Ultrasound Biomicroscopy Detects Peters’ Anomaly and Rieger’s Anomaly in Infants

Abstract

Aim. Congenital corneal opacities (CCOs) are the major causes of early visual deprivation in infants. Balloon ultrasound biomicroscopy (UBM) examination is an effective method to diagnose CCO. However, whether it is suitable for children examination is still unknown. Methods. 26 Peters’ anomaly (PA) or Rieger’s anomaly (RA) infants with congenital corneal opacities (CCO) (40 eyes) underwent UBM examinations to study their imaging features. Results. Based on the results, they were divided into UBM Dx-Type I: Descemet’s membrane (DM) and endothelium have heterogenous or discontinuous echo accompanied with corneal stroma echo-enhanced or shallow anterior chamber. Type II: Type I alteration plus abnormal strand of iris extended to the border of the posterior corneal defect or iridocorneal adhesion. Type III: Type I or II combined with the abnormal hyperechoic lens, lens luxation, or keratolenticular adhesion. Type IV: echoes of the DM and the endothelium are continuous, corneal stroma echo is enhanced, and an abnormal strand of peripheral iris extends to the prominent Schwalbe line, accompanied by iris stroma or pupil heteromorphism and a shallow or flat anterior chamber. Conclusion. UBM not only could accurately evaluate the anterior segment abnormalities in CCO infants but also would be a step forward for the management of PA- and RA-associated CCO.

Ultrasound biomicroscopy of the anterior segment in patients with primary congenital glaucoma: a review of the literature

“…2011; Chen et al. 2020). Advantage of this technique is that it enables examination in any position (Kosmala et al.…”

“…In most studies included in this review, this UBM technique was used (Dietlein et al 2000;Tandon et al 2017;Shi et al 2018Shi et al , 2020. Alternatively, the UBM probe can be covered with a sterile balloon filled with distilled water and placed directly on the eye (Mireskandari et al 2011;Chen et al 2020). Advantage of this technique is that it enables examination in any position (Kosmala et al 2018).…”

An Update on Pediatric Corneal Imaging Techniques

“…3 The UBM is an invaluable diagnostic and prognostic tool in evaluating anterior segment pathology including aniridia, iridolenticular adhesions, anterior chamber angle structures, and limbal dermoids. [54][55][56][57] In their series, Nischal and colleagues reported that UBM diagnosis agreed 100% with the histologic diagnosis, while 5/13 (38%) of cases were clinically misdiagnosed as sclerocornea (2), keratectasia (1), and congenital glaucoma (2). Respectively, Peter anomaly (first 3 cases) and congenital corneal dystrophy (last 2 cases) were diagnosed using UBM and confirmed histologically.…”

“…Typically, this requires a high level of cooperation from the patient with at least topical anesthestic drops or sedation 3. The UBM is an invaluable diagnostic and prognostic tool in evaluating anterior segment pathology including aniridia, iridolenticular adhesions, anterior chamber angle structures, and limbal dermoids 54–57…”

A systematic review of ultrasound biomicroscopy use in pediatric ophthalmology

“…The most common topic of literature evaluating use of UBM in pediatric subjects with corneal pathology was congenital corneal opacities (CCO), including but not limited to the spectrum of anterior segment dysgenesis. Key findings from these studies include: (1) AS-OCT and UBM can be used interchangeably for corneal thickness and depth measurements in patients with CCO [53], (2) in cases of CCO with penetrating keratoplasty histopathological correlation, UBM diagnosis was correct 100% of cases while clinical diagnosis prior to UBM was correct in 62% of cases [54], (3) UBM informs genotype-phenotype correlations [54], (4) UBM assisted in both diagnosis and treatment decisions for CCO [55][56][57][58][59]. Other pediatric corneal diseases evaluated using UBM includes keratoconus (acute hydrops [60,61], and intrastromal ring implantation [62]), and deep anterior lamellar keratoplasty (DALK) outcomes and indications [63].…”