Ocular Ultrasound as a Key to Diagnosing Uveitis-Masked Syndromes: Tips and Tricks.

Abstract

Background and Objectives: Uveitis-masked syndromes or masquerade syndromes (UMSs) are a group of ocular conditions with several systemic underlying causes, malignant or nonmalignant, that mimic the inflammatory status of the uvea. They are often difficult to detect and diagnose with traditional techniques, such as ophthalmic exams. Ocular B (bidimensional)-ultrasound (OBU) is a non-invasive, repeatable, rapid ultrasound method effective in indirect signs that lead back to systemic diseases. It is comparable in effectiveness with other imaging tools. The cause of UMSs can often be serious, and therefore early diagnosis and prompt treatment are critical. This study aimed to identify the sonographic signs of these forms, which can help physicians discover the cause underlying UMS. Materials and Methods: This was a consecutive, retrospective, nonrandomized study. This study was conducted at the University Hospital Polyclinic of Bari, Italy, from January 2022 to December 2024. A total of 186 patients were included, from 10 to 85 years old. They all underwent B-scan ultrasonography (Quantel Medical ABSolu Ocular Ultrasound). Results: All patients reported blurred vision, which could be accompanied by visual reduction (<20/40, Snellen charts), photophobia, floaters, flashes, proptosis, and redness. In all cases, we noted peculiar ultrasonographic signs, which allowed us to discriminate the underlying systemic diagnosis, such as vitreous corpuscles, choroid thickening, and primitive or metastatic solid tumors. Finally, we identified different diseases, such as primary intraocular lymphoma (PIOL), other lymphoproliferative conditions, orbital plasmacytoma, uveal melanoma, metastasis, endogenous endophthalmitis, retinal detachment, central serous retinopathy, metallic foreign bodies, ocular amyloidosis, and drug-induced UMSs. The sensitivity and specificity of ocular ultrasound compared to multimodal ocular imaging in UMSs were as follows: for primary intraocular lymphoma (PIOL) and other lymphoproliferative conditions, 0.98 (95% CI, 0.80-1) and 0.68 (90% CI, 0.40-0.92), respectively; for orbital plasmacytoma, 0.64 (92% CI, 0.52-0.86) and 0.66 (93% CI, 0.48-0.89), respectively; uveal melanoma, 1.00 (98% CI, 0.88-1.00) and 0.98 (95% CI, 0.86-0.98), respectively; metastasis, 0.75 (95% CI, 0.53-0.85) and 0.85 (95% CI, 0.48-0.98), respectively; endogenous endophthalmitis, 1.00 (95% CI, 0.50-1.00) and 0.83 (95% CI, 0.48-0.98), respectively; retinal detachment, both were 1.00 (95% CI, 0.87-1.00 and 0.84-0.97, respectively); central serous retinopathy, 0.60 (80% CI, 0.41-0.88) and 0.85 (95% CI, 0.52-0.98), respectively; metallic foreign bodies, 1.00 (95% CI, 0.78-1.00) and 0.99 (95% CI, 0.99-1.00), respectively; ocular amyloidosis, 0.77 (82% CI, 0.52-0.90) and 0.83 (80% CI, 0.49-0.88), respectively; and drug-induced UMSs, 0.64 (95% CI, 0.49-0.88) and 0.85 (95% CI, 0.52-0.98), respectively. Conclusions: Diagnosing UMS accurately can be quite challenging, and many of its different types frequently go undetected. This complexity in identification often leads to underdiagnosis, meaning it is essential to improve awareness and understanding of the condition in order to achieve better recognition and treatment. Early detection of these forms is imperative. The use of OBU can help diagnose indirect signs of these forms early and treat them promptly. It compares well with other diagnostic imaging techniques, such as MRI, but this does not mean that it replaces them; it can offer added value in multimodal imaging.