Добавил:
Sekretar
kiopkiopkiop18@yandex.ru
t.me/Prokururor I Вовсе не секретарь, но почту проверяю
Опубликованный материал нарушает ваши авторские права? Сообщите нам.
Вуз:
Предмет:
Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_103_библиотеки_им_акад_М_И_Перельмана
.pdf
24 Ophthalmic Ultrasound
https://t.me/med1917
Table 24.3 Ultrasound ndings in PVD, RD, and CD
Characteristic PVD RD CD
Echogenicity and
reectivity
Amplitude of
echo
Attachment to
the optic nerve
head
Mobility Good after-movements Poor after-movements No after-movements
Low gain Disappears Persists Persists
Low reective membranous
echo with a corresponding
low reective A-scan spike
Less than 100% 100% compared to choroid
Complete: Not attached to
the optic nerve head
Incomplete: Attached to the
optic nerve head
High reective
membranous echo with a
corresponding high A-scan
spike
and sclera
Attached to the optic nerve
head
High reective membranous
echo with a corresponding high
reective double or M spike on
A-scan
100%
Not attached to the optic nerve
head
293
Table 24.3 details the differences between
PVD, RD, and CD.
24.4.9 Retinoschisis
Retinoschisis splits the retinal layers into inner
and outer ones with cystic spaces in between. It
appears as a thin immobile membrane with a convex and smooth conguration on ultrasound. It is
usually located in the inferotemporal quadrant in
patients with hypermetropia. Retinoschisis must
be differentiated from RD.Retinoschisis is usually of lower amplitude and thinner than RD [14].
The height of retinoschisis does not decrease on
indentation, while the height of RD decreases on
indentation.
24.4.10 Retinal Tear
Retinal tears are breaks in the retina secondary to
PVD and vitreous traction. Ultrasound has over
90% sensitivity and specicity in detecting small
retinal tears [15]. On ultrasound, a retinal tear
appears as focal retinal elevations with high
reectivity and an adherent vitreous strand with
lower reectivity. They do not have good movements on kinetic scans. In a low gain setting, only
the retinal component will remain visible. A giant
retinal tear is a retinal tear that is more than
3-clock hours of the retina. On ultrasound, it
appears as two membranes attached to the optic
disc; the rst echo is the inverted posterior ap of
the tear, and the second echo is the detached retina [16, 17].
24.4.11 Endophthalmitis/
Panophthalmitis (Fig.24.4)
Endophthalmitis is inammation of the intraocular uids (vitreous/aqueous) secondary to infection after surgery, trauma, etc. Panophthalmitis is
purulent inammation of all coats of the eyeball
and intraocular structures. On ultrasound, vitreous inammation appears as point echoes in the
vitreous cavity and mild to moderate reectivity
on A-scan. Ultrasound ndings can also include
vitreous debris and loculations. There is associated retinochoroidal thickening and associated
RD and CD in some cases. Thickening of the
scleral coats and collection of uid in the subTenon’s space called the “T sign” is typically
seen in panophthalmitis [18].
24.4.12 Vogt-Koyanagi Harada
Syndrome (Fig.24.4)
Vogt-Koyanagi Harada (VKH) syndrome is a
bilateral granulomatous panuveitis with
associated central nervous system, auditory, and
skin involvement. On ultrasound, there are mild
to moderately low reective vitreous echoes
(Fig.24.4; lower left panel) and no PVD.There is
choroidal thickening with low to medium reectivity of the choroid (Fig.24.4; lower right panel)
294
https://t.me/med1917
S. Ganesan et al.
Fig. 24.4 Top left: Endophthalmitis. The vitreous cavity
shows plenty of low reective dot echoes (red arrow) and
membranous echoes (yellow arrow) with thickening of the
RCS complex. Top right: Panophthalmitis. Multiple vitre-
ous cavity echoes with subretinal low reective dot echoes
suggest a subretinal abscess (yellow arrow) with a promi-
[7, 19]. Serous RDs can be seen inferiorly or at
the posterior pole. Ultrasound is useful in monitoring response to corticosteroid treatment by
evaluating serous RDs and choroidal thickening
in eyes with opaque media.
