Computed tomography accuracy and features in detecting open globe injuries in patients with ocular trauma: a systematic review and meta-analysis

Abstract

Open globe injuries (OGIs) can have devastating impacts on patients' lives. Early detection of OGIs is crucial for improving outcomes, as any delay in treatment can result in significant consequences. Radiological imaging, particularly computed tomography (CT), aids ophthalmologists in diagnosing this condition, especially in challenging cases. This literature review aimed to evaluate the accuracy of CT scans in identifying features of OGIs based on current evidence. This systematic review adhered to the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol. PubMed and EBSCOhost databases were searched using the keywords 'rupture globe' or 'open globe' and 'computed tomography' or 'CT'. Articles published in English between 1990 and 2023 were considered for inclusion, whereas review articles were excluded from the analysis. The initial search yielded 169 studies, and nine studies were included in the final screening. This review encompassed 917 eyes. The pooled specificity of the CT scan in detecting OGIs among patients with ocular trauma was 0.94 with 95% CI (0.92-0.96), and the pooled sensitivity was 0.77 with 95% CI (0.72-0.81). The area under the curve was 0.91, indicating the excellent ability of the CT scan to detect open globe injury. CT scans demonstrated high diagnostic accuracy for detecting OGI. While CT is highly effective in identifying ocular trauma, careful interpretations remain essential. Additional studies with larger sample sizes are recommended to refine its diagnostic role further.

Keywords: computed tomography; ocular trauma; open globe; rupture globe.

Figure 1

Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flowchart

Figure 2

Forest plot of the sensitivity of the studies included

Figure 3

Forest plot of the specificity of the studies included

Figure 4

Summary receiver operating characteristic plot

Figure 5

Common computed tomography signs in open globe cases

Figure 6

Axial computed tomography scan without contrast of a right open globe injury. The thick straight arrow indicates eyelid hematoma, the thin straight arrow represents vitreous hemorrhage, the arrowhead shows lens dislocation, and the curved arrow highlights scleral wall irregularities. Image reproduced with permission from the American Roentgen Ray Society: Yuan WH, Hsu HC, Lin YY, Liao SW. CT of globe rupture: analysis and frequency of findings. AJR Am J Roentgenol. 2014;202(5):4-5. ^© 2014 American Roentgen Ray Society.

Figure 7

Axial computed tomography scan without contrast of left open globe. The small arrow represents intraocular air and the large arrow represents the metallic intraocular foreign body. Image reproduced with permission from the American Roentgen Ray Society: Yuan WH, Hsu HC, Lin YY, Liao SW. CT of globe rupture: analysis and frequency of findings. AJR Am J Roentgenol. 2014;202(5):4-5. ^© 2014 American Roentgen Ray Society.

Figure 8

Axial computed tomography scan without contrast of left open globe. The single arrow represents shallow anterior chamber depth (ACD). The parallel lines represent the ACD measured perpendicular to the long axis of the lens, from the back surface of the cornea to the front surface of the lens (double arrows). In this case, the ACD difference was 2.2 mm. Image reproduced with permission from the American Roentgen Ray Society: Yuan WH, Hsu HC, Lin YY, Liao SW. CT of globe rupture: analysis and frequency of findings. AJR Am J Roentgenol. 2014;202(5):4-5. ^© 2014 American Roentgen Ray Society.

Figure 9

Axial computed tomography scan without contrast of left globe (false positive open globe). The thin arrow represents wall deformity (clinical examination showed subconjunctival hemorrhage and edema) and the thick arrow represents eyelid hematoma. Image reproduced with permission from the American Roentgen Ray Society: Yuan WH, Hsu HC, Lin YY, Liao SW. CT of globe rupture: analysis and frequency of findings. AJR Am J Roentgenol. 2014;202(5):4-5. ^© 2014 American Roentgen Ray Society.

Figure 10

Axial computed tomography scan without contrast of left open globe (false negative). The curved arrow represents swelling of the left eyelid and the straight arrow represents normal anterior chamber depth (ACD) in the right eye compared to the shallow left eye. Image reproduced with permission from the American Roentgen Ray Society: Yuan WH, Hsu HC, Lin YY, Liao SW. CT of globe rupture: analysis and frequency of findings. AJR Am J Roentgenol. 2014;202(5):4-5. ^© 2014 American Roentgen Ray Society.

Figure 11

Axial computed tomography scan without contrast of left open globe (false negative). The arrow represents the missed shallow anterior chamber depth (ACD) of the left eye due to lens misalignment during the scan. Image reproduced with permission from the American Roentgen Ray Society: Yuan WH, Hsu HC, Lin YY, Liao SW. CT of globe rupture: analysis and frequency of findings. AJR Am J Roentgenol. 2014;202(5):4-5. ^© 2014 American Roentgen Ray Society.