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M.L. Arey, P.H. Blomquist; Sensitivity and Specificity of Computed Tomography in the Diagnosis of Occult Open Globe Injuries . Invest. Ophthalmol. Vis. Sci. 2005;46(13):5029.
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Purpose: To investigate the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of orbital computed tomography (CT) in the diagnosis of occult open globe injuries. Methods: Medical records including consultation, operative, and radiology reports were reviewed of all patients who underwent surgical exploration for suspected open globe injuries at Parkland Memorial Hospital from October 1998 through September 2003. Patients with corneal and/or corneoscleral lacerations, uveal prolapse on preoperative examination, or intraocular foreign body on CT were excluded. Results: Fifty–two eyes of fifty patients met inclusion criteria. Thirty–five eyes (67%) had an occult open globe injury discovered at the time of exploration. In total, the sensitivity of CT for occult open globe injury was 71%, specificity 76%, PPV 86%, and NPV 57%. Results were further broken down with regards to type of injury into blunt (27), sharp (5), or projectile (20). In 81% of blunt injuries an occult open globe injury was found at surgery, with CT sensitivity of 73%, specificity of 60%, PPV 89%, and NPV only 33%. For projectile injuries an occult open globe injury was present in 45% of cases, with CT sensitivity of 67%, specificity 82%, and PPV and NPV both 75%. Four of the 5 sharp injuries were found to have sustained an occult open globe injury, with CT sensitivity of 75%, specificity 100%, PPV 100% and NPV 50% in this small subset. Conclusions:While CT 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 surgical exploration.
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