nent hypo-echoic space behind the ocular coat called the
T-sign (red arrow). Bottom: VKH.The vitreous shows a
moderate number of low reective dot echoes with a moderate reective membrane extending from the optic nerve
head to the inferior periphery, suggesting retinal detachment (right) and diffuse choroidal thickening (left)
24.4.13 Posterior Scleritis
Posterior scleritis is a painful inammation of the
sclera posterior to the equator. On ultrasound,
there is a thickening of ocular coats, episcleral
24 Ophthalmic Ultrasound
https://t.me/med1917
295
Fig. 24.5 Top row; left: Posterior scleritis. A localized,
highly reective membrane echo is noted in posterior
pole. Peripapillary choroid and choroid adjacent to retinal
detachment are thickened with hypo-echoic space beneath
them. Top row; right: RD with cysticercosis. A moder-
ately high reective membrane echo with large cystic
lesions and intracystic hyper-reective clump echoes is
space uid, enlargement of the optic nerve
shadow, and exudative RD.A pathognomic sign
is the “T-sign,” i.e., uid accumulation in the subTenon’s space, i.e., between the optic nerve and
the sclera, seen as hypo-echo-lucency continuous
with the optic nerve head. A recent study has suggested a new criterion of scleral thickness of
>1.7 mm and a difference of 20% or more in
scleral thickness between two eyes of a patient
for the diagnosis of posterior scleritis [20].
noted. Bottom row; left: Retinochoroidal coloboma. A
retinochoroidal excavation is noted with sharp edges is
suggestive of RC coloboma involving the disc and macula. Bottom row; right: Posterior staphyloma. A retinochoroidal excavation with smooth edges in the posterior
pole in an eye with increased axial length suggests posterior staphyloma
24.4.14 Cysticercosis (Fig.24.5)
Cysticercosis is a parasitic infection caused by
Cysticercus cellulosae, the larval form of Taenia
solium, which affects various parts of the eye.
When present in the posterior segment, it can be
seen on ultrasound as a well-dened round to
oval echo-lucent cyst with a dense echogenic
nodule attached to the inner wall of the cyst is
suggestive of scolex and exhibits movements on
296
https://t.me/med1917
S. Ganesan et al.
kinetic scanning [21]. Dead cysts cause inammation, leading to vitreous dots, membranous
echoes, and possible RD.
24.4.15 Choroidal Coloboma
(Fig.24.5)
Colobomas occur due to the failure of closure of
the embryonic ssure and are typically located in
the inferonasal part of the fundus. On ultrasound,
there is excavation of varying depths involving
the retina, choroid, and/or optic disc [21]. It has a
smooth contour or outpouching. The edge is
overhanging, sharp, or shelved. The intercalary
membrane can be visualized in some cases across
the coloboma.
24.4.16 Posterior Staphyloma
(Fig.24.5)
Posterior staphyloma is an outpouching of the
wall of the eye that has a radius of curvature
lesser than the surrounding curvature of the wall
of the eye seen in pathological myopia. On ultrasound, an excavation with smooth edges is noted
at the posterior pole in an eye with increased
axial length [21].
24.4.17 Phthisis Bulbi
Phthisis bulbi is an end-stage ocular disease
related to scarring, inammation, atrophy, and
disorganization of the globe and intraocular contents. On ultrasound, the eye has a grossly
reduced axial length, distorted globe structure,
and ocular coat calcication [22].
