{
  "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.",
  "authors": [
    {
      "affiliations": [
        "Ophthamology, Princess Alexandra Eye Pavilion, Edinburgh, UK"
      ],
      "name": "Joanna Mair"
    },
    {
      "affiliations": [
        "Institure of Inflammation and Ageing, University of Birmingham, Birmingham, UK"
      ],
      "name": "Lana Bush"
    },
    {
      "affiliations": [
        "Queen’s University Belfast, Belfast, UK"
      ],
      "name": "Sophia Halliday"
    },
    {
      "affiliations": [
        "Western Eye Hospital, London, UK",
        "Imperial College London, London, UK"
      ],
      "name": "David McMaster"
    },
    {
      "affiliations": [
        "Oxford University Hospitals NHS Foundation Trust, Oxford, UK"
      ],
      "name": "Edward Sellon"
    },
    {
      "affiliations": [
        "Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA"
      ],
      "name": "Marcus H Colyer"
    },
    {
      "affiliations": [
        "Defence Health Agency J-9, Falls Church, Virginia, USA"
      ],
      "name": "Scott F McClellan"
    },
    {
      "affiliations": [
        "US Army Brooke Army Medical Center, San Antonio, Texas, USA"
      ],
      "name": "Grant A Justin"
    },
    {
      "affiliations": [
        "Ocular Repair Group, The University of Sydney Save Sight Institute, Sydney, New South Wales, Australia",
        "Opthalmology, Lions Eye Institute, Nedlands, Western Australia, Australia"
      ],
      "name": "Annette K Hoskin"
    },
    {
      "affiliations": [
        "Bascom Palmer Eye Institute, Miami, Florida, USA"
      ],
      "name": "Kara M Cavuoto"
    },
    {
      "affiliations": [
        "Sydney Eye Hospital, Sydney, New South Wales, Australia"
      ],
      "name": "James Leong"
    },
    {
      "affiliations": [
        "Consultorios Oftalmologicos Benisek Ascarza, Capital Federal, Argentina",
        "Capital Federal, Buenos Aires, Argentina"
      ],
      "name": "Andrés Rousselot"
    },
    {
      "affiliations": [
        "Wilmer, Johns Hopkins Hospital, Baltimore, Maryland, USA"
      ],
      "name": "Fasika Woreta"
    },
    {
      "affiliations": [
        "Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA",
        "Department of Ophthalmology, Naval Aerospace Medical Institute, Pensacola, Florida, USA"
      ],
      "name": "Kyle E Miller"
    },
    {
      "affiliations": [
        "White River Junction Veterans Administration Medical Center, White River Junction, Vermont, USA",
        "Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA"
      ],
      "name": "William G Gensheimer"
    },
    {
      "affiliations": [
        "Ophthalmology, St. Thomas’ Hospital, London, UK"
      ],
      "name": "Thomas H Williamson"
    },
    {
      "affiliations": [
        "Manchester Royal Eye Hospital, Manchester, UK"
      ],
      "name": "Felipe E Dhawahir-Scala"
    },
    {
      "affiliations": [
        "National Institute for Health Research (NIHR) Biomedical Research Centre (BRC) at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK",
        "Ophthalmology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK"
      ],
      "name": "Peter Shah"
    },
    {
      "affiliations": [
        "Ophthalmology, National University Health System, Singapore, Singapore"
      ],
      "name": "Gangadhara Sundar"
    },
    {
      "affiliations": [
        "Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA"
      ],
      "name": "Robert A Mazzoli"
    },
    {
      "affiliations": [
        "Helen Keller Foundation for Research and Education, Birmingham, Alabama, USA"
      ],
      "name": "Ferenc Kuhn"
    },
    {
      "affiliations": [
        "Worcestershire Acute Hospitals NHS Trust, Worcester, UK"
      ],
      "name": "Malcolm Woodcock"
    },
    {
      "affiliations": [
        "Corneal Service, Sydney Eye Hospital, Sydney, New South Wales, Australia",
        "Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia"
      ],
      "name": "Stephanie Watson"
    },
    {
      "affiliations": [
        "Northumbria University, Newcastle upon Tyne, UK"
      ],
      "name": "Renata S M Gomes"
    },
    {
      "affiliations": [
        "Department of Ophthalmology, National Healthcare Group Eye Institute, Singapore"
      ],
      "name": "Rupesh Agrawal"
    },
    {
      "affiliations": [
        "Institure of Inflammation and Ageing, University of Birmingham, Birmingham, UK",
        "Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, UK"
      ],
      "name": "Richard J Blanch"
    }
  ],
  "title": "Use of preoperative imaging in open globe injury management: a systematic review",
  "uid": "22934447-b6f6-5d4f-80df-3659dac44de5"
}