Zusammenfassung
Hintergrund: Kleine intrasklerale Fremdkörper (FK) unterschiedlicher Materialien, vor allem aus
Plastik und organischen Materialien, lassen sich mittels Röntgen/CT schlecht oder
nicht nachweisen. Ziel unserer Studie war es, die Eignung des Ultraschallbiomikroskopes
(UBM) zur Diagnostik dieser FK zu prüfen. Methoden: In-vitro-Darstellung mit Präparation eines Skleratunnels an 12 Schweineaugen, Bestückung
des Tunnels mit kleinen FK unterschiedlicher Materialien, Nachweis mit dem UBM (Humphrey
Ultraschall Biomikroskop, Modell 840). Ergebnisse: Auch kleine FK ab einer Größe von ca. 200 µm sind mit dem UBM im Bereich der vorderen
Augenabschnitte anhand typischer Schalleffekte nachweisbar. Es besteht allerdings
keine Spezifität für das Material des FK. Schlussfolgerung: Das UBM eignet sich bei einer hohen Auflösung von 100 µm und einer Eindringtiefe
von 5 mm auch zur Darstellung sehr kleiner intraskleraler FK. Das UBM ist eine sinnvolle
Alternative bzw. Ergänzung zur radiologischen Diagnostik nichtröntgendichter FK und
hilft bei der Lokalisation eines Fremdkörpers präoperativ. Das UBM kann sogar eine
operative Exploration überflüssig machen, wenn der FK in einem für das UBM zugänglichen
Bereich liegt.
Abstract
Background: Small intrascleral foreign bodies of different materials, especially plastic or organic,
can sometimes not easily - or not at all - be detected by routine X-ray examination
or computed tomography scan. The aim of our study was to evaluate the usefulness of
ultrasound biomicroscopy (UBM) with regard to the detection and localisation of such
foreign bodies. Methods: An in vitro study with the preparation of a scleral tunnel on 12 porcine eyes was
performed. Small foreign bodies of different types of material were placed in the
tunnel. The UBM was performed with a Humphrey Ultrasound Biomicroscope, Model 840,
to evaluate its diagnostic value in detecting and specifying these sclera-covered
foreign bodies. Results: Even small foreign bodies of the anterior ocular segment of only 200 µm in size can
be detected with the UBM due to the typical ultrasound patterns and artifacts. However,
there is no diagnostic specificity for the corresponding material. Conclusion: The UBM is a high-frequency ultrasonic device with an imaging depth of 5 mm and a
spatial resolution of 100 µm. Therefore it is a useful alternative or, respectively,
additional diagnostic tool to common imaging techniques like routine X-ray imaging
or CT scans, especially in the detection of non-metallic objects. It can provide important
information for the ophthalmic surgeon with regard to pre-operative evaluation of
the eye. Furthermore, the UBM might even substitute operative exploration of foreign
bodies if they are located in the anterior segment of the eye.
Schlüsselwörter
Trauma - Skleraverletzung - Ultraschallbiomikroskop - Fremdkörper
Key words
Trauma - scleral injury - foreign body - ultrasound biomicroscopy
Literatur
- 1
Barash D. et al .
Ultrasound biomicroscopic detection of anterior ocular segment foreign body after
trauma.
Am J Ophthalmol.
1998;
126 (2)
197-202
- 2
Dada T. et al .
Comparison of anterior segment optical coherence tomography and ultrasound biomicroscopy
for assessment of the anterior segment.
J Cataract Refract Surg.
2007;
33 (5)
837-840
- 3
Deramo V A. et al .
The role of ultrasound biomicroscopy in ocular trauma.
Trans AM Ophthalmol Soc.
1998;
96
155-165; discussion 765 - 367
- 4
Deramo V A. et al .
Ultrasound biomicroscopy as a tool for detecting and localizing occult foreign bodies
after ocular trauma.
Ophthalmology.
1999;
106
301-305
- 5
Dietlein T S, Engels B F, Jacobi P C. et al .
Ultrasound biomicroscopic patterns after glaucoma surgery in congenital glaucoma.
Ophthalmology.
2000;
107 (6)
1200-1205
- 6
Engels B F, Dietlein T S, Jacobi P C. et al .
Ultrasound biomicroscopy diagnosis of congenital glaucoma.
Klin Monatsbl Augenheilkd.
1999;
215 (6)
338-341
- 7
Fineman M S. et al .
Ultrasound biomicroscopic diagnosis of an occult intrascleral foreign body: an unusual
case of ocular siderosis.
Retina.
2001;
21 (3)
265-267
- 8
Genovesi-Ebert F. et al .
Ultrasound biomicroscopiy in the assessment of penetrating or blunt anterior-chamber
trauma.
Ophthalmologica.
1998;
212 (1)
6-7
- 9
Guha S, Bhende M, Baskaran M. et al .
Role of ultrasound biomicroscopy (UBM) in the detection and localization of anterior
segment foreign bodies.
Ann Acad Med Singapore.
2006;
35 (8)
536-545
- 10 Guthoff R, Pauleikhoff D, Hingst V. Bildgebende Diagnostik in der Augenheilkunde. Stuttgart;
Enke Verlag 1999: 71-73
- 11
Laroche D, Ishikawa H, Greenfield D. et al .
Ultrasound biomicroscopic localization and evaluation of intraocular foreign bodies.
Acta Ophthalmol Scand.
1998;
76 (4)
491-495
- 12
Nouby-Mahmoud G, Silverman R H, Coleman D J.
Using high-frequency ultrasound to characterize intraocular foreign bodies.
Ophthalmic Surg.
1993;
24 (2)
94-99
- 13
Ozdal M P, Mansour M, Deschenes J.
Ultrasound biomicroscopic evaluation oft he traumatized eyes.
Eye.
2003;
17 (4)
467-472
- 14
Pal N, Azad R V, Sony P. et al .
Optical coherence tomography-assisted localization of retained intraocular foreign
body.
Eye.
2005;
19 (6)
717-719
Dr. Andrea Martina Schild
Augenklinik, Universitätskliniken Köln
Kerpenerstr.62
50924 Köln
Phone: ++ 49/2 21/4 78 43 13
Fax: ++ 49/2 21/4 78 43 47
Email: a.schild@gmx.de
