Comparison between clinical and ultrasound findings in patients with vitreous hemorrhage

Abstract

Purpose To ascertain the causes of vitreous hemorrhage and to determine the accuracy of ultrasound (U/S) in these cases, based on the degree of agreement between ultrasound and clinical findings. Methods A chart review of 96 consecutive patients (106 eyes) with dense vitreous hemorrhage who underwent A-and B-scan U/S by one examiner between June 1996 and June 1999. U/S records were evaluated to determine the presence and exact distribution of areas of retinal detachment and the presence of posterior vitreous detachment, retinal tear, intraocular foreign body, or choroidal detachment. Clinical information was obtained from the medical records after the vitreous hemorrhage was reabsorbed or following vitreous surgery. Clinical and U/S findings were compared. Falsepositive and False-negative rates for U/S were calculated based on clinical findings. Results In 37 eyes (35%) the vitreous hemorrhage was because of proliferative diabetic retinopathy and in 33 eyes (31%) because of ocular trauma. The false-positive rate for retinal detachment (retinal detachment by U/S without clinical confirmation) was 18.9% (seven of 37 eyes). Retinal tears were diagnosed and localized accurately in only four of nine eyes (44%). Conclusions The most common cause of vitreous hemorrhage was proliferative diabetic retinopathy, followed by ocular trauma. U/S correctly diagnosed all cases of retinal detachment, but less than 50% of retinal tears. A total of 18.9% of the eyes were falsely diagnosed as having retinal detachment. U/S is an effective diagnostic tool in patients with vitreous hemorrhage.

Comparison between clinical and ultrasound finding in patients with vitreous hemorrhage

“…The most common cause of vitreous hemorrhage was found to be proliferative diabetic retinopathy followed by blunt trauma, penetrating trauma and vitreous detachment. A previous study by R Robinowitz et al 3 had similar observation where poliferative diabetic retinopathy was the most common cause of vitreous hemorrhage (35%) followed by penetrating trauma (20%) and post intraocular surgery (13% Intraocular foreign bodies were detected correctly in 100% cases. Comparable results were seen in study by R Robinowitz et al 3 .…”

Bedside Ocular Ultrasound for the Detection of Retinal Detachment in the Emergency Department

“…The sensitivity and specificity of EOUS in our sample were comparable to that described previously for ocular US performed by ophthalmologists. 13 If confirmed by a larger, randomized trial, then EOUS may eventually be used to exclude the diagnosis of RD without ophthalmology consultation.…”

“…13 Acute vitreous hemorrhages typically appear minimally echogenic on US, but can become more echogenic and appear thickened with time, thus mimicking the appearance of a RD. 14,15 On the other hand, a detached retina appears as a thick, often folded membrane that inserts into the optic disk.…”

“…First, RDs localize to the optic disk (see Figure 3). 13,15,16 Second, while the probe is in place over the eye, patients are asked to shift their gaze from side to side. 16 In the setting of a vitreous hemorrhage, the echogenic line that occurs from the layering of blood will continue to remain horizontal, versus shifting with RDs.…”

Evaluation of Orbital and Ocular Lesions on Sonography

“…Jemeld B et al, found US to be 78 % accurate whereas Rabinowitz R et al, found US to be 100 % accurate in diagnosing RD. 6,7 Posterior Vitreous Detachment and Vitreous Floaters: All 5 cases of Vitreous Detachment and 3cases of VF were correctly diagnosed by ultrasound. Rashmi et al found PHPV to be 100% specific and sensitive on usg.…”