|Year : 2021 | Volume
| Issue : 2 | Page : 62-67
Sonographic pattern of ocular pathologies at murtala muhammad specialist hospital, Kano, Nigeria
Abdussalam Usman Danjaji1, Saudat Garba Habib2, Usman Abubakar Mijinyawa3, Aisha Saidu Bala4
1 Department of Radiology, Murtala Muhammad Specialist Hospital, Kano, Nigeria
2 Department of Ophthalmology, Aminu Kano Teaching Hospital/Bayero University, Kano, Nigeria
3 Department of Ophthalmology, Murtala Muhammad Specialist Hospital, Kano, Nigeria
4 Department of radiology, Yusuf Maitama Sule University, Kano, Nigeria
|Date of Submission||26-Oct-2020|
|Date of Decision||27-Apr-2021|
|Date of Acceptance||12-Jul-2021|
|Date of Web Publication||10-Dec-2021|
Dr. Abdussalam Usman Danjaji
Department of Radiology, Murtala Muhammad Specialist Hospital, Kano, PMB 3540, Kano
Source of Support: None, Conflict of Interest: None
Context: Ultrasonography is a non-invasive, inexpensive and safe imaging modality for diagnosing ocular pathologies, which aids in diagnostic accuracy and patient care. Aim: The aim of the study is to determine the pattern of ocular pathologies using ultrasonography at Murtala Muhammad Specialist Hospital. Settings and Design: This is a retrospective and descriptive study on sonographic pattern of various ocular pathologies. Materials and Methods: A total of 290 patients with various ocular pathologies were retrospectively reviewed within the study period from January 2017 to July 2018, in whom fundal examination was not possible due to media opacities and/or intraocular haemorrhage. Statistical Analysis Used: The data generated were analysed using SPSS version 21.0 program (SPSS Inc., Illinois, USA). Results: Cataracts were the most common ocular pathology detected sonographically, accounting for (45.5%) followed by vitreous haemorrhage (14.8%) and then retinal detachment (7.9%). Cataract has the highest frequency in all age groups with the highest frequency (34.1%) in 61–75 years of age group, while retinal (39.1%) and vitreous detachments (66.7%) have the highest frequency in the 16–30 and 61–75 years of age groups, respectively. The retinal detachment (52.2%) was more frequent in females, while cataract (54.5%) and vitreous haemorrhage (74.4%) were more frequent in males. Retinoblastoma (60%) and endophthalmitis (100%) were seen more on the right side, but the retinal detachment, cataract and vitreous haemorrhage were seen more on the left side. Conclusion: Ultrasonography is an important tool in the diagnosis of various ocular pathologies.
Keywords: Nigeria, ocular pathologies, ultrasonography
|How to cite this article:|
Danjaji AU, Habib SG, Mijinyawa UA, Bala AS. Sonographic pattern of ocular pathologies at murtala muhammad specialist hospital, Kano, Nigeria. Niger J Basic Clin Sci 2021;18:62-7
|How to cite this URL:|
Danjaji AU, Habib SG, Mijinyawa UA, Bala AS. Sonographic pattern of ocular pathologies at murtala muhammad specialist hospital, Kano, Nigeria. Niger J Basic Clin Sci [serial online] 2021 [cited 2022 Jan 20];18:62-7. Available from: https://www.njbcs.net/text.asp?2021/18/2/62/332192
| Introduction|| |
The use of ultrasound in diagnosing orbital and ocular disorders was first documented by two American Ophthalmologists, Mundt and Hughes in 1956. Initially, the amplitude scan was introduced, and subsequently, Bronson and Turner developed the brightness mode (B-scan) in the 1970s.
B-scan ultrasound has become indispensable and valuable in the diagnostic imaging of eye disorders. The cystic nature of the eye and its anterior location makes ultrasound scan useful and efficient in diagnosing eye diseases. Ophthalmic ultrasonography employs high-frequency waves usually of 7.5–10 Hz, which have increased penetration into the ocular tissue transmitted by a small probe, thereby producing a cross-sectional image of the eye and orbital cavity.
