[Efficacy of clinical evaluation in diagnosing injury zone in open globe ocular trauma].
BACKGROUND
Risk of retinal damage in open globe eye injuries increases as the zone (location of the wound vertex) is more rearward. The value of clinical exploration to assess this variable is unknown.


OBJECTIVE
To establish the efficacy of clinical exploration as a diagnostic test to identify the injury zone in open globe ocular trauma.


METHODS
Assessment of patients with open globe ocular trauma, preoperative clinical assessment of injury zone and surgical description of the wound were carried out. The proportion and 95% confidence intervals (CI) of eyes whose zone changed during surgical repair were established, and the efficacy of clinical evaluation to diagnose zone was estimated. Features of eyes with and without zone change were compared using χ(2) test.


RESULTS
89 eyes, mean age 27.1 years. Clinically, the identified zone was I in 36 eyes (40.4%), II in 38 (31.5%) and III in 25 (28.1%); the identified zone during surgery was I in 36 eyes (40.4%), II in 43 (48.3%) and III in 10 (11.2%). Zone changed in 30 eyes (34%, 95% C.I. 24 to 44). Specificity (96%), positive predictive value (93%) and positive likelihood ratio (13.9) were high only for zone II. No feature was associated with zone change.


CONCLUSIONS
Clinical exploration was not efficient enough to identify injury zone in open globe trauma and has low prognostic value. It is not necessary to define the injury zone at first contact; it is enough identifying properly the agent, visual function and pupil reflexes for an efficient assessment.
Servicio de Oftalmología, Hospital Juárez de México, México, D.F., Mexico. vlimag@prodigy.net.mx
Virgilio
V
Lima-Gómez
María Guadalupe
MG
Colas-Calvere
Dulce Milagros Razo
DM
Blanco-Hernández
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D065306:Corneal Injuries; D005131:Eye Injuries / Q000175:diagnosis*; D015807:Eye Injuries, Penetrating / Q000175:diagnosis; D005260:Female; D006801:Humans; D016013:Likelihood Functions; D016850:Limbus Corneae / Q000293:injuries; D008297:Male; D008875:Middle Aged; D010808:Physical Examination; D011237:Predictive Value of Tests; D012025:Reflex, Pupillary; D012160:Retina / Q000293:injuries; D012590:Sclera / Q000293:injuries*; D012680:Sensitivity and Specificity; D014792:Visual Acuity; D055815:Young Adult