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© 2020 Scholars Journal of Applied Medical Sciences | Published by SAS Publishers, India
1115
Scholars Journal of Applied Medical Sciences
Abbreviated Key Title: Sch J App Med Sci
ISSN 2347-954X (Print) | ISSN 2320-6691 (Online)
Journal homepage: https://saspublishers.com/sjams/
Study of Diabetic Eye Disease Using Ocular B-Mode Ultrasonography
Safaa Bashir1, Mohamed Yousef1,2, Muna Mohamed1, Awadalla Wagealla3, Mogahid M.A Zidan3*, Salem Alghamdi4,
Ikhlas Abdelaziz1,4, Ala M.A.Ellgyoum5
1College of Medical Radiological Sciences, Sudan University of Science and Technology, Khartoum, Sudan
2Radiologic Sciences Program, Batterjee Medical College, Jeddah, Saudi Arabia
3Al-Ghad International College of Applied Medical Science, Medical Imaging Technology Department, Abha, KSA
4University of Jeddah, College of Applied Medical Sciences, Department of Medical Imaging and Radiation Sciences, Jeddah, Saudi Arabia
5Department of Radiology, Faculty of Radiology and Nuclear Medicine Sciences, National Rabat University, Khartoum Sudan
DOI: 10.36347/sjams.2020.v08i04.013 | Received: 02.04.2020 | Accepted: 09.04.2020 | Published: 17.04.2020
*Corresponding author: Mogahid M.A Zidan
Abstract
Original Research Article
Ultrasonography (US) of the eye is a useful tool in diagnosing conditions of the ocular globe it is characterized by
availability, ease, and cheapness. This study aims to study the diabetic eye disease using ocular B-mode
ultrasonography. A total of 300 (141 females and 159 males) Sudanese patients with long-duration diabetes mellitus
were investigated in the period spanning from 2016 to 2019. Nidek (Echoscan US – 4000) ultrasonic unit with a high-
frequency transducer 10 MHz was used to examine patients with clinically suspected eye abnormalities at Makkah Eye
Complex, Khartoum, Sudan. A Chi-square test was used to assess the relationship between qualitative variables. In
91% of patients with type II the prevalence of significant types of sonographic findings in diabetic eye disease was as
follows, males were more affected p-value (0.01). A Correlation is done between duration of disease and final
diagnose, it was found that there was no significant relationship between them p-value (0.452). There was no
significant correlation between type 2 and ultrasound findings p-value (0.204), there was a relationship between
patient history and final diagnose p-value (0.000), Comparing between controlled and non-controlled DM, there was
no significant correlation p-value (0.224), and (77.3%) of patients are treated with insulin. The study concluded that
the ocular B-mode ultrasonography is an effective method of diagnosing diabetic eye diseases by detecting a wide
range of diabetic eye disorders.
Keywords: Diabetes Mellitus, Eye Disease, Ocular B-mode Ultrasonography.
Copyright @ 2020: This is an open-access article distributed under the terms of the Creative Commons Attribution license which permits unrestricted
use, distribution, and reproduction in any medium for non-commercial use (NonCommercial, or CC-BY-NC) provided the original author and source
are credited.
INTRODUCTION
The ocular US has long been the province of
ophthalmologists, often using dedicated equipment [1].
However, radiologists are becoming increasingly
involved, using general (multipurpose) ultrasound
equipment with high-frequency small-parts probes. The
cornea, anterior chamber, iris, posterior chamber, and
lens rarely require US, because they can be properly
evaluated by clinical inspection, ophthalmoscopy, slit-
lamp examination, and US biomicroscopy using
frequencies up to 50 MHz [2, 3]. The globe lies in the
anterior region of the orbit. It is surrounded by fat but
separated from it by a membranous sac, the capsule of
Tenon. Its attachments include the corneoscleral
junction anteriorly and the optic nerve posteriorly.
Tenon’s capsule is pierced by the tendons of
the extraocular muscle [4, 5]. Nevertheless, any
condition that causes opacification of the light-
conducting media may obscure visualization of the
posterior segment of the globe at clinical examination,
thus requiring the B-mode US to rule out retinal,
vitreous, and choroidal detachments, tumors, and other
pathologic conditions that affect the posterior segment
of the eye.
