JKOS Journal of the Korean Ophthalmological Society J Korean Ophthalmol Soc 0378-6471 2092-9374 Korean Ophthalmological Society 10.3341/jkos.2010.51.1.106 jkos-51-106 Original Article Clinical Significance of Ultrasound Biomicroscopy in Early Stage of Traumatic Hyphema ChangDong Ho MD 1 LeePyung MD 1 LeeSeung Chan MD 2 JinKyung Hyun MD 1 Department of Ophthalmology, KyungHee University, College of Medicine, Seoul, Korea Department of Ophthalmology, Kangwon University, College of Medicine, Chuncheon, Korea Address reprint requests to Kyung Hyun Jin, MD Department of Ophthalmology, KyungHee University College of Medicine #1 Hoegi-dong, Dongdaemun-gu, Seoul 130-702, Korea Tel: 82-2-958-8451, Fax: 82-2-966-7340, E-mail: khjinmd@khmc.or.kr 09 2010 07 09 2010 51 1 106 111 02052008 15092009 Copyright © 2010 Korean Ophthalmological Society 2010 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Purpose

To evaluate the clinical significance of angle-opening distance 500 (AOD500) using ultrasound biomicroscopy (UBM) in the early stage of traumatic hyphema.

 Methods

The participants of this study were 46 hospitalized traumatic hyphema patients. We measured the quantity of initial blood clotting using a slit-lamp and the range of angle recession, AOD500 using UBM and then reviewed the relationship between the two.

 Results

The difference of AOD500 in the traumatic and the non-traumatic eye measured by UBM at admission increased significantly in the wider recessed angle group (p=0.008), but did not increase at a statistically significantly level in the larger initial blood clot grade group (≥ Grade 2).

 Conclusions

These results suggest that the measurement of the angle-opening distance of both eyes using UBM will aid in evaluating the range of angle recession in patients in the early stage of traumatic hyphema.

 Angle-opening distance 500 (AOD 500) Traumatic hyphema Ultrasound biomicroscopy (UBM) References Tesluk GC Spaeth GL The occurrence of primary open-angle glaucoma in the fellow eye of patients with unilateral angle-cleavage glaucoma Ophthalmology 19859290411 Pettit TH Keates EU Traumatic cleavage of the chamber angle Br J Ophthalmol 19636943844 Kaufman JH Tolpin DW Glaucoma after traumatic angle recession Am J Ophthalmol 19747864854 Sihota R Kumar S Gupta V Early predictors of traumatic glaucoma after closed globe injury: trabecular pigmentation, widened angle recess, and higher baseline intraocular pressure Br J Ophthalmol 20081269216 Kobayashi H Ono H Kiryu J Ultrasound biomicroscopic measurement of development of anterior chamber angle Br J Ophthalmol 19998355962 Agapitos PJ Noel LP Clarke WN Traumatic hyphema in children Ophthalmology 198794123841 Jung KS Hong SW Chang HK The incidence of complication and decreased visual acuity in traumatic hyphema patients aberrations to the amount of blood clot J Korean Ophthalmol Soc 1997 3818529 Edwards WC Layden WE Traumatic hyphema Am J aberrations 197375110 Crouch ER Jr Crouch ER Management of traumatic hyphema: therapeutic options J Pediatr Ophthalmol Strabismus 199936 23850 Cho JS Jun BK Lee YJ Factors associated with the poor final visual outcome after traumatic hyphema J Korean aberrations Soc 1998121229 Pavlin CJ Harasiewicz K Sherar MD Foster FS Clinical use of ultrasound biomicroscopy Ophthalmology 19919828795 Foster FS Palvin CJ Harasiewicz KA Advances in ultrasound biomicroscopy Ultrasound Med Biol 200026127 Ozdal MP Mansour M Deschenes J Ultrasound biomicroscopic evaluation of the traumatized eyes Eye 20031746772 Berinstein DM Gentile RC Sidoti PA Ultrasound aberrations in anterior ocular trauma Ophthalmic Surg Lasers 1997282017 Genovesi-Ebert F Rizzo S Chiellini S Ultrasound aberrations in the assessment of penetrating or blunt anterior-aberrations trauma Ophthalmologica 199821267 Lee KW Park CH Hahn DK Anterior chamber angle recession and elevation of intraocular pressure J Korean Ophthalmol Soc 1987285958 Figures and Tables

Ultrasound biomicroscopic image of the anterior chamber and the definition of angle-opening distance at 500 μm from the scleral spur (AOD500).

The photographs of the anterior segment and ultrasound biomicroscopy (UBM) in 2 traumatic hyphema patients (A, B). The angle recession (short arrow) was seen in UBM photograph at 12 and 3 o'clock (in the middle upper and lower photograph). The blood clot (long arrow) is well-visualized in the UBM photograph at 6 o'clock (in the right upper and lower photograph).

The grade of angle recession and angle opening distance 500 (AOD500) (μm). The difference of AOD500 in traumatic & nontraumatic eye measured by UBM at admission were increased statistically significantly in larger area recessed angle group (p=0.008).

Patient demographics

Angle-opening distance 500 (μm) in traumatic and nontraumatic eye, and the difference of angle-opening distance 500 (μm) in traumatic and nontraumatic eye (Mean± SD*)

AOD 500† (μm)
Traumatic eye 572.740±244.899
Nontraumatic eye 373.750±115.431
Traumatic eye AOD500- 198.997±198.334
 Nontraumatic eye AOD500
p-value‡ 0.000

SD=standard deviation

AOD500=angle-opening distance 500

p-value=statistical significance evaluated by paired t-test.

The difference of angle-opening distance 500 (μm) in traumatic and nontraumatic eye according to degree of angle recession

The degree of angle recession (˚) traumatic eye AOD500* – nontraumatic eye AOD500* p-value†
≤1 point of angle recession (+)‡ 158.777±149.269 0.008
≥2 point of angle recession (+)‡ 423.077±291.226

AOD500=angle-opening distance 500

p-value=statistical significance evaluated by Mann-Whitney U test

Angle recession was estimated in the 4 points (12, 3, 6, 9 o'clock) in the UBM.

Angle-opening distance 500 (μm) in traumatic and nontraumatic eye, and the difference of angle-opening distance 500 (μm) in traumatic and nontraumatic eye according to the grade group of initial blood clot

The grade of initial blood clot group traumatic eye AOD500* – nontraumatic eye AOD500* p-value†
Group 1‡ 192.301±204.933 0.173
Group 2§ 269.231±94.211

AOD500=angle-opening distance 500

p-value=statistical significance was evaluated by Mann-Whitney U test

Group 1=initial blood clot grade 0, Ⅰ

Group 2=initial blood clot grade Ⅱ, Ⅲ, Ⅳ.