Computed Tomography in the Diagnosis of Occult Open-Globe Injuries

Research output: Contribution to journalArticle

38 Citations (Scopus)

Abstract

Purpose: To determine the radiographic signs present on computed tomography (CT) most suggestive of occult open-globe injury. Design: Retrospective chart review. Participants: 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). Main Outcome Measures: 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.

Original languageEnglish (US)
Pages (from-to)1448-1452
Number of pages5
JournalOphthalmology
Volume114
Issue number8
DOIs
StatePublished - Aug 2007

Fingerprint

Tomography
Wounds and Injuries
Vitreous Hemorrhage
Lenses
Rupture
Lacerations
Prolapse
Intraoperative Complications
Retinal Detachment
Operating Rooms
Motion Pictures
Outcome Assessment (Health Care)
Sensitivity and Specificity

ASJC Scopus subject areas

  • Ophthalmology

Cite this

Computed Tomography in the Diagnosis of Occult Open-Globe Injuries. / Arey, Mark L.; Mootha, V. Vinod; Whittemore, Anthony R.; Chason, David P.; Blomquist, Preston H.

In: Ophthalmology, Vol. 114, No. 8, 08.2007, p. 1448-1452.

Research output: Contribution to journalArticle

@article{2a44d55f29a947ccbacb78adcdd99187,
title = "Computed Tomography in the Diagnosis of Occult Open-Globe Injuries",
abstract = "Purpose: To determine the radiographic signs present on computed tomography (CT) most suggestive of occult open-globe injury. Design: Retrospective chart review. Participants: 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). Main Outcome Measures: 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.",
author = "Arey, {Mark L.} and Mootha, {V. Vinod} and Whittemore, {Anthony R.} and Chason, {David P.} and Blomquist, {Preston H.}",
year = "2007",
month = "8",
doi = "10.1016/j.ophtha.2006.10.051",
language = "English (US)",
volume = "114",
pages = "1448--1452",
journal = "Ophthalmology",
issn = "0161-6420",
publisher = "Elsevier Inc.",
number = "8",

}

TY - JOUR

T1 - Computed Tomography in the Diagnosis of Occult Open-Globe Injuries

AU - Arey, Mark L.

AU - Mootha, V. Vinod

AU - Whittemore, Anthony R.

AU - Chason, David P.

AU - Blomquist, Preston H.

PY - 2007/8

Y1 - 2007/8

N2 - Purpose: To determine the radiographic signs present on computed tomography (CT) most suggestive of occult open-globe injury. Design: Retrospective chart review. Participants: 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). Main Outcome Measures: 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.

AB - Purpose: To determine the radiographic signs present on computed tomography (CT) most suggestive of occult open-globe injury. Design: Retrospective chart review. Participants: 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). Main Outcome Measures: 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.

UR - http://www.scopus.com/inward/record.url?scp=34547229186&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=34547229186&partnerID=8YFLogxK

U2 - 10.1016/j.ophtha.2006.10.051

DO - 10.1016/j.ophtha.2006.10.051

M3 - Article

C2 - 17678689

AN - SCOPUS:34547229186

VL - 114

SP - 1448

EP - 1452

JO - Ophthalmology

JF - Ophthalmology

SN - 0161-6420

IS - 8

ER -