title: Detection of metallic ocular foreign bodies with handheld sonography in a porcine model.
abstract: OBJECTIVE
  Eye conditions are common in emergency departments. Intraocular foreign bodies (IOFBs) are a frequent concern. Orbital computed tomography (CT) is traditionally used for evaluation. We sought to evaluate bedside ocular sonography for detecting metallic IOFBs.
  
  
  METHODS
  A pig model was chosen. A micrometer was used to create 3 precise metallic fragments: 0.012 x 0.012 x 0.012, 0.025 x 0.025 x 0.012, and 0.05 x 0.05 x 0.012 in. Individual eyes were randomized to the presence or absence of a foreign body. Randomization was also used to determine the specific size of any given IOFB. A standard 18-gauge spinal needle was used to puncture the sclera and introduce the IOFB into the vitreous. Each eye was then evaluated by 2 sonologists for the presence or absence of an IOFB.
  
  
  RESULTS
  A total of 28 eyes were used; 12 (43%) were randomized to no IOFB and 16 (57%) to the presence of an IOFB. Of the 16 eyes that received IOFBs, 8 (50%) were 0.012 x 0.012 x 0.012 in; 5 (31%) were 0.025 x 0.025 x 0.012 in; and 3 (19%) were 0.05 x 0.05 x 0.012 in. Sensitivity was 87.5% and specificity 95.8%. Positive predictive value (PPV) and negative predictive value (NPV) were 96.5% and 85.2%, respectively.
  
  
  CONCLUSIONS
  Bedside sonography may identify the presence of metallic IOFBs. The PPV allows a high degree of certainty that an IOFB is actually present if seen and may negate the need for uninfused orbital CT. The NPV was 85.2%. Given the potential grave consequences of a missed IOFB, sonography cannot be used as the definitive test to rule out the presence of a metallic IOFB. In the presence of negative findings, further imaging is warranted.
authors.affiliation: Department of Emergency Medicine, Medical College of Georgia, 1120 15th St, AF-2056, Augusta, GA 30912-4007, USA.
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Shiver
authors.forename: Matthew
authors.initials: M
authors.lastname: Lyon
authors.forename: Michael
authors.initials: M
authors.lastname: Blaivas
mesh_terms: D000818:Animals; D004195:Disease Models, Animal; D005123:Eye / Q000000981:diagnostic imaging; D005129:Eye Foreign Bodies / Q000000981:diagnostic imaging*; D008670:Metals; D019095:Point-of-Care Systems; D011237:Predictive Value of Tests; D011897:Random Allocation; D012680:Sensitivity and Specificity; D013232:Steel; D013552:Swine; D014463:Ultrasonography / Q000295:instrumentation* / Q000379:methods
chemical_list: D008670:Metals; D013232:Steel