24.4.18 Trauma
Ocular trauma secondary to blunt or penetrating
injuries can damage the eye, with the severity
ranging from minor injuries to globe ruptures
leading to temporary or permanent impairment of
visual function. Ultrasound of the posterior segment helps assess the internal ocular damage in
eyes with opaque media and detect various conditions such as dislocated crystalline lens/cataract or intraocular lens, PVD and vitreous
hemorrhage, retinal tears and RDs, CDs, optic
nerve avulsion, scleral rupture, incarcerated
wounds, and intraocular foreign bodies (IOFBs)
[21].
24.4.18.1 Dislocated Crystalline Lens/
Intraocular Lens (Fig.24.6)
Crystalline, cataractous, or intraocular lenses can
dislocate posteriorly into the vitreous after
trauma. On ultrasound, the dislocated lens is seen
as a hyper-reective globular shadow in the inferior vitreous, and the dislocated intraocular lens
has a hyper-reective surface with posterior
reverberation echoes [21].
24.4.18.2 Intraocular Foreign Body
(IOFB) (Fig.24.6)
Ultrasound is used to localize the position and
determine the number, size, and type of IOFB
and associated complications such as vitreous
hemorrhage and retinal detachment, especially in
opaque media. In cases of clear ocular media,
documentation of IOFB by ultrasound is important for medicolegal reasons. On ultrasound,
IOFBs appear hyperechoic, bright, and acoustically opaque lesions with acoustic shadowing of
ocular or orbital structures with a corresponding
100% reective echo on the A-scan (Fig. 24.6 top
right). IOFBs persist in low gain settings of 20 to
30 dB [21]. Spherical IOFBs characteristically
have reverberations. Metal and stone foreign
bodies have higher amplitude echoes than wood
and vegetable matter. Glass IOFBs are challenging to locate on ultrasound unless the sound beam
strikes perpendicular to the IOFB. Transverse
scans can help locate the foreign body, while longitudinal scans are used for better exposure of the
IOFB and accurately measure its dimensions.
Mobility of the IOFBs can be assessed on kinetic
scans, which can help assess if it is freely mobile
in the vitreous or adherent to the underlying
retina.
24 Ophthalmic Ultrasound
https://t.me/med1917
297
Fig. 24.6 Top left: Posterior dislocated lens. A highly
reective biconvex echo is noted inferiorly with back shadowing (arrow). Top right: Intra ocular foreign body. A
high reective linear echo is noted in the mid-vitreous cavity (arrow). Bottom left: Globe discontinuity. Vitreous
24.4.18.3 Optic Nerve Head Avulsion
Optic nerve head avulsion is a rare but serious
effect of trauma and is described as the separation of optic nerve bers from the globe at the
level of the lamina cribrosa. It appears as hypolucency posterior to the optic nerve head on ultrasound. A corresponding A-scan may show
marked widening of the nerve, suggesting hemorrhage and edema within the nerve sheath in
addition to optic nerve avulsion [23].
incarceration is seen temporally with suspected discontinuity of the ocular coat (arrow). Bottom right: Vitreous
incarceration. A variable reective membrane echo is
noted with good after-movement converging towards the
ocular coats (arrow), causing possible incarceration
24.4.18.4 Scleral Rupture (Fig.24.6)
Scleral rupture can be difficult to detect clinically. On ultrasound, the rupture site appears
as an area with decreased reflectivity, i.e.,
hypoechogenic with an irregular contour.
Indirect signs include vitreous incarceration
with VH and PVD, episcleral hemorrhage
close to the rupture site, retinal tractional
bands that converge at the site of rupture, RD,
and CD [21].
298
https://t.me/med1917
S. Ganesan et al.
Fig. 24.7 Left: Retinoblastoma. The vitreous cavity
shows an irregular hyperechoic mass with areas of high
internal reectivity, suggesting intralesional calcication.