B-scan is a minimally invasive, inexpensive and safe imaging modality for diagnosing ocular pathologies, which aids in diagnostic accuracy and hence an informed choice of management. Its inexpensive nature makes it cost-effective in developing countries.
Magnetic resonance imaging and computed tomographic scan have also been utilised to evaluate the eye. However, they are more costly and not readily available compared to ultrasound, especially in resource-limited environment like Nigeria. B-scan ultrasonography, though occasionally useful for anterior-segment diagnosis, is mostly used in the diagnosis of posterior-segment pathologies, especially in the presence of opacification of the media, which precludes detailed ocular examination of the posterior segment. It helps in the confirmation of diagnosis of choroidal and retinal detachments.
This study determines the pattern of ocular pathologies diagnosed by ocular ultrasonography and hence establishes its significance in the diagnosis of ocular diseases.
| Materials and Methods|| |
This was a retrospective and descriptive study that was conducted at a busy tertiary hospital in North-western Nigeria, whereby the records of patients who attended the eye clinic that satisfied the inclusion criteria were enrolled in the study. The study period was for 18 months from January 2017 to July 2018. The records of 290 patients with various ocular pathologies excluding those with open/penetrating injuries, whom fundal examination was not possible due to media opacities and/or vitreous haemorrhage, were retrospectively retrieved and reviewed.
A dedicated ultrasound machine (GE Medical System Co Ltd.; Logiq F6, Jiangsu China, 2016) with Doppler facility and transducer frequency of 7.5 MHz was used to examine these patients. The procedure was explained to the patients, and all examinations were done in supine position with closed eyelids; while the patient looked up at the ceiling and keeping the eyes stationary. The scans were performed by placing the US transducer over a closed eyelid after application of coupling gel. Vertical and horizontal scans of the eyes were then performed, with attention to ocular adnexa, globe and orbital soft tissues. Both eyes of each patient were scanned at every examination for comparison [Figure 1] and [Figure 2], with the asymptomatic eye scanned first.
|Figure 1: An ocular sonogram of a patient with increase in thickness and echogenicity of the right lens due to cataract|
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|Figure 2: An ocular sonogram showing a V-shaped structure in the left eye which is attached posteriorly to the optic disc consistent with retinal detachment with associated adjacent vitreous haemorrhage|
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Relevant patient information that was assessed includes age, gender, and sonographic findings, which were recorded on a data collection sheet. The data were analysed using the SPSS Inc., Illinois, USA Version 21.0. Statistical significance was calculated at 95% confidence interval.
| Results|| |
A total number of 290 cases were assessed which comprised 170 males (58.6%) and 120 females (41.4%). The male: female ratio was 1.4 [Table 1]. Their ages ranged from <1 to 90 years, with the majority of the patients within the range of 0–15 years followed by 61–75 years [Figure 3].
Cataract is the most common ocular pathology detected sonographically, accounting for (45.5%) followed by vitreous haemorrhage (14.8%) and then retinal detachment (7.9%) [Table 2]. However, cross-tabulation of the findings versus gender revealed that retinoblastoma (80%), retinal detachment (52.2%), anterior synechiae (66.7%), panophthalmitis (80%), iridocyclitis (100%) and microphthalmia (100%) were more frequent in females, while cataract (54.5%), vitreous haemorrhage (74.4%), lens dislocation (75%), bullous keratopathy (100%), asteroid hyalosis (100%), choroid detachment (100%), posterior synechiae (66.7%), posterior uveitis (66.7%), retinal calcifications (100%) and endophthalmitis (100%) were more frequent in males [Table 3] and [Table 4].
