Spotlight on Technology & Technique

UBM: Vivid and Versatile Imaging

By Samantha Stahl, Assistant Editor

Ultrasound biomicroscopes (UBMs) have garnered praise from ophthalmologists as a way to obtain high-resolution images and video of the anterior segment, particularly with glaucoma and cataract patients. The technology in devices like Accutome's UBM Plus aid in clinical diagnoses and management by providing information that Samuel Masket, MD, and Nicole Fram, MD, of Los Angeles, call “invaluable to surgical planning and successful patient outcomes.”

Diagnostic Versatility

The device is said to accommodate a range of demands, including angle evaluation, measuring sulcus-to-sulcus distance for sulcus-supported IOLs, and imaging of the iris and ciliary body cysts or tumors. One of the primary uses for UBMs in Dr. Fram's and Dr. Masket's office is evaluating pathology caused by malpositioned PCIOLs.

“Often, patients present with a combination of chronic inflammation, pigment dispersion and increased IOP called uveitis-glaucoma-hyphema (UGH) syndrome,” explains Dr. Fram. “The pupil is often surgically manipulated and will not dilate pharmacologically.” Patients with UGH syndrome may have malpositioned haptics in sulcus that are not visible on slit lamp examination, making it crucial to have the technology to confirm a malpositioned PCIOL.

By evaluating the position of the optic and haptics with the UBM, Dr. Fram is able to find the exact etiology for the pathology. Because the cornea is often compromised and edematous with malpositioned IOL cases, she explains that it is helpful in preoperative surgical planning to evaluate the precise position of the lens prior to the IOL repositioning and possible endothelial keratoplasty.

The UBM Plus was also used to confirm a patient's traumatic cyclodialysis and chronic hypotony. Dr. Masket explains that the hypotony was resolved with Ahmed segment placement, before again using UBM for postop confirmation of the repair.

Accutome's UBM Plus scans high-res images of the anterior segment, as shown here.

Drs. Fram and Masket recently published a paper in the Journal of Cataract and Refractive Surgery (in press 2011) on using UBM technology to investigate the posterior chamber depth in patients with negative dysphotopsia (ND).

“With the help of UBM technology, we were able to demonstrate that symptoms of ND improve with coverage of the anterior capsule via secondary piggyback IOL and reverse optic capture rather than collapse of the posterior chamber alone, as previously hypothesized,” she explains.

Quality Convenience

Before using the UBM Plus, Dr. Fram often had to refer patients to an academic center for imaging. While gonioscopy can give useful information, she explains that it is difficult to visualize the angle directly if the cornea is compromised.

“Referral to an outside facility is often inconvenient for the patient and requires additional cost.” Time and money—two things that patients aren't readily willing to give up.

As with any new instrumentation, Dr. Fram says there is an early learning curve with the device, as it requires an understanding of probe positioning and patient ergonomics to avoid tilt of the image displayed. She asserts that learning proper usage can be accomplished rapidly and “is well worth the amazing information provided.”

While anterior segment OCT is great for imaging in front of the iris and can have less of a learning curve for most clinicians, she says that the UBM is ideal for imaging behind the iris and “provides visualization of structures that would otherwise only be inferred.” OM

For more information, visit www.accutome.com.