Surgical translocation and ultrasound bio-microscopy of the ovaries in rabbits.

Experiments were designed to validate the use of ultrasound bio-microscopy (UBM) as a method for assessing ovarian structures in rabbits. In Experiment 1, female New Zealand White (NZW) rabbits (n=4) were given an ovulation-inducing treatment and the ovaries were examined ex situ by UBM using a 25 MHz oscillating sector transducer before being processed for histology. Pairwise correlations revealed strong relationships between UBM and histology in the number (Mean±SEM) of follicles ≥0.6 mm (17.3±2.3 compared with19.0±1.6, respectively; r=0.96; P=0.040), CL (8.5±2.9 compared with 8.8±3.0; r=0.99; P=0.003), the diameter of follicles (1.1±0.05 compared with 1.1±0.03 mm; r=0.96; P=0.035) and CL (2.1±0.7 compared with 1.8±0.6 mm, r=0.99; P<0.001). In Experiment 2, the ovaries of NZW rabbits (n=12) were surgically translocated to a subcutaneous position in the flank region to permit serial examination of ovarian structures in vivo by UBM. Beginning 2 weeks after surgery, the ovaries were examined by UBM daily for at least 18 days, and again 2 months after surgery. Post-operative complications were minor, and both ovaries of each rabbit were identified consistently. The number and diameter of follicles ≥0.6 mm were readily visualized during each examination. Multiple corpora lutea were detected in two rabbits, and serial follicular and luteal dynamics in these two rabbits were used to document the consistency of UBM and the retention of ovarian function after surgery. It is concluded that UBM is a valid tool for instant assessment of rabbit ovarian structures (follicles, corpora lutea, and cumulus-oocyte complexes) ex situ, and for serial assessment in vivo using a transcutaneous approach. Surgical translocation had no apparent untoward effect on ovarian function.

The grave necessity to make eye bank specular microscopy mandatory in all eye banks in the subcontinent to improve utilization of scarce donor corneas.

CONTEXT: Donor tissue scarcity, Eye Bank Specular Microscopy as yet not made mandatory and tissue utilization often based on clinical judgment only. AIMS: Prospectively analyze alteration in clinical grading of donor corneas and hence utilization, based on Eye Bank Specular Microscopy (EBSM) and to infer if EBSM should be mandatory in all eye banks. MATERIALS AND METHODS: 200 consecutive otherwise 'suitable for surgery' donor eyes were graded clinically. On quantitative and qualitative analysis of endothelial cells by EBSM, final grading was adjusted. Impact on subsequent utilization for various surgeries was analyzed with regard to Age of Donor, Death to Enucleation Time, Death to Preservation Time and Lens Status of Donor Eye. RESULTS: 76 eyes (38%) (P < 0.05) had significant change in grading. 12/59 (20.30%) tissues from donors <=40 years showed Cell Density (CD) between 1801-2500. 19/76 (25%) tissues from donor >60 years showed CD >= 2500. From donor >=81 years, 2/13 (15.3%) eyes showed CD between 2501-3000 and 1 (7.6%) eye showed CD > 3000. Owing to better grading after EBSM, 13/14 (92.85%) tissues with DTET >6 hours and 5/5 (100%) tissues with DTPT > 16 hours were transplanted. Out of 45 (22.5%) pseudo-phakic tissues, 21 (46.67%) tissues were used for Therapeutic/Tectonic Penetrating Keratoplasty (PKP) while 24 (53.33%) tissues were used for Optical PKP. CONCLUSIONS: EBSM significantly alters final grading of tissues and its subsequent utilization. Acquiring huge importance in areas where adequate supply of corneas is lacking, EBSM becomes an indispensable tool for optimizing availability of qualified tissues for surgery. EBSM should be made a mandatory analysis.

Assessment of anterior segment tumors with ultrasound biomicroscopy versus anterior segment optical coherence tomography in 200 cases.

