210 Vol. 29, No. 4, Oct – Dec, 2013 Pakistan Journal of Ophthalmology Original Article Evaluation of the Frequency of Posterior Segment Pathologies Determined by B-Scan Ultrasonography in Patients with Congenital Cataract Piyya Muhammad Musammat Rafi, Muhammad Rizwan Khan, Muhammad Naeem Azhar Pak J Ophthalmol 2013, Vol. 29 No. 4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . See end of article for authors affiliations …..……………………….. Correspondence to: Piyya Muhammad Musammat Rafi Bahawal Victoria Hospital Bahawalpur …..……………………….. Purpose: To evaluate the frequency of posterior segment pathologies determined by B-Scan Ultrasonography in patients with congenital cataract. Material and Methods: 204 Patients with congenital cataract admitted in ophthalmology department in Bahawal Victoria hospital Bahawalpur were included in the study. Study period was six months with non probability consecutive sampling. Age range was from new born to five years. Patients having cataract underwent B-Mode Ultrasonography. B-Mode Ultrasonography was done with HISCAN (OPTIKON), by 4 th year resident under supervision of consultant ophthalmologist. Outcome variables like vitreous disorders, retinal detachment and intraocular tumours were measured. Results: Ninety female and 114 male patients (total 237 eyes) were analysed. On B-Scan Ultrasonography seventeen eyes (7.17%) showed finding suggestive of posterior segment pathology while two hundred and twenty (92.83%) eyes showed no pathology in posterior segment in patient with congenital cataract. The most common finding was in the vitreous. Five (2.5%) eyes showed persistent fetal vasculature (PHPV) and three (1.5%) showed haemorrhage. Intraocular tumour was present as elevated fundus lesion in 3 (1.5%) eyes. Retinal detachment was present in one (0.5%) eye. Detectable optic nerve lesions were present in four eyes; in 1 eye (0.5%) there was optic disc drusen, elevated optic disc was present in 2 (1%) and one eye (0.5%) showed cupping. Other demonstrable findings were posterior staphyloma in one (0.5%) eye. Conclusion: B-Scan Ultrasonography proves accurate and beneficial in opaque ocular media to detect posterior segment pathologies. There is possibility that some kind of other pathology might be present behind the cataract. B-Mode Ultrasonography should be included as essential investigating tool in evaluation of eyes undergoing cataract surgery in paediatrics population. -mode Ultrasonography is used to investigate and diagnose variety of ocular conditions. B- Mode (brightness mode) Ultrasonography is of great help when optical methods fail to give clear view of posterior segment of the globe1. B-Scan Ultrasono- graphy uses high frequency (10MHz) sound waves to produce echoes as they strike interfaces between acoustically distinct structures2. B-Scan two dimen- sional USG (Ultrasonography) provides topographic information concerning the size, shape and quality of a lesion as well as its relationship to other structures2. The ability to examine the posterior segment of the eye accurately in patient with opaque media is essential for good surgical care of the cataract patient. Sometime congenital cataract is associated with posterior segment pathologies like vitreous disorder, B EVALUATION OF THE FREQUENCY OF POSTERIOR SEGMENT PATHOLOGIES DETERMINED BY B-SCAN ULTRASONOGRAPHY Pakistan Journal of Ophthalmology Vol. 29, No. 4, Oct – Dec, 2013 211 retinal detachment, intraocular tumour, and intraocular foreign body. The imaging modality that is simple, cheap and employed globally in this regard is B-Scan Ultrasonography. It is routinely used and recommended for use in patient with dense cataract3. Now, even a variety of studies have been undertaken that review the presence of posterior segments pathologies in adults3, no trial has so far demonstrated such findings in children suffering from congenital cataract, especially in our country. It therefore remains to be established that what kind of common pathologies are present in posterior segments that we routinely miss in children with congenital cataract. These common posterior segment pathologies have a significant impact in the clinical course and visual development of patients with congenital cataract. This study will demonstrate the frequency of these pathologies in cataract patients of this age group in our part of the world, so that appropriate planning in such patients could be done. MATERIAL AND METHODS This cross sectional study was carried out in Department of Ophthalmology, Bahawal Victoria hospital Bahawalpur. Study was conducted for a period of six months from 27th May 2012 to 28th November 2012. 