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Comparison of B-Scan ultrasonography, ultra-widefield fundus imaging, and indirect ophthalmoscopy in detecting retinal breaks in cataractous eyes

Eye (2024)Cite this article

Subjects

Abstract

Background/objectives

To evaluate the diagnostic performance of B-scan kinetic ultrasonography (USG), standard ultra-widefield (UWF) imaging, and indirect ophthalmoscopy (IDO) in retinal break detection in cataractous eyes.

Subjects/methods

We consecutively enrolled 126 cataract patients (including 246 eyes) with no comorbidities that could decrease best corrected visual acuity (BCVA). Three index tests (USG, nonmydriatic UWF, and mydriatic IDO) were performed preoperatively to screen for retinal breaks. One week after cataract extraction, a dilated IDO examination was repeated for the definitive diagnosis of retinal break as the reference standard. The sensitivity, specificity, Youden index (YI), and predictive values of each index test were calculated according to postoperative ophthalmoscopic findings. A deep-learning nomogram was developed to quantify the risk of retinal break presence using patients’ baseline data and findings reported from preoperative ophthalmic tests.

Results

Fifty-two eyes (21%) were excluded from appropriate preoperative UWF imaging because of massive lens opacity. The BCVA cutoff point with maximum YI indicating UWF applicability was 0.6 logMAR (YI = 0.3; area under curve [AUC] = 0.7). Among all 246 eyes, preoperative IDO, USG, and UWF showed fair interobserver agreement (all κ > 0.2). According to postoperative IDO findings, the index tests with the highest sensitivity and specificity were USG (100%) and preoperative IDO (99%), respectively.

Conclusions

For cataractous eyes without vision-impairing comorbidities, a BCVA better than 0.6 logMAR (Snellen acuity, 20/80) allows for appropriate nonmydriatic standard UWF imaging. In a high-volume clinic equipped with skilled ophthalmic examiners, screening with USG followed by directed IDO allows the efficient identification of retinal breaks in cataractous eyes.

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Fig. 1: Receiver operating characteristic (ROC) curve showing the diagnostic performance of preoperative best corrected visual acuity (BCVA) in indicating the applicability of UWF imaging in cataractous eyes.
Fig. 2: A false-positive retinal break was diagnosed by an ultra-widefield (UWF) imaging system.
Fig. 3: A deep learning-based nomogram showing the risk factors for retinal break presence in cataractous eyes.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author upon reasonable request.

References

  1. Uhr JH, Obeid A, Wibbelsman TD, Wu CM, Levin HJ, Garrigan H, et al. Delayed retinal breaks and detachments after acute posterior vitreous detachment. Ophthalmology. 2020;127:516–22.

    Article  PubMed  Google Scholar 

  2. Chen YP, Chen TL, Yang KR, Lee WH, Kuo YH, Chao AN, et al. Treatment of retinal detachment resulting from posterior staphyloma-associated macular hole in highly myopic eyes. Retina. 2006;26:25–31.

    Article  CAS  PubMed  Google Scholar 

  3. Lorenzo-Carrero J, Perez-Flores I, Cid-Galano M, Fernandez-Fernandez M, Heras-Raposo F, Vazquez-Nuñez R, et al. B-scan ultrasonography to screen for retinal tears in acute symptomatic age-related posterior vitreous detachment. Ophthalmology. 2009;116:94–9.

    Article  PubMed  Google Scholar 

  4. Kumar V, Surve A, Kumawat D, Takkar B, Azad S, Chawla R, et al. Ultra-wide field retinal imaging: a wider clinical perspective. Indian J Ophthalmol. 2021;69:824–35.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Jinabhai AN, Charman WN. Factors affecting image magnification in indirect ophthalmoscopy with Volk or similar lenses and a biomicroscope. Ophthalmic Physiol Opt. 2022;42:717–29.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Peng J, Zhang Q, Jin HY, Lu WY, Zhao PQ. Ultra-wide field imaging system and traditional retinal examinations for screening fundus changes after cataract surgery. Int J Ophthalmol. 2016;9:1299–303.

    PubMed  PubMed Central  Google Scholar 

  7. Nagiel A, Lalane RA, Sadda SR, Schwartz SD. ULTRA-WIDEFIELD FUNDUS IMAGING: a review of clinical applications and future trends. Retina. 2016;36:660–78.

    Article  PubMed  Google Scholar 

  8. Oh BL, Park UC, Kim BH, Lee EK, Yoon CK, Choe HR, et al. Role of Ultra-widefield Imaging in the evaluation of long-term change of highly myopic fundus. Acta Ophthalmol. 2022;100:e977–e85.

    Article  PubMed  Google Scholar 

  9. Li M, Yang D, Shen Y, Shang J, Niu L, Yu Y, et al. Application of mydriasis and eye steering in ultrawide field imaging for detecting peripheral retinal lesions in myopic patients. Br J Ophthalmol. 2023;107:1018–24.

  10. Yang SS, Jiang T. Vitrectomy combined with silicone oil tamponade in the treatment of severely traumatized eyes with the visual acuity of no light perception. Int J Ophthalmol. 2013;6:198–203.

    PubMed  PubMed Central  Google Scholar 

  11. Bhambra N, Antaki F, Malt FE, Xu A, Duval R. Deep learning for ultra-widefield imaging: a scoping review. Graefes Arch Clin Exp Ophthalmol. 2022;260:3737–78.

