Slit-Lamp Evaluation Provides Greater Depth Estimates in Stromal Ulcers Than High-Resolution Ultrasonic Biomicroscopy: A Prospective Study in 50 Dogs.

UBM provides more accurate ulcer depth measurement than slit-lamp, potentially preventing unnecessary corneal surgery in dogs.

This prospective study in 50 dogs compared corneal stromal ulcer depth (UD) estimation using slit-lamp biomicroscopy (SLB) versus ultrasound biomicroscopy (UBM), examining how each modality influences surgical decision-making. Three masked external examiners evaluated SLB images and estimated UD percentage, which was then compared to objective UBM measurements. Results demonstrated that SLB consistently overestimated ulcer depth, with a median examiner estimate of 63.3% compared to 42.1% measured by UBM—a statistically significant difference (p < 0.001). The mean absolute percentage difference between modalities was 38.7% relative to UBM, and this overestimation was particularly pronounced in anterior and medium stromal ulcers. Ulcer depth and ulcer width were the primary factors driving surgical decision-making, cited by 84–92% and 36–52% of evaluators, respectively. Critically, after reviewing UBM images and measurements, evaluators changed their initial medical versus surgical recommendation in 10–14% of cases, with the majority of changes being from surgical to medical management. This finding suggests that reliance on SLB alone may lead to unnecessary surgical interventions. UBM provides objective, quantitative depth assessment that can meaningfully refine surgical indications in canine corneal stromal ulcers. Veterinary ophthalmologists should consider integrating UBM into their diagnostic workup for stromal ulcers, particularly when surgical intervention is being contemplated, to avoid overtreatment based on subjective visual depth estimation.

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