Eyeworld

JAN 2015

EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.

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EW GLAUCOMA 32 January 2015 by Michel Puech, MD, FRCS Ultrasound biomicroscopy shows benefits for glaucoma and anatomy measurements ophthalmologists around France. The key advantage of UBM, when compared to other imaging tech- nologies—notably, ocular coherence tomography (OCT)—is clear visual- ization of structures located behind the iris, such as the ciliary bodies and processes and lens zonules. These structures are less visible when light-based imaging is used due to obfuscation from pigmentation. Ad- ditionally, I can collect data without utilizing a lid retractor, creating an easy and comfortable experience for the patient. Advantages It is important to note that while UBM comes with inherent advan- tages, it is best used in concert with other technologies to create the most complete anterior segment evaluation. For each patient to be imaged, my colleagues and I use the Visante anterior segment ocular coherence tomographer (AS-OCT) (Carl Zeiss Meditec, Jena, Germany) for measuring the anterior segment and for images of principal merid- ians scans. However, due to poor post-iris penetration of OCT—specif- ically in the case of a pigmented iris and ciliary body visualization—OCT is not sufficient for diagnosing ante- rior positioning of the ciliary body leading to plateau iris mechanism or ciliary melanoma. Accordingly, we use UBM in conjunction with AS-OCT because we can visualize the anterior segment with very high resolution. The image window is not sufficient to view the area in its entirety; therefore, UBM is utilized to observe the entire area and focus on the angle. UBM allows us to visu- alize the real position of the ciliary processes. It is the only imaging technology that can visualize the narrow angle risk of closure in dark conditions and diagnose plateau iris mechanism. Upgrades to the Aviso UBM (Quantel Medical, Clermont-Fer- rand, France) technology now allow us to use one machine with 10 MHz and 20 MHz probes for the posterior segment as well as probes for UBM imaging and B-mode biometry in case of cloudy media and no re- sponse of optical biometry. Ten years ago we had to use one machine for UBM and a separate machine for ultrasound, and now we can plug in M y first trial of ultra- sound biomicroscopy (UBM) was in 1996 in Hôtel-Dieu Hospital of Paris. The first UBM operated with an open probe. Since then, the technology behind UBM has undergone significant improve- ments, and the modality has quickly become invaluable for evaluating narrow angles in glaucoma patients, diagnosing iris or ciliary tumors, and analyzing IOLs after cataract surgery with clarity and ease. At Explore Vision Center in Paris, my colleagues and I are solely dedicated to ophthalmic imaging and per- formed 42,000 imaging procedures in the past year. On average, I use UBM imaging on 30 patients each day, all of who are referred by 1,500 Narrow angle without plateau iris. There is no anterior positioning of the ciliary body with regard to the scleral spur. Plateau iris mechanism with anterior positioning of ciliary body with regard to the scleral spur. Notice the contact between the ciliary body and iris root. Posterior chamber in the bag IOL Ciliary body tumor after treatment with measurements for long-term follow-up Source (all): Michel Puech, MD, FRCS C1 = 1.89 mm C2 = 2.42 mm C1 C1 C2 C2

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