Ultrasound Biomicroscopy Imaging in Paediatric Ophthalmology: A Case Series

Kianti Darusman¹, Cecilia Aquino¹, Inez Wong^1,2

1 National University Hospital, National University Health System (NUHS), Singapore
2 National University Singapore (NUS)

Purpose
Ultrasound biomicroscopy(UBM) allows high resolution imaging of anterior segment, including the lens, ciliary body and other regions obscured by overlying opaque structures. The present series aims to highlight its unique applications in paediatric patients.

Method
Retrospective study of 14 eyes of 10 consecutive patients under the age of 16 years (mean age 3.49 years,0.08–9) who underwent UBM-related procedures between October 2007 and September 2010.

Results
Three groups were identified. Three patients with bilateral congenital corneal opacification (CCO) were diagnosed to have Peters anomaly, primary aphakia, and sclerocornea. An optical iridectomy and UBM-guided iridocorneal adhesiolysis was performed for one eye, and penetrating keratoplasty for 3. Four eyes of 4 patients with glaucoma (Sturge-Weber 2, aniridia 1, CCO 1) underwent diode transcleral cyclophotocoagulation under UBM-guidance, which aided in the location of ciliary body in 2 eyes with distorted anatomy, and of untreated areas in 2 previously treated eyes. Of the 3 eyes with more than 6 months follow-up, mean pre-operative intraocular pressure of 29.7mmHg(22-40) on mean of 3 medications was reduced to 14mmHg(11-16) on 2.7 medications at mean follow-up of 18.6 months(17-21). Four patients underwent UBM for other purposes: 2 with atypical retrolental/ciliary masses for diagnosis, 1 with JIA-uveitis to rule out ciliary body detachment, and 1 with persistent pupillary membrane to assess associated anterior lens opacity.

Conclusion
UBM, an non-invasive imaging device which differentiates anterior segment anatomy and pathology without the need of optical clarity, is useful in the diagnosis and management of a range of paediatric eye disorders.