|Table 2: Frequency distribution of the sonographically diagnosed pathologies|
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The frequency distribution of the ocular pathologies based on the age of the patients [Figure 4] revealed that cataract has the highest frequency in all age groups with the highest frequency (34.1%) in 61–75 years of age group [Table 3], while retinal detachments (39.1%) and vitreous detachments (66.7%) have the highest frequency in the 16–30 and 61–75 years of age groups respectively [Table 4]. Moreover, lens dislocation (75%) and posterior synechiae (66.7%) are more frequent in the age group 61–75 years, while retinoblastomas are seen only between 0 and 15 years of age group as shown in [Table 3] and [Table 4]. Panophthalmitis (60%) and vitreous haemorrhages (37.2%) also showed the highest frequencies at 0–15 years of age group. Bullous keratopathy and asteroid hyalosis are only seen between the ages of 61 and 75 years as shown in [Table 3] and [Table 4], while endophthalmitis and posterior uveitis are only seen between the ages of 0–15 and 16–30 years respectively. However, microphthalmia revealed bimodal distribution with 50% seen between the age of 0 and 15 and 50% seen between 61 and 75 years as shown in [Table 3].
Retinoblastoma (60%), posterior uveitis (66.7%) and endophthalmitis (100%) were seen more on the right, but the retinal detachment (47.8%), choroid detachment (75%), cataract (46.2%), vitreous haemorrhage (65.1%), lens dislocation (50%), panophthalmitis (80%), iridocyclitis (100%), anterior (100%) and posterior synechiae (66.7%) were seen more on the left [Figure 5], [Table 3] and [Table 4].
| Discussion|| |
Ocular ultrasound is an important valuable tool in the diagnosis of many ocular pathologies ranging from traumatic, inflammatory, infective, metabolic and degenerative diseases. Its use in various studies has been documented worldwide. A study in Ethiopia on the role of ultrasonography in a developing country in the diagnosis of ophthalmic diseases concluded that ultrasound is a valuable and available tool for the diagnosis of ocular pathology.
Ocular B-scan enables the diagnosis of 97.5% of ocular injuries not diagnosed at clinical examination due to hazy media. Another study in India showed that the sensitivity of ultrasonography was 97.7% and the specificity was 80% among patients with statistical significance (P < 0.001). However, in the present study, various ocular pathologies were conveniently identified sonographically with sensitivity of 98.6% and specificity of 81.8%. Males (58.6%) were more than females (41.4%) and this correlated with previous studies by Hemang et al. and Sharma et al., This may be a reflection of the health-seeking attitude of society. Cataracts and vitreous haemorrhage are the most common abnormalities seen in this study, which is similar to the findings of a study in India, where the most commonly observed indication for ophthalmic B-scan ultrasonography was ocular trauma, leading to cataract formation. However, Hemang et al. demonstrated vitreous haemorrhage as the most common sonographic diagnosis which accounted for 20%. Another study in Ilorin, Nigeria, on ocular trauma, found the most common posterior-segment lesions to be retinal detachment, vitreous haemorrhage and hyphema, whereas in this study, cataract and vitreous haemorrhage are the most common, followed by retinal and vitreous detachment. This variation could be due to the fact that our study encompasses all patients not only trauma cases. Another reason could be due to the difference in the type and severity of injury. Shazlee et al. also confirmed the usefulness of ocular B-scan in the diagnosis of some ocular pathologies: vitreous haemorrhage, post-traumatic cataract, retinal detachment, lens dislocation, choroid detachment, intraocular foreign bodies, partial retinal detachment and posterior vitreous detachment. This study revealed that in addition, ocular B-scan is very useful in the diagnosis of more ocular pathologies: corneal oedema, vitreous detachment, posterior synechiae, intraocular lens dislocation, panophthalmitis, aphakia, iridocyclitis, bullous keratopathy, asteroid hyalosis, microphthalmia, posterior uveitis, retinal calcification and endophthalmitis. Surprisingly, in our study, intraocular foreign body was not diagnosed, unlike in a similar study in Benin, South-Southern Nigeria, which documented intraocular foreign body with retinal detachment to be one of the most common diagnoses. This could probably be due to the fact that perforated or penetrating ocular injuries were excluded from our study. Another study in Southern Nigeria revealed that retinal detachment, cataract and vitreous haemorrhage were the most common findings in the order of decreasing frequency, unlike in our study, where cataract was the most common ocular pathology which is to be expected in developing countries like Nigeria, with cataract as the leading cause of reversible blindness. This is also being the reason for having more patients in the adult and elderly age group in this study due to senile cataract.
