Diagnostic Accuracy of B-scan Ultrasonography in Detecting Vitreoretinal Pathology after Open-Globe Injury.

Abstract

Purpose: To assess the diagnostic accuracy of B-scan ultrasonography (echography) after open-globe injury (OGI) repair in detecting vitreoretinal pathology, as confirmed by intraoperative inspection during subsequent pars plana vitrectomy (PPV).

Design: Retrospective, single-center, consecutive case series.

Participants: Patients with OGI treated at the University of Iowa Hospitals and Clinics (UIHC) from February 2018 through December 2023 who underwent OGI repair and had at least one B-scan performed post-repair but prior to subsequent PPV.

Methods: B-scans were performed by an experienced echographer and reviewed by the managing vitreoretinal surgeon for the presence of vitreous hemorrhage (VH), retinal tear (RT), retinal detachment (RD), choroidal detachment, and vitreoretinal incarceration. B-scan findings were compared to findings on direct inspection during PPV, which served as the gold standard.

Main outcome measures: Sensitivity, specificity, and positive/negative predictive value of B-scan findings.

Results: The study included 62 eyes of 61 patients, predominantly with severe OGIs (mean presenting logMAR VA of 2.52 ± 0.41; 75% with Ocular Trauma Score of 1 or 2). B-scan had excellent diagnostic accuracy for VH, but for every other type of vitreoretinal pathology there were significant false positives, false negatives, or both. B-scan sensitivity was particularly low for vitreoretinal incarceration (11%), RT (32%), and RD (78%).

Conclusions: This study identified much lower diagnostic accuracy of B-scan ultrasonography after OGI for all vitreoretinal pathologies except VH compared to previous, smaller studies that reported perfect accuracy (100% sensitivity and specificity). Ultrasonography provides useful clinical information but should not be solely relied upon to diagnose or rule out severe vitreoretinal pathology that may prompt vitreoretinal referral and/or PPV after OGI.