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A. E. Wen, E. H. Black, C. Kim; Reliability of Computed Tomography in the Diagnosis of Open-Globe Injuries. Invest. Ophthalmol. Vis. Sci. 2007;48(13):5484.
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To determine the sensitivity and false negative associations of orbital and ocular computed tomography (CT) in the diagnosis of open-globe injuries in the clinical setting.
Retrospective review was performed on charts of 107 consecutive patients who underwent CT evaluation of the head and orbits and open globe repair at a tertiary referral center between June 1998 and June 2006. CT scan results were reviewed for patients with clinically or surgically confirmed open globe injuries; sensitivity and false negative rates were calculated and correlated with specific clinical and CT findings.
The overall sensitivity of orbital and ocular CT in detecting open globe injuries was 56.07%, with sensitivity being greatest in detecting injuries limited to the sclera (73.68%), slightly less in injuries involving both the sclera and cornea (62.50%), and least in injuries involving only the cornea (40.38%). The CT results were reviewed to document comments on the presence of detectable intraocular pathology, such as vitreous hemorrhage, intraocular emphysema, deformation of the globe or vitreous space, displacement of the lens, or intraocular foreign body (IOFB). The percentage of cases with identified intraocular pathology was 74.36% for scleral injuries, 62.50% for corneoscleral, and 51.92% for corneal. Correctly identified open globe injuries generally had a much higher association with detected intraocular pathology when compared to cases in which the diagnosis was missed [Fig.1 Percentage of Intraocular Pathology in True Positive vs. False Negative Cases by Wound Type].
CT is not sensitive enough to be relied upon as the sole diagnosis of open globe injuries. CT is least sensitive when the injury is limited to the cornea. Cases in which the injury is limited to the cornea may have relatively few CT findings, which may increase the chance of a false negative diagnosis.
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