The US can also provide useful additional
information about disease detected in the
ophthalmoscope examination. It is the quickest and
simplest method of imaging the eye; it is widely
available, provides high-resolution images, and enables
dynamic study. With appropriate training, qualified
professionals can perform the ocular US using a
systematic study protocol. Although computed
tomography (CT) and magnetic resonance imaging
(MRI) is very useful in many ocular and orbital
conditions, they cannot scan in real-time, have a poorer
spatial resolution, and have a limited role in the
evaluation of the vitreous, retina and choroid.
Medical Imaging Technology
Safaa Bashir et al., Sch J App Med Sci, April., 2020; 8(4): 1115-1119
© 2020 Scholars Journal of Applied Medical Sciences | Published by SAS Publishers, India
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An accurate visual representation of the
anatomy and sometimes of the functional state of the
patient has been a goal of clinicians for several decades
in many medical fields, although this aspect is often still
neglected in diabetic patients. Nevertheless, the rapid
rise in the prevalence of diabetes to 382 million
individuals worldwide during the last 20 years and the
expected rise to 592 million by 2030[6] has global
implications and requires paradigm-shifting approaches
to diagnosis, treatment monitoring, and prevention.
Over the long term, hyperglycemic conditions can lead
to serious diseases affecting the cardiovascular system,
eyes, kidneys, nerves, and teeth [7-11] Also, people
with diabetes. Also have a higher risk of developing
infections, cognitive impairment and dementia [12, 13],
and lower-limb amputations [14]. This study aims to
study the diabetic eye disease using ocular B-mode
ultrasonography.
MATERIALS AND METHODS
A descriptive, analytical study, the study took
place in Sudan-Khartoum in the ultrasound department
of Makkah eye complex, during the period from 2016 to
2019, this study included 300 Sudanese patients with
long-duration diabetes mellitus more than 10 years, they
have attended the ultrasound department for the
ultrasound investigation. All examinations were done
by using a Nidek (Echoscan US – 4000) ultrasonic unit,
equipped with a high-frequency direct contact 10 MHZ
transducer, display on the 110×20 cm graphics sony
thermal printer. Initial examinations were done under
high gain (80 dB to 100 dB) and low gain (60 dB to 70
dB) sensitivity.
Technique and study protocol
Ultrasound evaluations of the eye and orbit
were performed in the supine or sitting position. The
probe was placed directly over the conjunctiva or
cornea or placed over closed lids. The former has the
advantage of reducing the sound attenuation caused by
the lids; however, it requires sterilization of the probe
between procedures. A coupling solution was used to
provide standoff and avoid attenuation caused by air.
STATISTICAL ANALYSIS
All measurable data were initially summarized
in a comparison table. Statistical analysis was
performed using the Statistical Package for the Social
Sciences (SPSS) version 16 for windows (IBM
Corporation, Armonk, NY, USA) and Microsoft Excell
2007, the result was presented in the form of graphs and
tables.
RESULTS
Fig-1: Frequency distribution of age \years
Table-1: Frequency distribution of residence
Residence
Frequency
Percent
Valid Percent
Cumulative Percent
Center
208
69.3
69.3
69.3
East
56
18.7
18.7
88.0
West
15
5.0
5.0
93.0
North
21
7.0
7.0
100.0
Total
300
100.0
100.0
Table-2: Frequency distribution of duration of DM
Duration
\years
Frequency
Percent
Valid
Percent
Cumulative
Percent
10-19
209
69.7
69.7
69.7
20-29
86
28.7
28.7
98.3
30-35
5
1.7
1.7
100.0
Total
300
100.0
100.0
Minimum =10, maximum =35, means =15.96±4.90
Safaa Bashir et al., Sch J App Med Sci, April., 2020; 8(4): 1115-1119
© 2020 Scholars Journal of Applied Medical Sciences | Published by SAS Publishers, India
1117
Fig-2: Correlation between duration and patients age
Table-3: Frequency distribution of type of DM
Type of DM
Frequency
Percent
Valid Percent
Cumulative Percent
1
27
9.0
9.0
9.0
2
273
91.0
91.0
100.0
Total
300
100.0
100.0
Fig-4: Frequency distribution of clinical history of the patients
Table-4: Frequency distribution of Pathologic US findings
Ultrasound findings
Frequency
Percent
Valid Percent
Cumulative Percent
Hyper-mature cataract
36
12.0
12.0
12.0
Vitreous changes
32
10.7
10.7
22.7
Normal
21
7.0
7.0
29.7
Retinal Detachment
64
21.3
21.3
51.0
