A.J. Adekanmi1, O.A. Ogun2, A.T. Adeniji-Sofoluwe1 and M.O. Obajimi1
- Department of Radiology, College of Medicine, University of Ibadan and University College Hospital, Ibadan, Nigeria.
- Department of Ophthalmology, College of Medicine, University of Ibadan and University College Hospital, Ibadan, Nigeria
Background: Orbito-ocular diseases are a major public health issue, often causing visual impairment with serious socioeconomic implications on individual lives. Ocular ultrasonography is an invaluable diagnostic tool when clinical examination of the ocular fundus is difficult.
Objectives: To describe the indications, sonographic findings, and contribution of orbito-ocular ultrasonography to the management of orbito-ocular diseases in the University College Hospital, Ibadan.
Materials and Methods: A retrospective review of B-mode ocular ultrasound findings and hospital data of all patients referred to the Radiology department of the University College Hospital, Ibadan for ocular Ultrasound between January 2014 – December 2018.
Results: There were 142 patients, aged 1-85 years, (median age =28 years). 72 (50.7%) patients were under 30 years of age, and 50 (35.2%) were pediatric cases. Male to female ratio was 1.84:1. The commonest presenting complaint was blurred vision in 97 (68.3%) cases, followed by eye trauma in 54 (38.0%). B-mode Ultrasound, demonstrated cataract in 63 (44.4%,) cases, vitreous hemorrhage in 42 (29.6%), retinal detachment in 27 (19.0%), vitreous detachment in 19 (13.4%), normal findings in 17 (12%) and orbital tumors in 13 (9.2%) patients. B-mode ultrasound scan and clinical diagnosis demonstrated good agreement in 91 /142 cases (64.1%), partial agreement in 23/142 (16.2%) cases, and no agreement in 28 (19.7%). Kappa agreement scores, K were 74.3% and 70.9%, for ruptured globe and cataract respectively.
Conclusion: Orbito-ocular ultrasonography contributes significantly to the diagnosis of orbito-ocular disease and shows good correlation with clinical diagnoses. However, a future study with larger numbers is required.
Keywords: Ocular disease, Retinal detachment, Vitreous hemorrhage, Ultrasound.
Dr. O.A. Ogun
Department of Ophthalmology,
College of Medicine,
University of Ibadan,
Orbito-ocular diseases are major public health issues, often causing visual impairment with serious socioeconomic implications on individuals’ lives.1,2 According to WHO3, an estimated 1.3 billion people globally live with some form of visual impairment.1 In Nigeria, an estimated 4.25 million adults have moderate to severe visual impairment or blindness in the better eye, according to the Nigerian national blindness survey in 20094, and this number was projected to increase by over 40% by 2019 4. Lifestyle modifications was advocated to forestall this trend as 80% of all causes of visual impairment and blindness are known to be preventable or curable 4. However, this is yet to be achieved globally, with avoidable or treatable vision loss anticipated to increase 5. Diagnostic imaging, particularly ocular ultrasound, has become a proven tool that improves the accuracy of clinical diagnoses, with the potential to improve early detection, improve care, and treatment.6
Although clinical examination is the mainstay of diagnosis in most patients with eye disease, ocular ultrasound scan is an invaluable tool for detecting and outlining soft-tissue abnormalities of the eye and orbit. Ocular Ultrasound is particularly useful when fundus examination is equivocal or impaired by media opacification.7,8 The superficial location of the eye and its cystic composition provides a suitable window for imaging.9 Compared with other imaging techniques such as X-rays, computed tomography (CT) scanning, and Magnetic resonance imaging (MRI), ultrasonography is simple, does not utilize ionizing radiation, is non-invasive, affordable, safe, repeatable, and a real time imaging modality which provides detailed cross-sectional anatomy of the entire eye globe 10.
Previous studies, in other climes, have demonstrated the reliability of ocular ultrasound for the investigation of ocular pathologies such as cataract, lens dislocation, choroidal dislocation, retinal tears, vitreous and retinal detachments, vitreous hemorrhage, subretinal hemorrhage8,11,12; evaluation and diagnosis of ocular tumours7,13-16 ; localizing foreign bodies within the globe and to evaluate the extent of damage in ocular trauma.12 However, there is paucity of data on the clinico ultrasonographic orbito-ocular disease evaluation in our environment. In this study, which represents a mini audit of interdisciplinary collaboration between radiologists and ophthalmologists at the UCH, Ibadan, we evaluated the hospital presentation time of patients, correlated ultrasonographic features with clinical diagnosis. We provided evidence of the current trend of ultrasound use in our institution’s clinical management of orbito-ocular diseases.
MATERIALS AND METHODS
This retrospective descriptive study was conducted in both the Departments of Ophthalmology and Radiology of the University College Hospital, Ibadan, Oyo State, South-Western Nigeria. The study included case notes and radiology reports of all patients referred for ocular sonography between January 2013 and December 2018. Two ultrasound scanners were used for the evaluations of the patients, namely the General Electric, Logic P5 ultrasound unit, and Ultrasonix SP ultrasound scanner. Ultrasonographic images were acquired using a 7.5 10MHz linear transducer. Ultrasound of all the patients was performed in the supine position, with the transducer applied gently to the globe over the closed eyelid, after coupling gel was applied, using the B-scan ultrasound mode. Scanning of both globes was done in orthogonal planes with gentle movement of the eyeballs during the examination as one examines the intraorbital and intrabulbar structures. Orbital pathologies were documented in a radiology report for each patient. The authors retrieved and reviewed the radiology reports and clinical data of all patients who had performed ocular ultrasound scans during the study period. Data were extracted and entered into a structured spreadsheet in Excel and analysed using SPSS, version 22 (IBM). This research was conducted following the principles of the Helsinki declaration (Helsinki, 1978). Continuous variables were reported using frequencies and proportions, while Chi-square tests were used to analyse associations between categorical variables.