PURPOSE: To compare ultrasound biomicroscopy (UBM) versus anterior segment optical coherence tomography (AS-OCT) for imaging of tumors of the anterior segment of the eye. DESIGN: Retrospective, noninterventional case series. PARTICIPANTS: We included 200 patients. METHODS: Review of medical records of patients who underwent both UBM and AS-OCT for evaluation of anterior segment tumors. MAIN OUTCOME MEASURES: Comparison of tumor surface and internal visualization. RESULTS: There were 200 eyes with anterior segment tumors involving the iris stroma in 96 (48%), ciliary body in 14 (7%), combined iris and ciliary body in 32 (16%), iris pigment epithelium (IPE) in 44 (22%), conjunctiva in 6 (3%), sclera in 4 (2%), and others in 6 (1% each). The diagnoses included nevus in 75 eyes (38%), melanoma in 47 (24%), cyst in 48 (24%), epithelioma (adenoma) in 5 (3%), metastasis, melanocytosis and melanocytoma in 4 eyes each (2%), and others (1% each). Image analysis (UBM vs AS-OCT) revealed adequate visualization of all tumor margins (189 [95%] vs 80 [40%]), posterior tumor shadowing (9 [5%] vs 144 [72%]), and high overall image quality (159 [80%] vs 136 [68%]). Comparison for better image resolution (UBM vs AS-OCT) disclosed UBM provided better overall tumor visualization (138 [69%] vs 62 [31%]) and better resolution of the posterior margin (147 [74%] vs 53 [27%]), whereas AS-OCT provided better resolution of the anterior margin (40 [20%] vs 160 [80%]) as well as better overall resolution of anterior segment anatomy (41 [21%] vs 159 [80%]). Better resolution was found with UBM for pigmented tumors (n = 162; 107 [66%] vs 55 [34%]) as well as for nonpigmented tumors (n = 38; 23 [61%] vs 15 [39%]). Regarding location, iris tumor resolution was similar with each technique (49 [52%] vs 45 [48%]). CONCLUSIONS: For anterior segment tumors, UBM offers better visualization of the posterior margin and provides overall better images for entire tumor configuration compared with AS-OCT.

Appositional closure identified by ultrasound biomicroscopy in population-based primary angle-closure glaucoma suspects: the Liwan eye study.

PURPOSE: To describe the characteristics of the iridocorneal angle using ultrasound biomicroscopy (UBM) in Chinese people classified gonioscopically as having suspected primary angle-closure (PACS) glaucoma. METHODS: PACS were defined as not having visible posterior (usually pigmented) trabecular meshwork in two or more quadrants examined by static gonioscopy. The PACS and 1 of 10 those who did not meet this criterion were identified from a population-based survey. Iridotrabecular meshwork contact (ITC) was identified and further classified into low and high, according to standard UBM images. Those with high ITC were further classified according the configuration of ITC: B-type, with contiguous ITC from the base of the angle, and S-type, with ITC localized to the region of Schwalbe's line. RESULTS: ITC was identified in 78.6% of the superior, 40.2% of the nasal, 59.8% of the inferior, and 25.6% of the temporal quadrants in the PACS (n = 117). These proportions were 43.9%, 15.8%, 29.8%, and 14.0% in the controls (n = 57), respectively. About two thirds of the eyes with ITC were classified as high. In those with high ITC, the number with B- and S-type ITC was very similar. The proportions of any high ITCs increased substantially from 15.4% in those with Shaffer angle grade 4 and 45.0% in grade 3, to 71.0% in grade 2, 70.2% in grade 1, and 86.4% in grade 0. CONCLUSIONS: More ITC is identified on UBM imaging than by gonioscopy. Careful consideration should be given to the assessment modality regarded as the reference standard in defining anatomic risk factors for glaucomatous visual loss and the need for treatment.

Effect of cycloplegia on axial length and anterior chamber depth measurements in children.