Middle: Choroidal melanoma. A homogenous mass lesion
24.4.19 Tumors
24.4.19.1 Retinoblastoma (Fig.24.7)
Retinoblastoma is a rare childhood cancer of the
retina arising due to biallelic mutations of the
cone photoreceptor precursor. Worldwide, 8000
new cases are reported yearly, with most children
presenting with the condition before 5years of
age. The hallmark of retinoblastoma is the presence of calcium. When calcium is present in large
quantities, the mass has high internal reectivity
and causes intense back shadowing masking the
structures behind it, like the choroid, sclera, and
optic nerve, especially if the tumor is close to the
optic nerve. Non-calcied tumors express low to
medium reectivity. If calcium is present in very
less quantities, like specks, they are represented
as tiny point areas of high internal reectivity
within areas of medium internal reectivity [21].
The surface can vary from dome to irregular conguration. There can be associated exudative
RD.Diffuse inltrating retinoblastoma can present as a small elevation from the retina or irregular retinal thickening with no calcication.
with moderate surface and internal reectivity with associated localized retinal detachment. Right: Small choroidal
hemangioma. A small mass lesion with a highly reective
surface echo and moderate reective internal echo
is commonly dome-shaped and, less commonly,
can be collar button- or mushroom-shaped.
Lobulated types and those with irregular surface
contours have also been described. The tumor
consistency is often solid, uniformly homogenous, with low to medium internal reectivity
except in areas of hemorrhage due to intervening
necrosis. Choroidal excavation may also occur.
Acoustic hollowing is secondary to the densely
packed cellular nature of the tumor, causing
decreased echogenicity at the tumor base compared with the adjacent choroid [24, 25].
Attenuation of the sound waves on the A-scan
towards the base of the tumor is called angle
kappa. Associated exudative RD can extend from
the margins and not from the summit of the
tumor. The adjoining sclera should be examined
for the presence of extra-scleral invasion.
Table 24.4 lists the clinical and ultrasound
ndings of other choroidal tumors, such as choroidal hemangioma, osteoma, and metastasis.
24.4.20 Pediatric Retinal Disease
24.4.19.2 Choroidal Melanoma
(Fig.24.7)
Choroidal melanoma arises from uveal melanocytes predominantly originating from the choroid
located posterior to the equator. On ultrasound, it
24.4.20.1 Retinopathy ofPrematurity
(ROP) (Fig.24.8)
ROP is an abnormality of retinal blood vessels
that occur in premature infants; when not treated
in time, it can progress to RD.Indirect ophthal-
24 Ophthalmic Ultrasound
https://t.me/med1917
Table 24.4 Choroidal hemangioma vs. choroidal osteoma vs. choroidal metastasis [26]
Characteristic Choroidal hemangioma Choroidal osteoma Choroidal metastasis
Clinical Two types
1. Circumscribed: Red
dome-shaped posterior
pole choroidal elevation.
2. Diffuse: Tomato ketchup
fundus associated with
Sturge-Weber syndrome
Ultrasound Circumscribed: Elevated
dome-shaped acoustically
solid mass, no choroidal
excavation.
High surface reectivity and
high internal reectivity
between 50 and 100% due to
vascular channels.
Diffuse: Diffuse thickening
of choroid extending from
the optic nerve head to the
equator.
Associated exudative RD
Peripapillary yellow-white to
orange-red colored benign
ossifying at and elevated
choroidal lesion
Mature bone causes high
reectivity with back
shadowing of orbital tissues
persisting at low gain, usually
located over the posterior pole
Metastatic carcinoma of the
choroid. Cream-colored single or
multifocal lesions located in the
posterior pole with an irregular
surface.
Choroidal elevations may be mild
or moderate
Varying internal reectivity from
moderate to high with
heterogenous internal structure.
