The impact of echography on evaluation and management of poterior egment diorder

Purpoe To invetigate the impact on patient management of poterior egment echographic evaluation at an academic intitution. Deign Retropective, noncomparative, conecutive cae erie. Method Record were reviewed of all patient evaluated for the firt time with ocular echography for poterior egment evaluation at Bacom Palmer Eye Intitute between eptember 2000 and Augut 2001. Patient with prior poterior egment echography, intraocular tumor, or upected optic nerve or orbital dieae were excluded. An “impactful” echographic evaluation wa defined a an evaluation that confirmed the diagnoi and management plan. A “pivotal” evaluation wa defined a an evaluation that either (1) made or ubclaified the diagnoi or (2) etablihed or changed the management plan or both. Main outcome meaure include proportion of impactful and pivotal echographic evaluation and factor aociated with pivotal evaluation. Reult The tudy included 154 eye of 143 patient. The requeting phyician wa a retina fellowhip-trained faculty member in 55 cae (36%), a nonretina faculty member in 22 (14%), a fellow in 9 (6%), and a reident in 68 (44%). Reaon for obtaining echography included evaluation for retinal tear or detachment in 83 eye (54%), evaluation for poterior egment dieae (for example, before cataract extraction) in 40 (26%), evaluation for endophthalmiti in 10 (7%), evaluation for intraocular foreign body in 8 (5%), characterization of choroidal detachment in 4 (2%), and other in 9 (6%). Echography confirmed the upected diagnoi and pre-echography management plan in 128 eye (83%). Echography made or ubclaified the diagnoi in 20 eye (13%) and etablihed or changed the management plan in 12 eye (8%). Accounting for definitional overlap, echography wa pivotal in 22 eye (14%). ignificant predictor of a pivotal evaluation or an evaluation that affected the management plan include a retina faculty member a the requeting phyician (P = .003), lack of a management plan before echography (P < .001), and certain reaon for obtaining echography (for example, to rule out retinal tear or detachment and to rule out intraocular foreign body; P = .032). The final clinical or pathologic diagnoi confirmed the echographic diagnoi in 148 eye (96%). Concluion Poterior egment echography may be a very ueful diagnotic tool. It value may be optimized in certain ubet of patient. Conideration uch a thee may contribute to more cot-effective allocation of reource.