Jasmin Zvorničanin1, Edita Zvorničanin2. 1. Eye Clinic, University Clinical Center, Tuzla, Bosnia and Herzegovina. 2. Institute of Public Health Tuzla Canton, Tuzla, Bosnia and Herzegovina.
Sir,We read with interest the excellent article by Salz and Witkin1 on imaging in diabetic retinopathy. We congratulate the authors on a thorough review and the clinical pearls and would like to make a contribution.The authors indicate that B-scan ultrasonography is most useful in patients with vitreous hemorrhage or other media opacity that precludes direct visualization of the retina during ophthalmic examination, but it is not particularly useful for imaging diabetic retinopathy if the media is clear.1 Furthermore, in studies analyzing various vitreoretinal disorders, the overall sensitivity of ultrasonography in identifying the anatomical position of the retina was 97.3–97.7%.23 However, in patients with more complex ultrasonography findings, such as tractional retinal detachment and choroidal detachment, the agreement between the ultrasonography and the surgical findings is slightly lower, between 92.2%3 and 92%,4 respectively. The main cause of misdiagnosis could be defined as the presence of multiple complicated echoes in eyes with tractional retinal detachment.2However, ultrasonography examination can change the initial treatment plan in 4.8% and subclassify diagnosis and aid with further surgical planning in 13% of patients scheduled for pars plana vitrectomy.2 When considering only patients with poor visualization of the posterior segment, these figures are even higher at 9% and 20%, respectively.2 These outcomes are consistent with previous studies that reported ultrasonography established or changed the management plan in 8% and subclassified the diagnosis in 13% of patients with various posterior segment pathologies including cataract and choroidal detachment.5Overall, we agree with Salz and Witkin that ultrasonography of the eye remains a useful part of the ophthalmic examination for detection and evaluation of vitreoretinal changes in patients with diabetic retinopathy.