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Slit-Lamp Evaluation Provides Greater Depth Estimates in Stromal Ulcers Than High-Resolution Ultrasonic
M Caro-Suarez1,2, D Costa3, M Leiva4,5
1Ophthalmology Department, Hospital Veterinario Puchol, Madrid, Spain.
Purpose:
To compare the estimation of corneal stromal ulcer depth (UD) by slit-lamp biomicroscopy (SLB) and ultrasound biomicroscopy (UBM) images, to identify factors influencing surgical decision-making, and to evaluate whether decisions based on SLB images change after reviewing UBM depth measurements.
Methods:
Fifty dogs with corneal stromal ulceration were included. SLB and UBM images of the deepest part of each ulcer were obtained. Three masked external examiners estimated UD percentage using the SLB images. Clinical records were reviewed, and a questionnaire evaluated whether surgery was recommended and which factors influenced that decision. Finally, UBM images with depth measurements were provided, and examiners were asked whether this information altered their initial surgical recommendation.
Results:
Median UD estimated by the evaluators was 63.3% (interquartile range [IQR]: 40.0-78.7), which was significantly higher than the UD measured by UBM (42.1%; IQR: 30.2-55.9; p < 0.001). The mean absolute percentage difference in UD% between SLB estimates and UBM measurements (relative to UBM) was 38.7%. This difference was evident in both anterior and medium stromal ulcers (p < 0.001). The factors most frequently influencing surgical decision-making were UD (84.0%-92.0%) and ulcer width (36.0%-52.0%). After reviewing the UBM images, evaluators modified their initial medical versus surgical recommendation in 10.0%-14.0% of cases, most commonly changing from surgery to medical management.
Conclusion:
The SLB tended to provide higher UD% estimates than UBM, with a mean absolute percentage difference of 38.7% (relative to UBM), particularly in anterior and medium stromal ulcers. UD and ulcer width drive surgical decisions. UBM provides the necessary precision that may help refine surgical indication and avoid unnecessary corneal surgery.
