Comparison of ultrasonic and ophthalmoscopic evaluation of retinopathy of prematurity.
OBJECTIVE
Screening for detection of retinopathy of prematurity (ROP) currently is limited to indirect ophthalmoscopy, which requires considerable examiner skill and experience. We investigated whether conventional 10 MHz B-scan ultrasonography could document the clinical stages of ROP as accurately as indirect ophthalmoscopy.


METHODS
Thirty-four eyes of 18 neonates were examined by masked, independent observers with indirect ophthalmoscopy and digitally recorded 10-MHz B-scan ultrasonography. After pupil dilation and lid speculum placement, the retinologist recorded the stage of retinopathy with a retinal drawing. The ultrasonographer, without use of papillary mydriatics or lid speculum, determined the presence or absence of a ridge or tractional elements, if present on the ridge.


RESULTS
Ultrasound grade correlated with clinical grade (R = .79, P < .001). However, nine eyes were overdiagnosed by one stage, and one eye, in which a peripheral detachment was mistaken for an artifact, was underdiagnosed.


CONCLUSIONS
Ten-megahertz ultrasonography offers the potential of imaging and detecting the clinical stages of ROP; the use of higher ultrasound frequencies, now becoming commercially available, is likely to enhance diagnostic accuracy. Care must be taken to distinguish between artifact and true anatomical structures in noncontact ultrasound examinations. Neonates with suspected ROP could be screened with B-scan ultrasonography by neonatal personnel without pupillary dilatation or lid speculum, thus eliminating potential morbidity, and clinically significant cases of ROP then could be referred to the retinologist.
Jokl
Danny H Kauffmann
DH
Columbia Presbyterian Hospital, New York, New York, USA.
Silverman
Ronald H
RH
Springer
Alan D
AD
Towers
Helen
H
Kane
Steven
S
Lopez
Robert
R
Chiang
Michael F
MF
Lloyd
Harriet O
HO
Barbazetto
Irene
I
Horowitz
Robyn
R
Vidne
Orit
O
D005654:Fundus Oculi; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D009887:Ophthalmoscopy / Q000379:methods*; D012160:Retina / Q000000981:diagnostic imaging* / Q000473:pathology; D012178:Retinopathy of Prematurity / Q000145:classification / Q000000981:diagnostic imaging* / Q000628:therapy; D014463:Ultrasonography