title: Role of Diagnostic Endoscopy in Posterior Segment Evaluation for Definitive Prognostication in Eyes With Corneal Opacification.
abstract: OBJECTIVE
  Direct visualization of the posterior segment is not possible with conventional imaging techniques in eyes with corneal opacification. This study evaluated the efficacy of videoendoscopy in visualizing and hence prognosticating the visual outcomes in such eyes.
  
  
  METHODS
  Prospective, noncomparative, consecutive interventional case series.
  
  
  METHODS
  This study included 64 eyes of 64 patients with corneal opacification who underwent a diagnostic ophthalmic endoscopy procedure from March 2014 to May 2016. All eyes also underwent conventional B-scan ultrasonography as part of their comprehensive ocular examination. The findings that were noted during endoscopy included the optic disc characteristics, anatomic integrity of the retina, and condition of the retinal blood vessels. The principal outcome measure was the determination of whether the results of the videoendoscopy helped in establishment of or brought a change in the management plan; accordingly, they were classified as either "contributory" or "noncontributory."
  
  
  RESULTS
  The videoendoscopy findings were classified as contributory in 62 of 64 eyes. The remaining 2 eyes had vitreous hemorrhage; endoscopic vitrectomy was done in them to detect an inoperable retinal detachment in 1 eye. With the help of the stereoscopic picture of the fundus provided by the endoscope, a poor visual prognosis in 17 eyes with retinal detachment and 22 eyes with attached retina was determined. Additionally, in eyes that had an attached retina on ultrasound B-scan, the endoscope helped in detecting a glaucomatous disc in 10 of those eyes; 7 of them had glaucomatous optic atrophy. In 3 patients ultrasound did not detect a retinal detachment (false-negative). One eye with detached retina on ultrasound did not actually have a retinal detachment (false-positive). Thus ultrasound had a sensitivity of 88.4% and a specificity of 97.3% in detecting RD as compared with an endoscopic evaluation. Based on the endoscopic findings, 34 of 64 (53%) eyes were identified as having a better visual prognosis and underwent subsequent vision-restoring procedures. This included 10 (16%) patients who directly underwent a corneal procedure and 24 (37.5%) patients who had endoscopic vitreoretinal procedures initially before undergoing a corneal procedure. Endoscopy helped in identifying poor prognosis in 30 of 64 (46.8%) eyes; thus, further invasive procedures could be avoided. The endoscopy procedure in itself did not lead to any complications.
  
  
  CONCLUSIONS
  Diagnostic endoscopy provided invaluable supplemental information about the posterior segment in eyes with corneal opacification. This helped in better prognostication and in reserving corneal reconstructive procedures for eyes with a favorable visual prognosis.
authors.affiliation: Kanuri Santhamma Center for Vitreo-retina Services, Hyderabad, India.
authors.forename: Rajeev R
authors.initials: RR
authors.lastname: Reddy Pappuru
authors.affiliation: Kanuri Santhamma Center for Vitreo-retina Services, Hyderabad, India. Electronic address: drmudittyagi@gmail.com.
authors.forename: Mudit
authors.initials: M
authors.lastname: Tyagi
authors.affiliation: Kanuri Santhamma Center for Vitreo-retina Services, Hyderabad, India.
authors.forename: Remya M
authors.initials: RM
authors.lastname: Paulose
authors.affiliation: Kanuri Santhamma Center for Vitreo-retina Services, Hyderabad, India.
authors.forename: Vivek P
authors.initials: VP
authors.lastname: Dave
authors.affiliation: Kanuri Santhamma Center for Vitreo-retina Services, Hyderabad, India.
authors.forename: Taraprasad
authors.initials: T
authors.lastname: Das
authors.affiliation: Kanuri Santhamma Center for Vitreo-retina Services, Hyderabad, India.
authors.forename: Jay
authors.initials: J
authors.lastname: Chhablani
authors.affiliation: Kanuri Santhamma Center for Vitreo-retina Services, Hyderabad, India.
authors.forename: Raja
authors.initials: R
authors.lastname: Narayanan
authors.affiliation: Kanuri Santhamma Center for Vitreo-retina Services, Hyderabad, India.
authors.forename: Rushil K
authors.initials: RK
authors.lastname: Saxena
authors.affiliation: Kanuri Santhamma Center for Vitreo-retina Services, Hyderabad, India.
authors.forename: Divya
authors.initials: D
authors.lastname: Balakrishnan
authors.affiliation: Tej Kohli Cornea Institute, LV Prasad Eye Institute, Hyderabad, India.
authors.forename: Sayan
authors.initials: S
authors.lastname: Basu
authors.affiliation: Tej Kohli Cornea Institute, LV Prasad Eye Institute, Hyderabad, India.
authors.forename: Virender S
authors.initials: VS
authors.lastname: Sangwan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003318:Corneal Opacity / Q000150:complications / Q000175:diagnosis*; D004724:Endoscopy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009898:Optic Disk / Q000000981:diagnostic imaging; D057972:Posterior Eye Segment / Q000000981:diagnostic imaging*; D011379:Prognosis; D011446:Prospective Studies; D015203:Reproducibility of Results; D012160:Retina / Q000000981:diagnostic imaging; D012163:Retinal Detachment / Q000150:complications / Q000175:diagnosis; D012171:Retinal Vessels / Q000000981:diagnostic imaging; D014463:Ultrasonography; D014741:Video Recording; D014792:Visual Acuity; D055815:Young Adult