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REPLY: REPLY: sonography in patients with suspected globe injury in the acute setting. e thank Lecler et al for their insightful comments and for Ophthalmic sonography does have a role in select cases to Wsharing their opinion on the use of sonography in patients answer specific questions regarding ocular surgical planning and with open globe injuries. Many valid points have been raised follow-up after globe repair. There is evidence to show that sonog- about the limitations of CT, with which we agree. raphy has a major role in detecting complex pathologies that de- CT has evolved as the imaging technique of choice for evalu- velop after globe repair, specifically differentiating a retinal de- ating patients with polytrauma in the United States. This imaging tachment from a choroidal detachment. The findings from technique is widely used in emergency departments and trauma sonography provide useful information for planning manage- centers. ment and predicting visual outcome. Andreoli et al reported all CT of the face detects not only globe injuries and radiopaque these important factors in patients after globe repair. Our study foreign bodies but also intraorbital soft-tissue injuries and orbito- differs in that it mainly deals with patients before globe repair and facial fractures, which have major treatment implications. The uses the limited preoperative clinical data available in the acute chaotic environment of the trauma resuscitation units dealing trauma setting. with patients with various forms of blunt and penetrating trauma In summary, the authors have made a compelling argument makes it impractical for ophthalmic sonography to be performed for sonography to determine prognostic information after globe in all emergency settings. The procedure requires both specialized repair. The safety of ophthalmic sonography should be estab- ophthalmic sonography equipment and expertise in its interpre- lished before using it in patients prior to globe repair. Ultimately, tation, which are not available around the clock in many trauma ophthalmic sonography is an effective tool in the follow-up of centers. In an emergent situation, CT and clinical examination patients after globe repair to identify various traumatic patholo- provide ample information to decide whether a globe injury re- gies, plan surgical repair, and predict patient outcomes. quires exploration. Our study shows that this information alone also provides prognostic information. REFERENCE There is still not enough evidence to show that sonography can 1. Andreoli MT, Yiu G, Hart L, et al. B-scan ultrasonography following be performed without inducing pressure on the globe. Pressure open globe repair. Eye (Lond) 2014;28:381–85 CrossRef Medline on the globe risks the extrusion of intraocular contents and po- X U.K. Bodanapally tentiates endophthalmitis or suprachoroidal hemorrhage, all of Department of Radiology X O. Saeedi which could further damage the already injured globe. Hence, the Department of Ophthalmology and Visual Sciences experts at the University of Maryland Shock Trauma center avoid R Adams Cowley Shock Trauma Center University of Maryland School of Medicine http://dx.doi.org/10.3174/ajnr.A5379 Baltimore, Maryland AJNR Am J Neuroradiol 38:E101 Nov 2017 www.ajnr.org E101 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png American Journal of Neuroradiology American Journal of Neuroradiology

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Publisher
American Journal of Neuroradiology
ISSN
0195-6108
eISSN
1936-959X
DOI
10.3174/ajnr.A5379
Publisher site
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Abstract

REPLY: sonography in patients with suspected globe injury in the acute setting. e thank Lecler et al for their insightful comments and for Ophthalmic sonography does have a role in select cases to Wsharing their opinion on the use of sonography in patients answer specific questions regarding ocular surgical planning and with open globe injuries. Many valid points have been raised follow-up after globe repair. There is evidence to show that sonog- about the limitations of CT, with which we agree. raphy has a major role in detecting complex pathologies that de- CT has evolved as the imaging technique of choice for evalu- velop after globe repair, specifically differentiating a retinal de- ating patients with polytrauma in the United States. This imaging tachment from a choroidal detachment. The findings from technique is widely used in emergency departments and trauma sonography provide useful information for planning manage- centers. ment and predicting visual outcome. Andreoli et al reported all CT of the face detects not only globe injuries and radiopaque these important factors in patients after globe repair. Our study foreign bodies but also intraorbital soft-tissue injuries and orbito- differs in that it mainly deals with patients before globe repair and facial fractures, which have major treatment implications. The uses the limited preoperative clinical data available in the acute chaotic environment of the trauma resuscitation units dealing trauma setting. with patients with various forms of blunt and penetrating trauma In summary, the authors have made a compelling argument makes it impractical for ophthalmic sonography to be performed for sonography to determine prognostic information after globe in all emergency settings. The procedure requires both specialized repair. The safety of ophthalmic sonography should be estab- ophthalmic sonography equipment and expertise in its interpre- lished before using it in patients prior to globe repair. Ultimately, tation, which are not available around the clock in many trauma ophthalmic sonography is an effective tool in the follow-up of centers. In an emergent situation, CT and clinical examination patients after globe repair to identify various traumatic patholo- provide ample information to decide whether a globe injury re- gies, plan surgical repair, and predict patient outcomes. quires exploration. Our study shows that this information alone also provides prognostic information. REFERENCE There is still not enough evidence to show that sonography can 1. Andreoli MT, Yiu G, Hart L, et al. B-scan ultrasonography following be performed without inducing pressure on the globe. Pressure open globe repair. Eye (Lond) 2014;28:381–85 CrossRef Medline on the globe risks the extrusion of intraocular contents and po- X U.K. Bodanapally tentiates endophthalmitis or suprachoroidal hemorrhage, all of Department of Radiology X O. Saeedi which could further damage the already injured globe. Hence, the Department of Ophthalmology and Visual Sciences experts at the University of Maryland Shock Trauma center avoid R Adams Cowley Shock Trauma Center University of Maryland School of Medicine http://dx.doi.org/10.3174/ajnr.A5379 Baltimore, Maryland AJNR Am J Neuroradiol 38:E101 Nov 2017 www.ajnr.org E101

Journal

American Journal of NeuroradiologyAmerican Journal of Neuroradiology

Published: Nov 1, 2017

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