing Comprehensive eye examination including vitreous and retinal biomicroscopy was performed on an emergency basis followed by blind B-scan kinetic US. Sensitivity, specificity and predictive values of the index test (B-scan US) were analyzed and compared with the standard reference (baseline examination). In cases of disagreement between both diagnostic methods, a new gold standard was established based on the findings of subsequent directed indirect ophthalmoscopy based on the echographic findings. Positive and negative likelihood ratios and a likelihood nomogram with pretest and posttest odds of retinal tears were calculated for B-scan US. Main Outcome Measures Index test performance for the detection of retinal tears secondary to age-related PVD. Results Both diagnostic methods performed comparably. The sensitivity of B-scan US for detection of retinal tears was 96% and that of baseline examination was 89%. Both methods had similar negative predictive values of 99%. B-scan US specificity was 98%. The estimated pretest and posttest probability for a positive B-scan US were 10.8% and 89%, respectively. Conclusions Proper B-scan kinetic US is a noninvasive and accurate diagnostic method for the detection of retinal tears that can be reliably used in no view or small pupil cases with symptomatic PVD. Financial Disclosure(s) The authors have no proprietary or commercial interest in any of the materials discussed in this article.