BACKGROUND: Cycloplegia has been shown to have no effect on axial length measurement made with the IOLMaster in adults. The current study aimed at evaluating the effect of cycloplegia on axial length and anterior chamber depth (ACD) measurements made with the IOLMaster and an ultrasonic biometer in children. METHODS: Pre- and post-cycloplegic axial length and ACD were measured with the IOLMaster followed by the Sonomed A-5500 in 31 children aged from seven to 15 years by the same examiner. The 95% limits of agreement (LoA) were determined, if there were no significant correlations found between the mean differences and their means. RESULTS: Seven subjects were excluded. Results from the remaining 24 subjects show that the effects of cycloplegia, instruments, and interaction between cycloplegia and instrument on axial length measurement were insignificant (repeated measure ANOVA F(1,23) < 2.19, p > 0.15). The 95% LoA in cycloplegia were better with the IOLMaster (-0.04 to 0.04 mm) than with the Sonomed A-5500 (-0.13 to 0.14 mm). The 95% LoA between the two instruments were similar with and without cycloplegia (pre-cycloplegia: -0.20 to 0.27 mm; post-cycloplegia: -0.17 to 0.22 mm). There was no significant interaction between cycloplegia and instrument in ACD measurement (repeated measure ANOVA F(1,23)= 0.85, p = 0.37), however, ACD was 0.05 to 0.06 mm shorter before cycloplegia (repeated measure ANOVA F(1,23)= 44.70, p < 0.001) and was 0.06 to 0.08 shorter measured with the IOLMaster (repeated measure ANOVA F(1,23)= 28.81, p < 0.001). CONCLUSION: Effects of cycloplegia on axial length measurement in children made with IOLMaster and Sonomed A-5500 were insignificant. In contrast, ACD measurement was significantly affected by cycloplegia and different instruments.

High-frequency ultrasound measurement for assessing post-thrombotic syndrome and monitoring compression therapy in chronic venous disease.

BACKGROUND: The purpose of this study was to validate high-frequency ultrasound (HFU) measurement of dermal thickness for quantification of edema in patients with different severities of chronic venous disease. METHODS: HFU measurements of dermal thickness were made with a 17-MHz probe (Philips iU22 Ultrasound scanner, Bothell, Wash) or a 20-MHz medium-focus probe (DermaScan-C, Cortex Technology, Denmark), 7.5 cm above the medial malleolus. For validation, 20 patients with venous leg ulcers who were not receiving compression therapy, 20 patients with previous deep vein thrombosis (DVT) and symptoms of post-thrombotic syndrome (PTS) without ulceration, and 31 age-matched healthy controls were measured on a single occasion. To investigate the effect of compression on dermal thickness, the leg ulcer patients from the validation study were treated with compression therapy for 7 weeks and measured after 1, 3, 5, and 7 weeks. The association between dermal thickness and the clinical (C) component of the CEAP classification was examined in a cross-sectional analysis of 157 patients with a confirmed history of DVT >or=3 years ago. RESULTS: Dermal thickness in patients with venous leg ulcers before compression therapy (median, 2.56 mm; interquartile range [IQR], 2.31-2.82 mm) was significantly greater (P = .002) than that in patients with symptoms of PTS without ulceration (median, 2.16 mm; IQR, 1.90-2.36 mm). Dermal thickness in both groups was significantly greater (P < .0001) than the control group (median, 1.34 mm; IQR, 1.29-1.44 mm). Compression therapy caused a steady and significant decrease in dermal thickness during the first 5 weeks until normal control levels were achieved. Dermal thickness increased with increasing CEAP category. In 121 patients with a positive diagnosis of DVT >or=3 years ago from Radiology Department records, a hypothetical test cutoff of 1.985 mm for the prediction of severe PTS noted as C(4b), C(5), and C(6) (lipodermatosclerosis or leg ulceration) had a positive predictive value of 46.9% and a negative predictive value of 90.3%. CONCLUSION: HFU measurement of dermal thickness enables the monitoring of edema reduction by compression therapy. A prospective study is required to determine the temporal dynamics of dermal thickness changes after DVT and the relationship to the development of PTS. This test has the potential to be beneficial in the follow-up of patients after a DVT and provide clinical evidence for using graduated elastic compression stockings to control edema and prevent the development of more advanced skin changes.

