Year: 2025
Type: review
Abstract: IMPORTANCE: Primary repair of open globe injury (OGI) is typically undertaken urgently. Imaging plays an important role in the preoperative assessment, including detection of an OGI and presence of an intraocular foreign body (IOFB). Evidence is lacking on the utility of preoperative imaging in diagnosing OGI and IOFB. OBJECTIVE: The primary objective is to assess the role of pre-operative imaging in OGI. Studies including patients who had sustained an OGI and reporting the findings of radiologic imaging in pre-operative assessment of OGI were eligible for inclusion. DATA SOURCES: A systematic review was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement, searching the Cochrane Central Register of Controlled Trials, PubMed, Medline and ClinicalTrials.gov. STUDY SELECTION: Prospective and retrospective studies reporting preoperative imaging assessment after OGI were included with no restriction on language or start date up until 15 December 2023. DATA EXTRACTION AND SYNTHESIS: Eleven studies, 10 retrospective and 1 prospective, with a total of 1126 patients were included, of which 8 assessed computed tomography (CT) detection of OGI and 3 assessed ultrasound for the detection of IOFB. Risk of bias was assessed using the Quality Assessment Tool for Diagnostic Accuracy Studies-2 (QUADAS-2) tool. MAIN OUTCOMES AND MEASURES: Sensitivity of CT detection for OGI compared with clinical examination by an ophthalmologist and IOFB detection using intraoperative examination findings as gold standard. Preoperative B Scan ultrasonography (US) sensitivity for IOFB detection compared with CT. RESULTS: CT was 74% sensitive (95% CI 66.4% to 80.0%) and 93% specific (95% CI 88.2% to 95.4%) in OGI detection compared with clinical diagnosis. CT findings associated with OGI included scleral deformity, altered anterior chamber (AC) depth, lens abnormality and vitreous haemorrhage. CT was 69% sensitive (95% CI 51.4% to 82.0%) for IOFB detection using intraoperative examination findings as the gold standard.Preoperative B Scan US was not examined for OGI detection but had 86% sensitivity for IOFB detection (95% CI 77% to 92%) compared with the gold standard of CT, but safety with respect to pressure on the globe extruding intraocular contents was not studied. CONCLUSIONS AND RELEVANCE: CT had moderate sensitivity but high specificity for OGI detection, and therefore cannot replace clinical assessment by an ophthalmologist. A negative CT does not exclude an IOFB.
Source: British Journal of Ophthalmology
Authors: Joanna Mair, Lana Bush, Sophia Halliday, David McMaster, Edward Sellon, Marcus H Colyer, Scott F McClellan, Grant A Justin, Annette K Hoskin, Kara M Cavuoto, James Leong, Andrés Rousselot, Fasika Woreta, Kyle E Miller, William G Gensheimer, Thomas H Williamson, Felipe E Dhawahir-Scala, Peter Shah, Gangadhara Sundar, Robert A Mazzoli, Ferenc Kuhn, Malcolm Woodcock, Stephanie Watson, Renata S M Gomes, Rupesh Agrawal, Richard J Blanch
Institutions: Princess Alexandra Eye Pavilion, University of Birmingham, Queen's University Belfast, Western Eye Hospital, Imperial College London, Oxford University Hospitals NHS Trust, Uniformed Services University of the Health Sciences, Defense Health Agency, Brooke Army Medical Center, United States Army, Lions Eye Institute, The University of Sydney, University of Miami, Johns Hopkins University, Johns Hopkins Hospital, Naval Aerospace Medical Institute, Dartmouth–Hitchcock Medical Center, White River Junction VA Medical Center, St Thomas' Hospital, Manchester Royal Eye Hospital, University Hospitals Birmingham NHS Foundation Trust, Moorfields Eye Hospital NHS Foundation Trust, National Institute for Health and Care Research, NIHR Moorfields Biomedical Research Centre, University College London, National University Health System, Helen Keller Eye Research Foundation, Worcestershire Acute Hospitals NHS Trust, Northumbria University, National Healthcare Group, Royal Centre for Defence Medicine
Language: English
Subfield: Ophthalmology
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W4417538586