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M. T. Andreoli, C. M. Andreoli, N. Guha-Thakurta, P. A. Caruso, M. Cunnane, P. A. D. Rubin, C. Kloek; Computed Tomography Findings in Open Globe Injuries. Invest. Ophthalmol. Vis. Sci. 2007;48(13):720.
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Patients with trauma suspicious for open globe injury frequently have a limited clinical examination due to pain, edema, or intraocular hemorrhage. Computed Tomography (CT) scanning is frequently used as an adjunct in these circumstances. However, CT findings can be misleading. Here we attempt examine the sensitivity of CT scanning for detecting open globe injury and characterize the associated findings.
One hundred forty CT scans performed between 1/1/2000 and 11/22/2006 on patients with known open globe injuries were identified and determined to be of adequate quality. The scans were read in batch by one of three neuro-radiologists who were asked to make a binary decision on presence or absence of several findings related to ocular trauma (evidence of globe rupture, volume loss, presence of IOFB, lens abnormalities, etc).All scans were performed with multi-detector CT scanning of the orbits with 1 mm collimation in the axial plan without contrast and displayed with axial and coronal reformatting.
The patients studied included 28 women and 112 men with an average age of 42.4 years. There was at least one finding indicating definite radiologic evidence of an open globe injury in 102 of 140 scans yielding a sensitivity of 72.9 percent. Of these 102 patients, 90 had ocular volume loss (anterior chamber or vitreous cavity) with 66 these patients of these having a shallow anterior chamber compared to the fellow eye. Fifteen of these patients had severe ocular volume loss (greater then 50% of overall ocular volume). Fifty-seven patients had irregularity of the posterior globe contour. Six patients had intraocular air and 19 patients had and intraocular foreign bodies (IOFBs). Seventy-four patients (53%) had lens abnormalities (25 displaced, 24 deformed, 28 absent or poorly defined). Sixty-three patients (45%) had evidence of posterior segment pathology such as vitreous hemorrhage or retinal detachment. Fourteen (10%) had associated orbital fractures.
Common CT findings in patients with open globe injuries include: volume loss (particularly shallow anterior chamber), lens abnormalities, posterior segment pathology and less commonly air in the eye or IOFBs. CT is a useful adjunct in the management of open globe injuries; however, CT is only 72.9% sensitive for open globe injury. CT should not be used in lieu of exploratory surgery when clinical suspicion exists.
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