Accuracy and repeatability of direct ciliary sulcus diameter measurements by full-scale 50-megahertz ultrasound biomicroscopy.

BACKGROUND: Phakic intraocular lens (pIOL) implantation has been a popular means for the treatment of high ametropia. Measurements of ciliary sulcus diameter is important for pIOL size determining. But till now, no perfect system can directly measure it. The present study was to evaluate the accuracy, repeatability and reproducibility of direct sulcus diameter measurements obtained by a full-scale 50-megahertz (MHz) ultrasound biomicroscopy (UBM). METHODS: A fresh cadaver human eye with a scale marker inserted through the posterior chamber plane from 3 o'clock to 9 o'clock meridian and 30 randomly selected eyes from 30 normal subjects were scanned by full-scale 50-MHz UBM in horizontal meridional scan plane. The distance between the scales and the whole length of the marker inside the cadaver eye were measured by the same observer using the "built-in" measurement tools and the indicating error of instrument was calculated. Reproducibility of the measurement was evaluated in 30 eyes by 2 operators using Blander and Altman plot test. Repeatability was evaluated from 10 successive eyes randomly selected from the 30 eyes by one operator. RESULTS: On a scale of 1 mm, the greatest indicating error was 40 microm; the mean largest indicating error of 1 mm scale from the 10 images was (26 +/- 14) microm; on a scale of 11 mm, the greatest indicating error was 70 microm; the error rate was 0.64%. The mean length of the needle inside the eye of the 10 images was 11.05 mm, with the mean indicating error of 47 microm, the average error rate was 0.43%. For ciliary sulcus diameter measurements in vivo, the coefficient of variation was 0.38%; the coefficients of repeatability for intra-observer and inter-observer measurements were 1.99% and 2.55%, respectively. The limits of agreement for intra-observer and inter-observer measurement were -0.41 mm to 0.48 mm and -0.59 mm to 0.58 mm, respectively. CONCLUSION: The full-scale 50-MHz UBM can be a high accuracy and good repeatability means for direct measuring the ciliary sulcus diameter and useful for size determining of posterior chamber pIOL.

Contrast harmonic ultrasound and indocyanine-green fluorescence video angiography for evaluation of dermal and subdermal microcirculation in free parascapular flaps.

PURPOSE: Contrast harmonic ultrasound (CHI) with a linear transducer is a new diagnostic approach that allows dynamic and quantitative flow detection of tissue perfusion in microsurgery. The aim of the study was the evaluation of perfusion of the dermal and subdermal layers of microvascular tissue transplants with CHI in comparison to ICG-fluorescence angiography. MATERIAL AND METHOD: In a prospective clinical study indocyanine-green fluorescence video angiography and contrast enhanced high resolution ultrasound (5-10 MHz; linear transducer; Logiq 9; GE) were used for evaluation of the microcirculation in 10 transplanted free parascapular flaps. Two regions were analysed, the centre of the flap and the region of the anastomosis. The perfusion patterns of both methods were compared. RESULTS: The perfusion indexes measured by ICG-fluorescence angiography correlated very precisely in all patients with the quantitative perfusion curves of contrast-enhanced US with CHI. Two flaps with slow filling and low dye intensity showed low contrast enhancement in CHI with modified perfusion curves with slow increase. In two cases a reduced perfusion and filling were found. There were no statistical differences between the two diagnostic methods (p>0.01). CONCLUSION: CHI improves US detections of dermal and subdermal microcirculation in comparison to ICG fluorescence angiography. CHI is a new diagnostic method for postoperative monitoring of free flaps.

Agreement among 3 methods to measure corneal thickness: ultrasound pachymetry, Orbscan II, and Visante anterior segment optical coherence tomography.

