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R Joel Welch, Quan Dong Nguyen, Stephen R OConnell; Sensitivity and Specificity of Computed Tomography Findings in the Diagnosis of Combat-related Open-globe Injuries. Invest. Ophthalmol. Vis. Sci. 2014;55(13):5479.
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While computed tomography (CT) improves the ability to evaluate severe ocular trauma, the accuracy of CT findings in diagnosing an open-globe injury in the combat setting has not been established. The purpose of this study is to determine the sensitivity and specificity of various CT findings in the diagnosis of combat-related open-globe injuries.
The CT scans of 56 soldiers (112 eyes) who sustained combat-related head injuries during service in Afghanistan in early 2011 were reviewed. Seven separate radiographic findings related to eye injury were evaluated including presence or absence of lens dislocation, vitreous hemorrhage, anterior chamber flattening, scleral deformity, intraocular foreign body, intraocular air, and periocular foreign body. After the scans were analyzed, the extent of true ocular injury was determined by reviewing the surgical history. Forty-three eyes sustained open-globe injuries and 23 of those globes underwent primary enucleation. The sensitivities, specificities, and positive/negative predictive values (PPV, NPV) of the seven radiographic findings in diagnosing open-globe injury were then calculated.
Presence of intraocular air on CT had sensitivity of 60% and specificity of 90% (PPV 79%, NPV 78%). Presence of periocular foreign body had 47% sensitivity and 74% specificity (PPV 53%, NPV 69%). CT evidence of intra-ocular foreign body had 74% sensitivity and 90% specificity (PPV 82%, NPV 85%). Vitreous hemorrhage occupying more than 50% of the intraocular space had sensitivity of 51% and a specificity of 99% (PPV 96%, NPV 76%). Presence of mild to severe scleral deformity had a sensitivity of 58% and specificity of 94% (PPV 86%, NPV 78%). Anterior chamber flattening had 65% sensitivity and 97% specificity (PPV 93%, NPV 82%). Presence or absence of lens dislocation had sensitivity of 56% and specificity of 100% (PPV 100%, NPV 78%).
CT is a useful tool for evaluating the extent of ocular injury in the combat setting with nearly all of the analyzed radiographic findings having exceptional specificity. Lens dislocation and vitreous hemorrhage yield the highest specificity. Intraocular foreign body on CT, on the other hand, demonstrates highest sensitivity. While surgical exploration of combat-related ocular injuries will remain paramount, CT has significant clinical utility in diagnosing combat-related open-globe injuries.
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