Elsevier

Ophthalmology

Volume 107, Issue 10, October 2000, Pages 1899-1906
Ophthalmology

Computed tomography in the diagnosis and prognosis of open-globe injuries

https://doi.org/10.1016/S0161-6420(00)00335-3Get rights and content

Abstract

Objective

Determine sensitivity, specificity, and prognostic signs of orbital and ocular computed tomography (CT) in diagnosing patients with open globe injury.

Design

Randomized masked review of computed tomograms and retrospective clinical correlation of patients with ocular trauma.

Participants

Two hundred patients who underwent CT evaluation for ocular trauma between 1989 and 1993.

Methods

CTs were read by three masked observers; findings were tabulated and compared for variability among observers; sensitivity and specificity were calculated and CT findings were grouped according to visual outcome retrieved from record review.

Results

In the absence of clinical information, sensitivity and specificity were 75% and 93%, respectively. The positive predictive value ranged from 88% to 97%, with a calculated overall positive predictive value of 95%. Patients who had a poor visual outcome (visual acuity <2/200) or who underwent enucleation had significantly more CT findings than patients with a good visual outcome. Vitreous hemorrhage, absence of lens, and severe distortion of vitreous space are among the most common CT findings associated with poor visual outcome.

Conclusions

CT is not sensitive enough to be solely relied upon for diagnosis of all open globe injuries. CT findings only complement clinical findings, increasing the clinician’s overall ability to make an accurate diagnosis of open globe injury, and may provide useful prognostic information regarding visual outcome.

Section snippets

Methods

Two-hundred patients who underwent preoperative CT scanning for eye injuries between 1989 and 1993 were identified retrospectively from the Johns Hopkins Hospital Radiology Data Bank. Of these, 167 films were obtained. Clinical and/or surgical diagnoses of open globe injuries were obtained from hospital charts and a database of patients with open globe injury treated at the Wilmer Eye Institute.11 The CT scans from patients were placed in similar film jackets so the observers were blind to

Results

The sensitivity of the CT scan in predicting whether an eye had an open globe injury was calculated for each observer and ranged between 73% and 79% (Table 2). The specificity of the CT scan for correctly identifying eyes without open globe injuries ranged from 86% to 97%. The positive predictive value ranged from 88% to 97%, with a calculated overall positive predictive value of 95%. The overall sensitivity and specificity obtained by combining observations from all three observers was 75% and

Discussion

CT is available in most hospital emergency departments and has become a standard component in the workup of cases of severe head and facial trauma. A single study allows clinicians to assess the intracranial space, the presence of facial or orbital fractures, ocular injuries, and more. Performance of CT scan requires minimal patient cooperation and can be done in the presence of life support equipment. Unlike magnetic resonance imaging, there are few if any contraindications such as metallic

Conclusions

CT scan is an important test in the diagnosis and prognosis of open globe injury. Although the sensitivity of CT may not be high enough to be used as an isolated screening tool, it has significant clinical usefulness as an adjunct to clinical examination and provides prognostic information for these types of injuries with minimal disturbance to the globe.

Cited by (0)

View full text