    Article  PubMed  Google Scholar 

  12. Vaiano AS, Coronado Quitllet E, Zinzanella G, De Benedetti G, Caramello G. Ultrasound measurements of the distance between limbus and retinal break in eyes with media opacities. Retina. 2017;37:1400–6.

    Article  PubMed  Google Scholar 

  13. Ryan EH. Current treatment strategies for symptomatic vitreous opacities. Curr Opin Ophthalmol. 2021;32:198–202.

    Article  PubMed  Google Scholar 

  14. McHugh ML. Interrater reliability: the kappa statistic. Biochem Med. 2012;22:276–82.

    Article  Google Scholar 

  15. Cheng W, Song Y, Gao X, Lin F, Li F, Wang P, et al. Axial length and choriocapillaris flow deficits in non-pathological high myopia. Am J Ophthalmol. 2022;244:68–78.

    Article  CAS  PubMed  Google Scholar 

  16. Radeck V, Schindler F, Helbig H, Gamulescu MA, Cvetkov Y, Barth T, et al. Characteristics of bilateral retinal detachment. Ophthalmologica. 2023;246:99–106.

  17. Agarkar S, Gokhale VV, Raman R, Bhende M, Swaminathan G, Jain M. Incidence, risk factors, and outcomes of retinal detachment after pediatric cataract surgery. Ophthalmology. 2018;125:36–42.

    Article  PubMed  Google Scholar 

  18. Yang D, Li M, Li W, Wang Y, Niu L, Shen Y, et al. Prediction of refractive error based on ultrawide field images with deep learning models in myopia patients. Front Med. 2022;9:834281.

    Article  Google Scholar 

  19. Kim MJ, Lee JH, Park JI, Choi JY, Sohn J, Hwang HS, et al. Novel utilisation of ultrawide-field fundus photography for detecting retinal nerve fibre layer defects in glaucomatous eyes. Br J Ophthalmol. 2022;106:1524–9.

    Article  PubMed  Google Scholar 

  20. Li M, Yang D, Shen Y, Shang J, Niu L, Yu Y, et al. Application of mydriasis and eye steering in ultrawide field imaging for detecting peripheral retinal lesions in myopic patients. Br J Ophthalmol. 2023;107:1018–24.

    Article  PubMed  Google Scholar 

  21. Javitt JC, Tielsch JM, Canner JK, Kolb MM, Sommer A, Steinberg EP. National outcomes of cataract extraction. Increased risk of retinal complications associated with Nd: YAG laser capsulotomy. The Cataract Patient Outcomes Research Team. Ophthalmology. 1992;99:1487–97.

    Article  CAS  PubMed  Google Scholar 

  22. Takkar B, Azad S, Bhatia I, Azad R. Clinical patterns and risk factors for rhegmatogenous retinal detachment at a tertiary eye care centre of northern India. Nepal J Ophthalmol. 2017;9:60–5.

    Article  PubMed  Google Scholar 

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Funding

National Natural Science Foundation of China (NSFC 81300747, NSFC 82101103, and NSFC 82101087), General Program of Shanghai Municipal Natural Science Foundation (Research Project of Science and Technology Commission of Shanghai Municipality (19ZR1408600 and 22ZR1410400)), Young Clinical Scientist Training Program, Shanghai Medical College, Fudan University (2023, DGF828019–2/038), Excellent Young Doctor Training Program of Shanghai, Shanghai Municipal Health Commission (2015–2018).

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Author notes

  1. These authors contributed equally: Ao Miao, Jie Xu, Kai Wei.

Authors and Affiliations

  1. Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China

    Ao Miao, Jie Xu, Peimin Lin, Liangliang Niu, Yumeng Shi, Dongjin Qian, Yi Lu, Yongxiang Jiang & Tianyu Zheng

  2. NHC Key Laboratory of Myopia (Fudan University); Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China

    Ao Miao, Jie Xu, Peimin Lin, Liangliang Niu, Yumeng Shi, Dongjin Qian, Yi Lu, Yongxiang Jiang & Tianyu Zheng

  3. Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China

    Ao Miao, Jie Xu, Peimin Lin, Liangliang Niu, Yumeng Shi, Dongjin Qian, Yi Lu, Yongxiang Jiang & Tianyu Zheng

  4. Bio-Med Big Data Center, CAS Key Laboratory of Computational Biology, Shanghai Institute of Nutrition and Health, University of Chinese Academy of Sciences, Chinese Academy of Sciences, Shanghai, China

    Kai Wei

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Contributions

AM, YXJ, and TYZ were responsible for designing the protocol, writing the protocol and report, conducting the search, extracting and analyzing data, interpreting results, updating reference lists, and creating “Summary of findings” tables. PML, YXJ, and YL were responsible for designing the protocol, writing the report, extracting, and analyzing the data, and interpreting the results. LLN and KW built the nomogram and contributed to the design of the protocol, writing the report, extracting, and analyzing data, and interpreting results. YMS, JX, and DJQ contributed to data extraction and provided feedback on the report.

Corresponding authors

Correspondence to Yongxiang Jiang or Tianyu Zheng.

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Miao, A., Xu, J., Wei, K. et al. Comparison of B-Scan ultrasonography, ultra-widefield fundus imaging, and indirect ophthalmoscopy in detecting retinal breaks in cataractous eyes. Eye (2024). https://doi.org/10.1038/s41433-024-03093-2

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