Associated exudative RD
299
Fig. 24.8 Left: Stage 4 ROP.A highly reective mem-
branous echo (arrow) with moderate after-movements
extending from the optic nerve head to the periphery in
the temporal quadrant, suggestive of temporal falciform
moscopic evaluation or fundus camera-based
imaging are the conventional methods of evaluation. Ultrasonography is widely used in advanced
stages of ROP.In circumstances like non-dilating
pupils or the setting of cataracts on a preterm
infant, ultrasound can be useful in assessing all
fold. Right: Stage 5 ROP. A moderate reective membrane extending from the optic nerve head to the periphery suggests total retinal detachment with an open funnel
conguration (arrow)
the stages of ROP [27]. The demarcation line in
Stage 1 is seen as a shallow ridge. Retinal thickening with a ridge is noted in stage 2. Stage 3 is
seen as a giant ridge. Stage 4a is seen as an anteriorly drawn retina towards the lens margin with
vitreous condensation. Stage 4b is seen as high
300
https://t.me/med1917
S. Ganesan et al.
reective echoes of brovascular tissue pulling
up the retina in a concave conguration with
macular involvement. Further progression of this
stage by cicatricial processes results in complete
tractional retinal detachment, which appears as a
funnel-shaped, highly reective membrane
attached to the optic disc in four different congurations, namely, open-open, close-open,
open-close, and close-close. A peripheral trough
signies areas of the avascular retinal fold. The
presence of subretinal echoes, suggestive of layering of subretinal hemorrhage or cholesterol, is
considered to be prognostically poor. Axial
length measurement is mandatory as reduced
axial length can signify poor anatomical
outcomes.
24.4.20.2 Coats Disease
Coats disease, the commonest cause of leukocoria characterized by an exudative retinal detachment, retinal telangiectasia, aneurysms, and
exudation known to occur in males is an idiopathic ocular condition. The classical nding is
the subretinal cholesterol appearing as subretinal
echoes in ultrasound. Total RD is seen behind the
crystalline lens but does not present with shifting
uid; less massive detachments are present with
shifting uid.
24.4.20.3 Persistence ofFetal
Vasculature (PFV)
PFV occurs due to the failure of regression of the
hyaloid vasculature in utero. The location of persistent vasculature remnants determines the spectrum of presentation. PFV is of three types:
posterior, anterior, and hybrid. In posterior PFV,
the hyaloidal stalk connects between the back
surface of the lens and the optic nerve head, and
on ultrasound, it presents as a variably reecting
thin vitreous band extending between the back
surface of the lens and the optic nerve head with
or without peripapillary tractional RD [28].
Anterior PFV presents with reduced axial length,
cataract, prominent, elongated ciliary process,
shallow anterior chamber, engorged iris vessels,
and retrolental membrane. This presents as irregular thickening behind the posterior capsule, very
often unilateral.
24.4.21 Silicon Oil-Filled Eye
(Fig.24.9)
The sound velocity in an eye lled with silicon
oil (~987m/s) is much slower than in a normal
eye (~1532m/s). Hence, an echogram of a silicon
oil-lled eye shows an apparently enlarged eye in
Fig. 24.9 Left: Emulsied silicon oil bubbles. In the vit-
reous cavity, a few medium reective mobile dot echoes
(arrow) s/o residual emulsied silicon oil bubble. This can
be clearly differentiated from asteroid hyalosis (Fig.24.1),
where there is clear space behind it. Right: Silicon oillled eye with RD.Apparently, an enlarged globe with a
highly reective membrane-like echo was noted inferiorly, suggesting possible retinal detachment
24 Ophthalmic Ultrasound
https://t.me/med1917
Fig. 24.10 Optic nerve head drusen. Localized very highly reective clump echo (arrow) over the optic nerve head
(left), persisting even in the low gain (right)
301
a supine position [29]. Retinal and choroidal status cannot be clearly dened, and detecting RD
in these eyes is challenging due to high sound
attenuation. A prone or sitting position is preferable to scan the normal ocular wall. Since the silicon oil moves towards the retina, in a prone
position, the retina is identied with the help of a
single spike when the retina is attached; in a
detached retina, two spikes will be seen.
