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Editor,—We describe the new technology of three dimensional ultrasonic imaging1 2 to evaluate invisible fundus. There were two previous reports on clinical applications of three dimensional ultrasonography.3 4However, these reports solely described the results of three dimensional ultrasonography to evaluate the extension of a choroidal melanoma. We report here on the first clinical application of three dimensional ultrasonography for invisible fundus.
In 1990, a 44 year old man, diagnosed with Behçet's disease was referred to our hospital for a cataract. A phacoemulsification operation was performed for the cataract in the right eye, which resulted in a corrected visual acuity of 20/20. However, he developed severe postoperative inflammation. Elschnig's pearl type emerged 6 months after cataract surgery, requiring posterior capsulotomy by YAG laser. In 1994, band keratopathy appeared and progressed gradually as a result of chronic uveitis of Behçet's disease. By November 1999, although his corrected visual acuity was still 10/20, ophthalmoscopic evaluation of the vitreous body and the fundus became impossible because of band keratopathy and severe after cataract. Because of the chronic uveitis, this patient could not receive a penetrating keratoplasty operation or excimer laser treatment for band keratopathy. Thus, three dimensional ultrasonography was performed using a 3D i-Scan ultrasonography system1 2 (Ophthalmic Technologies Inc, Downsview, Ontario, Canada) to measure the degree of vitreous opacification and to detect the presence of proliferative tissues in the vitreous body. As shown in Figures 1 and 2, we could diagnose the absence of adhesion of the proliferative tissue to the retina by observing from both superior side and nasal side. Because this examination excluded the possibility of retinal traction by proliferative tissues and retinal detachment, only periodic check ups have been conducted.
Two dimensional ultrasonography has traditionally been used to examine retinal or vitreous diseases with invisible fundus. Three dimensional ultrasonography has an advantage over two dimensional ultrasonography in that cross sections of the eye can be observed and the size of the space occupied by the lesion can be measured. Two dimensional ultrasonography, however, is superior to three dimensional ultrasonography for observing the dynamic changes of the membranous tissue associated with eye movement. We report here of a case in which two dimensional ultrasonography could not detect the adhesion of the proliferative tissue to the retina. This case was successfully examined by three dimensional ultrasonography. By observing many cross sections, we could diagnose the absence of adhesion of the proliferative tissue to the retina. Three dimensional ultrasonography was essential in determining the therapeutic approach for this patient. Further improvement of the technique using three dimensional ultrasonography may expand the possible application of this technique to patients with other invisible fundus as well.
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