PURPOSE: To assess the agreement of central and paracentral corneal thickness measurements between ultrasound pachymetry (USP), Orbscan II, and Visante anterior segment optical coherence tomography (ASOCT). DESIGN: Observational cross-sectional study. PARTICIPANTS: Seventy eyes of 70 subjects. METHODS: Each subject underwent Orbscan II (using an acoustic equivalent correction factor of 0.89), ASOCT, and USP examination. Bland-Altman plots were used to evaluate agreement between instruments. MAIN OUTCOME MEASURES: Central and paracentral corneal thickness measurements by the 3 methods and agreement, as evaluated by 95% limits of agreement (LOA). RESULTS: The mean measurements of average central corneal thickness by USP, Orbscan II, and ASOCT were 553.5+/-30.26 microm, 553.22+/-25.47 microm, and 538.79+/-26.22 microm, respectively. There was high correlation between instruments: USP with ASOCT (r = 0.936, P<0.001), USP with Orbscan II (r = 0.900, P<0.001) for central corneal thickness measurements, and Orbscan II with ASOCT for average paracentral 2- to 5-mm measurements (r = 0.947, P<0.001). The mean differences (and upper/lower LOA) for central corneal thickness measurements were 0.31+/-13.34 microm (26.44/-25.83) between USP and Orbscan II, 14.74+/-10.84 microm (36.0/-6.51) between USP and ASOCT, and 14.44+/-9.14 microm (32.36/-3.48) between Orbscan II and ASOCT. The average mean difference (and upper/lower LOA) between Orbscan II and ASOCT for paracentral 2- to 5-mm corneal thickness measurements was 10.35+/-8.67 microm (27.35/-6.65). CONCLUSION: Anterior segment optical coherence tomography underestimated corneal thickness compared with that measured with USP. Anterior segment optical coherence tomography had better agreement with the gold standard USP, as compared with Orbscan II. However, important discrepancies among instruments exist. Clinicians should be aware that corneal thickness measurements are influenced by the method of measurement and that, although highly correlated, these instruments should not be used interchangeably for the assessment of corneal thickness.

Micromechanical properties of demineralized dentin collagen with and without adhesive infiltration.

In a previous study, we reported the upper limit of Young's modulus of the unprotected protein at the dentin/adhesive interface to be 2 GPa. In this study, to obtain a more exact value of the moduli of the components at the d/a interface, we used demineralized dentin collagen with and without adhesive infiltration. The prepared samples were analyzed using micro-Raman spectroscopy (micro RS) and scanning acoustic microscopy (SAM). Using an Olympus UH3 SAM (Olympus Co., Tokyo), measurements were recorded with a 400 MHz burst mode lens (120 degrees aperture angle; nominal lateral resolution, 2.5 microm). A series of calibration curves were prepared using the relationship between the ultrasonically measured elastic moduli of a set of known materials and their SAM response. Finally, both the bulk and bar wave elastic moduli were computed for a set of 13 materials, including polymers, ceramics, and metals. These provided the rationale for using extensional wave measurements of the elastic moduli as the basis for extrapolation of the 400 MHz SAM data to obtain Young's moduli for the samples: E = 1.76 +/- 0.00 GPa for the collagen alone; E = 1.84 +/- 0.65 GPa for the collagen infiltrated with adhesive; E = 3.4 +/- 1.00 GPa for the adhesive infiltrate.

Ultrasound Biomiscroscopy in the diagnosis and management of cyclodialysis clefts.

PURPOSE: To report the role of Ultrasound Biomicroscopy (UBM) as a tool in the diagnosis and management of cyclodialysis clefts. METHODS: Six eyes of 6 patients with hypotony and suspected or diagnosed cyclodialysis clefts underwent UBM evaluation. Post-treatment UBM was performed in four eyes to assess the effect of the treatment. RESULTS: Cyclodialysis clefts were accurately diagnosed and delineated in 6 eyes by UBM. Complete closure was documented after treatment in 3 eyes, and a residual cleft in one eye. These findings were compared to gonioscopic findings. CONCLUSIONS: UBM is a safe, accurate and noninvasive diagnostic tool in the diagnosis of cyclodialysis clefts and is of particular use when other conventional methods of diagnosis are inconclusive.