Retinal detachment+ Vitreous Hemorrhage
24
8.0
8.0
59.0
Mature cataract
21
7.0
7.0
66.0
Vitreous Detachment
27
9.0
9.0
75.0
Cataract
1
.3
.3
75.3
Vitreous Hemorrhage
38
12.7
12.7
88.0
Retinal cyst
1
.3
.3
88.3
optic nerve changes
3
1.0
1.0
89.3
RD+ vitreous changes
3
1.0
1.0
90.3
Hyper-mature cataract + vitreous changes
3
1.0
1.0
91.3
Retinal changes
1
.3
.3
91.7
High myopia+ hyper-mature cataract
1
.3
.3
92.0
Vitreous detachment
+vitreous changes
5
1.7
1.7
93.7
Retinal detachment
+ mature cataract
8
2.7
2.7
96.3
vitreous changes + axial length defect
1
.3
.3
96.7
axial length defect
2
.7
.7
97.3
lens disorder
2
.7
.7
98.0
high myopia
1
.3
.3
98.3
Hyper-mature cataract + VH
2
.7
.7
99.0
vitreous changes+ vitreous hemorrhage
1
.3
.3
99.3
Hyper-mature cataract + posterior vitreous detachment
1
.3
.3
99.7
high myopia + vitreous changes
1
.3
.3
100.0
Total
300
100.0
100.0
Safaa Bashir et al., Sch J App Med Sci, April., 2020; 8(4): 1115-1119
© 2020 Scholars Journal of Applied Medical Sciences | Published by SAS Publishers, India
1118
Fig-5: B scan images transverse scanning Patient 67-year-old male
shows retinal detachment
Fig-6: B scan images transverse scanning Patient 65-year-old male
shows vitreous hemorrhage
DISCUSSION
In recent years there have been major advances
in ocular imaging particularly in the field of ocular
coherence tomography (OCT) and in the last few years
we have seen developments such as Angio OCT and
steady-state OCT, and there are many advances in
wavefront imaging particularly of the anterior segment.
However, there remains an imaging modality that has
been steadily developing and often forgotten, but it does
not rely on optical technology. Ultrasound imaging
utilizes technology that can image any part of the eye
under any circumstances.
The current study is descriptive-analytical
study included 300 diabetic patients complain of eye
problems their age ranged between (35-77) years old,
they were divided to four groups, the most affected
group was the (60-69) year’s Figure (1), this was agreed
with a study done by (Osman 2017), According to the
gender, the current study found that the male was more
affected 159 (53%) than female 141(47%) this result
agrees with the study conducted by Christopher R
Forrest [15]. The study showed that the most affected
patients were lived in a center table (1). This consigned
with a study done by Osman [17]. According to the
duration of the disease, the study reported that the
groups (10-19) years 209 (69.7%), (20-29) years 86
(28.7%) table (2). and (30-35) years were the most
affected patients respectively this result agrees with the
previous study which was done by Osman [17]. The
study found that most of the patients had diabetic type
II (91%) Table (3), this result agrees with the study
done by Mohamed [16]. According to the history of the
patients, a study revealed that most of the patients with
diabetes and hypertension (163 patients 54.3%),
patients with diabetes and trauma represented
57patients (19%), patients with trauma and
hypertension (20%), figure (4)this result agree with
done by Osman [17]. The study found that the right eye
155 (51.7%) was more affected than left 145 (48.3%)
this result agrees with a study conducted by Abdellateef
[18]. The study found a highly incidence of eye
problems in ultrasound was retinal detachment 64 (21.3
%) figure (4), followed by vitreous hemorrhage 38
(12.7%)figure(5), hyper mature cataract 36 (12%),
vitreous change 32 (10.7%), vitreous detachment 27
(9%), retinal detachment + vitreous hemorrhage 24
(8%), mature cataract 21 (7%), retinal detachment +
mature cataract 8 ( 2.7 %), vitreous detachment +
vitreous change 5 ( 1.7% ) table (4), this agree with
finding of the study done by Mohaned et al. [19].
B-mode biometry has a learning curve, but
once mastered it can be used for axial length
measurement in every clinical situation, with proof of
reliability, in particular when optical biometry is not
available. The other advantage of B-mode biometry is
that it provides an anatomical overview of the posterior
segment of the eye, enabling assessment of the
vitreoretinal interface, anatomical analysis of the
macular region and visualization of peripheral lesions,
which can be hidden by dense cataracts during slit-lamp
examination.
CONCLUSION
The study concluded that ocular B-mode
ultrasonography is an effective method of diagnosing
diabetic eye diseases by detecting a wide range of
diabetic eye disorders.
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