| Conclusion|| |
This study demonstrates that ocular sonography plays a valuable role in the field of ophthalmology in terms of diagnosis of various ocular pathologies, especially the posterior-segment abnormalities in the presence of opacification of the media which precludes detailed ocular examination of the posterior segment. However, B-scan is less-sensitive modality for identification of bony involvement of a tumour, its extension to adjacent structures and brain. In addition, it is not useful in open globe injuries and orbital fracture.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Sharma OP. Orbital sonography with its clinic-Surgical correlation. Indian J Radiol Imaging 2005;15:537-54. [Full text]
Emilija DD. Ultrasonography in ocular trauma. Maced J Med Sci 2013;34:105-13.
Faheem US, Ashok KN, Shafi MJ. Pre-operative posterior segment evaluation by ultrasonography in dense cataract. Pak J Ophthalmol 2009;25:135-8.
Bangal SV, Bhandari AJ, Siddiqui F. Pattern of ocular pathologies diagnosed with B-scan ultrasonography. Nig J Ophthalmol 2016;24:71-5.
Javed EA, Ali A, Ahmad I, Hussain M. Diagnostic applications of B-scan. Pak J Ophthalmol 2007;23:80-3.
Ossoinig KC. Quantitative echography–The basis of tissue differentiation. J Clin Ultrasound 1974;2:33-46.
Aironi VD, Gandage SG. Pictorial essay: B-scan ultrasonography in ocular abnormalities. Indian J Radiol Imaging 2009;19:109-15.
] [Full text]
Deepak GB, Daniel SG, Chaan SN. Sonography of the eye. Am J Radiol 2006;187:1061-72.
De La Hoz Polo M, Torramilans Lluís A, Pozuelo Segura O, Anguera Bosque A, Esmerado Appiani C, Caminal Mitjana JM. Ocular ultrasonography focused on the posterior eye segment: What radiologists should know. Insights Imaging 2016;7:351-64.
Haile M, Mengistu Z. B-scan ultrasonography in ophthalmic diseases. East Afr Med J 1996;73:703-7.
Monsudi KF, Musa HS. Importance of ultrasonography in evaluating eye injuries: Data from Birnin Kebbi, Nigeria. South Sud Med J 2018;11:65-7.
Garima R, Pratap SP, Shrikant R, Suresh P. Role of ultrasonography in evaluation of pathologies of posterior segment of the orbit. International J Anat Rad Surg 2018;7:46-51.
Hemang DC, Gurudatt NT, Viplav SG, Parth JD, Hiral KB, Hemadri Rajwadi, et al
. Role of ultrasonography in evaluation of orbital lesions. Gujarat Med J 2013;68:73-8.
Nzeh DA, Owoeye JF, Ademola-Popoola DS, Uyanne I. Sonographic evaluation of ocular trauma in Ilorin, Nigeria. Eur J Ophthalmol 2006;16:453-7.
Shazlee MK, Ali M, SaadAhmed M, Hussain A, Hameed K, Lutfi IA, et al
. Diagnostic accuracy of ultrasound B scan using 10 MHz linear probe in ocular trauma; results from a high burden country. Pak J Med Sci 2016;32:385-8.
Ukponmwan CU, Marchien TT. Ultrasonic diagnosis of orbito-ocular diseases in Benin City, Nigeria. Niger Postgrad Med J 2001;8:123-6. [Full text]
Eze BI, Onu AC, Imo AO, Mgbor SO. Utility and effectiveness of orbito-ocular B-scan ultrasonography in an African developing country. J Health Care Poor Underserved 2013;24:1440-7.
Lam D, Rao SK, Ratra V, Liu Y, Mitchell P, King J, et al
. Cataract. Nat Rev Dis Primers 2015;1:15014.
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]
[Table 1], [Table 2], [Table 3], [Table 4]