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M.L. Arey, V.V. Mootha, A.R. Whittemore, D.P. Chason, P.H. Blomquist; Computed Tomography in the Diagnosis of Occult Open Globe Injuries . Invest. Ophthalmol. Vis. Sci. 2006;47(13):3967.
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To determine the radiographic signs present on computed tomography (CT) most suggestive of occult open globe injury.
A retrospective chart review of all eyes of patients 18 years or older undergoing surgical exploration to rule out occult open globe injury following CT examination at Parkland Memorial Hospital between October 1998 and September 2003 was conducted. Patients with obvious corneal or corneoscleral lacerations or with uveal prolapse were excluded. CT films were obtained and independently reviewed by three blinded observers (two neuroradiologists and one ophthalmologist).
52 eyes of 50 patients underwent surgical exploration to rule out occult open globe injury. CT films could not be located for 4 unilateral cases. For the 48 eyes with CT films available, the sensitivity of CT for determining occult open globe injury varied from 56–68% between the observers, specificity 79–100%, positive predictive value 86–100%, and negative predictive value 42–50%. Open globe injuries averaged 5.7 CT findings per patient, while intact globes averaged 3.7 (p=0.029). Statistically significant CT findings for occult open globe injury included any change in globe contour (p=0.001), obvious volume loss (p=0.003), an absent or dislocated lens (p=0.048), vitreous hemorrhage (p=0.003), retinal detachment (p=0.044), and intraorbital foreign body (p=0.017). Additionally, moderate to severe change in globe contour, obvious volume loss, total vitreous hemorrhage, and absence of lens were seen only in eyes with occult rupture. CT findings interpreted as intraocular air and intraocular foreign body (IOFB) were both seen in globes found to be intact at exploration.
While CT scanning may provide valuable information in those cases where an occult open globe injury is suspected, its sensitivity and specificity are inadequate to be fully relied upon, and such patients should generally be taken to the operating room for formal surgical evaluation. Significant changes in globe contour and/or obvious volume loss are strong predictors of globe rupture, and any vitreous hemorrhage should be concerning for occult injury. Intraocular air and IOFB findings on CT, generally felt to be pathognomonic for open globe injury, are not necessarily diagnostic.
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