B-scan ultrasonography to screen for retinal tears in acute symptomatic age-related posterior vitreous detachment.
OBJECTIVE
To evaluate the performance characteristics of B-scan ultrasonography (US) as a diagnostic test for the detection of retinal tears in acute symptomatic age-related posterior vitreous detachment (PVD).


METHODS
Evaluation of a diagnostic test through a cross-sectional study with prospective data collection. The study intended to meet the 14 items proposed by the Quality Assessment of Diagnostic Accuracy Studies panel.


METHODS
Two hundred thirty-nine patients with acute-onset age-related PVD were consecutively enrolled in a nonreferral hospital.


METHODS
Comprehensive eye examination including vitreous and retinal biomicroscopy was performed on an emergency basis followed by blind B-scan kinetic US. Sensitivity, specificity and predictive values of the index test (B-scan US) were analyzed and compared with the standard reference (baseline examination). In cases of disagreement between both diagnostic methods, a new gold standard was established based on the findings of subsequent directed indirect ophthalmoscopy based on the echographic findings. Positive and negative likelihood ratios and a likelihood nomogram with pretest and posttest odds of retinal tears were calculated for B-scan US.


METHODS
Index test performance for the detection of retinal tears secondary to age-related PVD.


RESULTS
Both diagnostic methods performed comparably. The sensitivity of B-scan US for detection of retinal tears was 96% and that of baseline examination was 89%. Both methods had similar negative predictive values of 99%. B-scan US specificity was 98%. The estimated pretest and posttest probability for a positive B-scan US were 10.8% and 89%, respectively.


CONCLUSIONS
Proper B-scan kinetic US is a noninvasive and accurate diagnostic method for the detection of retinal tears that can be reliably used in no view or small pupil cases with symptomatic PVD.


BACKGROUND
The authors have no proprietary or commercial interest in any of the materials discussed in this article.
Lorenzo-Carrero
Jose
J
Ophthalmology Department, POVISA Hospital, Vigo, Spain. josel.carrero@yahoo.es
Perez-Flores
Ines
I
Cid-Galano
Monica
M
Fernandez-Fernandez
Marta
M
Heras-Raposo
Fernando
F
Vazquez-Nuñez
Ramon
R
Lopez-Fuentes
Marta
M
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D003941:Diagnostic Techniques, Ophthalmological; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009887:Ophthalmoscopy; D011237:Predictive Value of Tests; D011336:Probability; D011446:Prospective Studies; D012167:Retinal Perforations / Q000000981:diagnostic imaging* / Q000209:etiology; D012307:Risk Factors; D012680:Sensitivity and Specificity; D014463:Ultrasonography; D020255:Vitreous Detachment / Q000150:complications / Q000000981:diagnostic imaging*