24.4.22 Common Optic Nerve
Lesions
24.4.22.1 Papilledema
Papilledema is swelling of the optic disc secondary to increased intracranial pressure (ICP). On
ultrasound, the optic nerve sheath diameter
(ONSD) is used to assess ICP indirectly. Normal
ONSD ranges from 2.2 to 5mm. ONSD >5mm
is suggestive of ICP [30]. ONSD is measured
3mm behind the posterior scleral surface of the
eyeball [31]. The 30° test involves measuring the
optic nerve head in primary gaze and when the
patient’s gaze is directed 30° laterally. A decrease
of the optic nerve head by 10% in the lateral gaze
is considered positive and indicates increased
subarachnoid uid [31].
24.4.22.2 Optic Disc Cupping
Optic disc cupping occurs in cases of advanced
glaucoma or could be physiological. On ultrasound, it is seen as an excavation of the optic
nerve head. It is best visualized on vertical transverse and longitudinal scans [32, 33]. A cup-disc
ratio of a minimum of 0.5 is required for ultrasound detection of cupping.
24.4.22.3 Optic Disc Drusen
(Fig.24.10)
Optic disc drusen are calcied nodules within
the optic nerve head. On ultrasound, drusen are
seen as very high reective echoes over
the optic nerve head, which persists in low
gain[21].
24.5 Conclusion
Ultrasound B-scan is a useful non-invasive tool
in multiple posterior segment conditions. Clinical
correlation is important while interpreting a
B-scan.
Funding Nil.
Disclosure Nil.
302
https://t.me/med1917
S. Ganesan et al.
References
1. Mundt G, Hughes W.Ultrasonics in ocular diagnosis.
Am J Ophthalmol. 1956;41:488–98.
2. Baum G, Greenwood I.The application of ultrasonics locating techniques to ophthalmology*: heoretic
considerations and acoustic properties of ocular
media: part I.Reective properties. Am J Ophthalmol.
1958;46(5):319–29.
3. Purnell EW. Ultrasound in ophthalmological diagnosis. In: Grossman C, Homes JH, Joyner C, Purnell
EW, editors. Diagnostic ultrasound. New York:
Plenum Press; 1966. p.95–109.
4. Coleman DJ, Konig WF, Katz L. A hand-operated,
ultrasound scan system for ophthalmic evaluation.
Am J Ophthalmol. 1969;68:256–63.
5. Ossoinig K.Clinical echo-ophthalmology. In: Blodi
FC, editor. Current concepts in ophthalmology, vol.
III.St Louis: CV Mosby Co; 1972. p.101–30.
6. Lizzi FL, Coleman DJ.History of ophthalmic ultrasound. J Ultrasound Med. 2004;23(10):1255–66.
https://doi.org/10.7863/jum.2004.23.10.1255.
7. Green RL, Byrne SF. Chapter 14: Diagnostic
ophthalmic ultrasound. In: Ryan SJ, editor.
Retina. Philadelphia: Elsevier/Mosby; 2006.
p.265–350.
8. Allison KL, Price J, Odin LJ.Asteroid hyalosis and
axial length measurement using automated biometry.
Cataract Refract Surg. 1991;17(2):181–6.
9. Capeans C, Santos L, Tourino R, et al. Ocular
echography in the prognosis of vitreous haemorrhage in type II diabetes mellitus. Int Ophthalmol.
1997;21(5):269–75.
10. Dawood Z, Mirza SA, Qadeer A.Role of B-scan ultrasonography for posterior segment lesions. JLUMHS;
2008.
11. Freyler H, Egerer I. Echography and histological
studies in various eye conditions. Arch Ophthalmol.
1977;95(8):1387–94.
12. Jalkh AE, Avila MP, El-Markabi H, etal. Immersion
A- and B-scan ultrasonography. Its use in preoperative evaluation of diabetic vitreous hemorrhage. Arch
Ophthalmol. 1984;102(5):686–90.
13. Fledelius HC. Ultrasound in ophthalmology.
Ultrasound Med Biol. 1997;23(3):365–75.
