Computed tomography in the diagnosis of occult open-globe injuries.
OBJECTIVE
To determine the radiographic signs present on computed tomography (CT) most suggestive of occult open-globe injury.


METHODS
Retrospective chart review.


METHODS
Forty-eight eyes (of 46 patients), 34 of which were found to have an occult open-globe injury on surgical exploration.


METHODS
A retrospective chart review of all eyes of patients 18 years or older undergoing surgical exploration to rule out occult open-globe injury after 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. The CT films were obtained and independently reviewed by 3 masked observers (2 neuroradiologists and 1 ophthalmologist).


METHODS
Presence of occult open-globe injury with respect to radiographic globe and orbital findings.


RESULTS
The sensitivity of CT for determining occult open-globe injury varied from 56% to 68% between the observers, specificity ranged from 79% to 100%, positive predictive value ranged from 86% to 100%, and negative predictive value ranged from 42% to 50%. Open-globe injuries averaged more CT findings per patient compared with intact globes (P = 0.047). 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), and retinal detachment (P = 0.044). 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.


CONCLUSIONS
Although CT scanning may provide valuable information in patients in whom an occult open-globe injury is suspected, its sensitivity and specificity are inadequate to be relied on fully, and such patients generally should be taken to the operating room for formal surgical evaluation. Significant changes in globe contour or obvious volume loss are strong predictors of globe rupture, and any vitreous hemorrhage should be a concern for occult injury.
Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, Texas 75390-9057, USA.
Mark L
ML
Arey
V Vinod
VV
Mootha
Anthony R
AR
Whittemore
David P
DP
Chason
Preston H
PH
Blomquist
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005129:Eye Foreign Bodies / Q000000981:diagnostic imaging* / Q000601:surgery; D015807:Eye Injuries, Penetrating / Q000000981:diagnostic imaging* / Q000601:surgery; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012421:Rupture; D012590:Sclera / Q000293:injuries* / Q000601:surgery; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed