Table Of Content14318_FM.pgs 9/22/06 4:29 PM Page i
Ophthalmic Ultrasound: A Diagnostic Atlas
Second Edition
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Ophthalmic Ultrasound:
A Diagnostic Atlas
Second Edition
Cathy W. DiBernardo, R.N., R.D.M.S., R.O.U.B.
Associate Professor
Department of Ophthalmology
The Wilmer Eye Institute
Johns Hopkins University School of Medicine
Baltimore, Maryland
Ellen F. Greenberg, C.O.T., R.D.M.S., R.O.U.B.
Former Senior Echographer
Wilmer Eye Institute
Johns Hopkins University School of Medicine
Baltimore, Maryland
Private Practice
Owings Mills, Maryland
Thieme
New York • Stuttgart
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Thieme Medical Publishers, Inc.
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New York, NY 10001
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Library ofCongress Cataloging-in-Publication Data
DiBernardo, Cathy.
Ophthalmic ultrasound: a diagnostic atlas/Cathy W. DiBernardo, Ellen F. Greenberg.
— 2nd ed.
p.; cm.
ISBN 1-58890-503-9 (TMP : hardcover : alk. paper) —
ISBN 3-13-108632-7 (GTV : hardcover : alk. paper)
1. Eye—Ultrasonic imaging—Atlases. I. Greenberg, Ellen F.
II. DiBernardo, Cathy. Ophthalmic ultrasound. III. Title.
[DNLM: 1. Eye Diseases—ultrasonography—Atlases. 2. Eye
—ultrasonography—Atlases. WW 17 D544o 2006]
RE79.U4D53 2006
617.7(cid:2)1543—dc22 2006022037
Copyright ©2007 by Thieme Medical Publishers, Inc. This book, including all parts thereof, is legally protected by copyright. Any use,
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Important note:Medical knowledge is ever-changing. As new research and clinical experience broaden our knowledge, changes in treatment
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the possibility of human error by the authors, editors, or publisher of the work herein or changes in medical knowledge, neither the
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Printed in the United States ofAmerica
5 4 3 2 1
TMP ISBN 1-58890-503-9
1-978-58890-503-1
GTV ISBN 3-13-108632-7
1-978-3-13-108632-7
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Dedication
We dedicate this book to our family members: Brooke Wesley, Nicholas DiBernardo,
and Benjamin, Heather, and Robyn Greenberg. Their unending support, devotion,
and willingness to give up precious time with us have enabled us to finish
this second edition in a timely fashion.
Cathy W. DiBernardo and Ellen F. Greenberg
It is also dedicated in loving memory to Timothy Murphy Kennard. You encouraged
me to accept the challenge and even though you were not physically here for
its completion, I know your spirit has been here encouraging me
throughout the process.
Cathy W. DiBernardo-Kennard
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Contents
Foreword
Neil R. Miller . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .ix
Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .xi
Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .xiii
1. Basic Screening Techniques and Indications for Ultrasound . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1
2. Anterior Segment Evaluation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11
3. The Vitreous . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .28
4. The Retina . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .40
5. The Choroid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .62
6. Trauma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .70
7. Intraocular Tumors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .79
8. The Optic Nerve . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .104
9. Extraocular Muscles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .114
10. Evaluation ofthe Orbit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .121
11. Additional Ocular Conditions and Biometry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .133
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .145
vii
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Foreword
We live and practice ophthalmology in an era of operator dependent. One cannot evaluate the results of
sophisticated imaging techniques: computed tomo- a B-scan (let alone an A-scan!) as one does a CT scan or
graphic (CT) scanning and CT angiography, magnetic MR image. The key is having a superb, experienced
resonance (MR) imaging and MR angiography, and dig- ultrasonographer. We at the Wilmer Eye Institute are
ital subtraction angiography. All of these procedures fortunate to have such an individual. Cathy DiBernardo
can be helpful to the physician dealing with ocular and co-authored the first edition ofthis extraordinary atlas
orbital disease, but none is more useful than oph- with Andrew Schachat and Sharon Fekrat, two of her
thalmic ultrasound. Since this modality, pioneered by colleagues from the Retina division of the Institute.
Karl Ossoinig at the University of Iowa, first appeared Published in May 1998, that first edition provided
on the scene in the 1970s, improvements in technique physicians with an understanding of what ultrasonog-
have made it virtually indispensable to the ophthal- raphy had to offer them and their patients, and it
mologist. It is the only method of determining the provided both new and seasoned ultrasonographers
optimum intraocular lens power for a patient about to with a potpourri of outstanding cases. Now, Cathy and
undergo cataract surgery, it provides an accurate rep- her colleague, Ellen F. Greenberg, have written an
resentation of tissue status in patients with opaque equally outstanding second edition that not only show-
media, and it is crucial in the investigation of patients cases the major improvements in echographic tech-
with clinical evidence oforbital disease. In my opinion, niques during the last eight years but also demonstrates
it is the most sensitive test for thyroid eye disease, it even more clearly the ultrasonographic characteristics
can often provide a tissue-specific diagnosis of an of lesions of the various components of the eye and
orbital mass, and it can accurately assess the diameter orbit. Any physician who uses, or wishes to use, ultra-
of the optic nerve and provide evidence of whether sonography in his or her practice needs this atlas. As
enlargement of the nerve is caused by a solid process does any ultrasonographer who wants to learn more
or surrounding fluid. about the technical aspects of ultrasonography and
Having heaped these praises on the technique, it needs a readily available compendium of the common
must be emphasized that the technique is extremely and uncommon disorders that affect the eye and orbit.
Neil R. Miller, M.D.
Professor
Department ofOphthalmology and Neurosurgery
Johns Hopkins University School ofMedicine
Baltimore, Maryland
ix