237 eyes were included in this study. Hypothesized % frequency of outcome factor in the population (p): 4%+/-2.5 Confidence limits as % of 100(absolute +/- %) (d): 2.5%. Design effect (for cluster surveys-DEFF): 1. Non probability consecutive sampling technique was adopted. All children with positive congenital cataract up to the age of 5 years were included in this study because of late pursuance of congenital cataract cases in our settings. Following children were excluded from our study; individual with history of trauma to the globe any time after birth, individuals with uveitis, cases with known glaucoma and previous ocular surgery. Data Analysis All the data was computerized and SPSS version 10 was used for analysis of data. Descriptive statistics was used to analyse the data. Quantitative variables like age was measured by mean and standard deviation. Qualitative variables like gender and posterior segment pathologies including vitreous disorders (haemorrhage), retinal detachment, and intraocular tumours were measured by frequency and percentage. Confounding variables like age, was controlled by making cross matched stratified tables. The chi-square test was used for analysis and the value of p< 0.05% was considered significant. RESULTS Two hundred and thirty seven eyes of two hundred and four patients were included in the study. Ninety (44.1%) were female and one hundred and fourteen (55.9%) were male patients. Age range was from seven days to five years. Mean age was four years with PIYYA MUHAMMAD MUSAMMAT RAFI, et al 212 Vol. 29, No. 4, Oct – Dec, 2013 Pakistan Journal of Ophthalmology standard deviation 3.23. Below one year were 72 (35.3%), from one year to three years were 83 (40.7%), and from three years to five years were 49 (24%). On B-Scan Ultrasonography seventeen eyes (7.17%) showed finding suggestive of posterior segment pathology while two hundred and twenty (92.83%) eyes showed no pathology in posterior segment in patient with congenital cataract. The most common finding was in the vitreous. Five (2.5%) eyes showed persistent fetal vasculature and three (1.5%) showed haemorrhage. Intraocular tumours were present as elevated fundus lesion in 3 (1.5%) eyes. Retinal detachment was present in one (0.5%) eye. Detectable optic nerve lesions were present in four eyes; in 1 eye (0.5%) was optic disc drusen, elevated optic disc was present in 2 (1%) and one eye (0.5%) showed cupping. Other demonstrable findings were posterior staphyloma in one (0.5%) eye. Statistically the value of the test of significance (p value) is of the order of >0.05 for all variables, which shows that the relationships of various outcome variables with different age groups and gender of the patients are insignificant. DISCUSSION Over the last 30 years, ultrasonography has greatly advanced which has enabled us to study posterior segment of the eye even in the presence of opaque media like dense cataract. Cataract is a one of the leading cause of treatable blindness in developing countries. Many of these cases have advanced cataracts that preclude visualization of fundus prior to cataract surgery. Such visualization is considered important to provide accurate prognosis for vision after cataract surgery. Under such circumstances ultrasonographic examination can provide infor- mation regarding such abnormalities4. In this study high percentage (3.37%) of findings were present in the vitreous cavity; including two patients with vitreous haemorrhage and one with nonspecific homogenous hyper-echoic vitreous (1.5%), other five patients showed bands and membrane consistent with persistent hyperplastic vitreous (2.5%). Persistent hyperplastic primary vitreous is often associated with cataract in children. Only one eye in this study showed characteristics of retinal detachment (0.5%) on B-scan USG. Frequency of retinal detachment differ in traumatic and non traumatic eyes of patients as well as with the age of patients. Qureshi MA et al found Retinal detachment in non-traumatic cataract patients was (1.47%) and (21.12%) in traumatic cataract patients7. Along with three primary variables (retinal detachment, intraocular tumours and vitreous disorders) there were other findings detectable by B- Mode USG, these broadly classified into optic disc lesions and miscellaneous lesions. Optic disc swelling was present in 1%, cupping in 0.5% and drusens in 0.5%. Shaikh et al8 in their study of 227 eyes found similar optic disc findings. Optic disc edema was 0.45%, retinal detachment in 0.9%, vitreous hemo- rrhage in 1.32% and posterior staphyloma in 3.52%. CONCLUSION B-Scan ultrasonography proves accurate and beneficial in opaque ocular media to detect posterior segment pathologies. There is possibility that some kind of other pathology might be present behind the cataract. B-Mode ultrasonography should be included as essential investigating tool in evaluation of eyes undergoing cataract surgery in paediatrics population. Author’s Affiliation Dr. Piyya Muhammad Musammat Rafi Medical Officer Bahawal Victoria Hospital Bahawalpur Dr. Muhammad Rizwan Khan Medical Officer Bahawal Victoria Hospital Bahawalpur Dr. Muhammad Naeem Azhar Ophthalmologist LRBT Free Eye Hospital, Lahore REFERENCES 1. Ehlers JP, Shah CP, Fenton GL, Hoskins EN, Shelsta HN. Pediatrics. In: The Wills eye manual, office and emergency room diagnosis and treatment of eye disease. New Delhi: Wolters Kluwer health. 2008: 179- 81. 2. Kanski JJ. Imaging techniques. In: Clinical ophthalmology, a systemic approach. London: Butterworth – Heinemann. 2007: 44-5. 3. Aironi VD, Gandage SG. Pictorial essay: B-scan Ultrasonography in Ocular abnormalities. Indian J Radiol Imaging. 2009; 19: 109-15. 4. 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