14. Hillman JS, Ridgway AE. Retinoschisis and retinal detachment, an ultrasonic comparison. Bibl
Ophthalmol. 1975;83:63–7.
15. Nischal KK, James JN, McAllister J. The use
of dynamic ultrasound B-scan to detect retinal
tears in spontaneous vitreous haemorrhage. Eye.
1995;9(4):502–6.
16. DiBernardo C, Blodi B, Byrne SF. Echographic
evaluation of retinal tears in patients with spontaneous vitreous hemorrhage. Arch Ophthalmol.
1992;110(4):511.
17. Jalkh AE, Jabbour N, Avila MP, et al.
Ultrasonographic ndings in eyes with giant retinal
tears and opaque media. Retina. 1983;3(3):154–8.
18. Marchini G, Pagliarusco A, Tosi R, Castagna
G. Ultrasonographic ndings in endophthalmitis.
Acta Ophthalmol Scand. 1995;73(5):446–9. https://
doi.org/10.1111/j.1600- 0420.1995.tb00306.x.
19. Byrne S, Green R.Ultrasound of the eye and orbit.
2nd ed. St Louis, MO: Mosby; 2002.
20. Maleki A, Ruggeri M, Colombo A, etal. B-scan ultrasonography ndings in unilateral posterior scleritis. J
CurrOphthalmol. 2022;34(1):93–9.
21. Bhende M, Kamat H, Krishna T, et al. Atlas of ophthalmic ultrasound and ultrasound biomicroscopy. JP
Medical Ltd; 2013.
22. Coleman JD. Ultrasonography of eye and orbit.
2nd ed. Lippincott: Williams and Wilkins; 1977.
p.47–122.
23. Sawhney R, Kochhar S, Gupta R, et al. Traumatic
optic nerve avulsion: role of ultrasonography. Eye.
2003;17(5):667–70.
24. Singh P, Singh A. Choroidal melanoma. Oman
J Ophthalmol. 2012;5(1):3–9. https://doi.
org/10.4103/0974- 620X.94718.
25. Yeh PT. B-scan for the diagnosis of choroidal diseases. J Med Ultrasound. 2013;21(3):123–5.
26. Wang TJ, Yang CH, Liao SL, et al. Characteristic
ultrasonographic ndings of choroidal tumors. J Med
Ultrasound. 2003;11(2):55–9.
27. Lee KF, Abdul Rahim A, Raja Azmi MN, et al.
Ultrasonographic ndings in eyes with retinopathy of prematurity in Malaysia. Med J Malaysia.
2013;68(1):39–43.
28. Prakhunhungsit S, Berrocal AM. Diagnostic and
management strategies in patients with persistent
fetal vasculature: current insights. Clin Ophthalmol.
2020;14:4325–35.
29. Abbas R.Ophthalmic ultrasonography and ultrasound
biomicroscopy. Springer International Publishing;
2021.
30. Agrawal A, Cheng R, Tang J, Madhok
DY. Comparison of two techniques to measure
optic nerve sheath diameter in patients at risk for
increased intracranial pressure. Crit Care Med.
2019;47(6):e495.
31. Kimberly HH, Shah S, Marill K, Noble V.Correlation
of optic nerve sheath diameter with direct measurement of intracranial pressure. Acad Emerg Med.
2008;15(2):201–4.
32. Darnley-Fisch DA, Byrne SF, Huhges JR, et al.
Contact B-scan echography in the assessment of optic
nerve cupping. Am J Ophthalmol. 1990;109(1):55–61.
33. Özen Ö, Özer MA, Tosun A, Özen S.Evaluation of
the optic nerve and scleral-choroidal-retinal layer
with ultrasound elastography in glaucoma and physiological optic nerve head cupping. Med Ultrason.
2018;20(1):76–9.
Соседние файлы в папке Библиотека им академика М.И. Перельмана