1
|
Figueiredo F, Sandhu J, Shaw M. Clinical outcomes of traumatic globe rupture in corneal graft patients. Int Ophthalmol 2024; 44:120. [PMID: 38424221 PMCID: PMC10904414 DOI: 10.1007/s10792-024-03008-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 10/11/2023] [Indexed: 03/02/2024]
Abstract
PURPOSE This study reports the mechanisms, complications and graft survival following sight-threatening traumatic globe rupture in patients having previously undergone corneal transplantation in the same eye. METHODS A retrospective, observational, single-center consecutive cohort study at the Royal Victoria Infirmary, Newcastle upon Tyne, UK over a 20-year period. Medical records and Newcastle Corneal Transplantation Service electronic database (eNCTS) review was undertaken of all consecutive patients who underwent corneal transplantation with a history of traumatic globe rupture. Main outcome measures include mechanism of injury, final best-corrected distance visual acuity (BCDVA), graft survival and complications. RESULTS A total of 921 keratoplasties were undertaken between 1997 and 2017 with 24 (3.0%) patients identified with a history of traumatic globe rupture. A bimodal relationship of age and mechanism of trauma was observed. The mean age (SD) of individuals reporting cause as a fall was 71.5 (14.8) years, and 45.3 (20.8) years (P < 0.05) amongst individuals reporting accidental trauma or assault. The pre- and post-trauma mean (SD) LogMAR BCDVA was 0.6 (0.9) and 1.7 (1.0), respectively (P = 0.001). The overall graft-failure rate was 60.9% (11 grafts) during a mean (SD) follow-up period of 3.5 (4.1) years. Globe rupture with lens damage was associated with poorer final BCDVA (P < 0.05). CONCLUSIONS This study represents the first published series from England for this type of patient cohort. Overall visual outcomes were poor with a bimodal relationship of age and mechanism of trauma. Worse prognostic factors included lens and posterior segment complications. Re-grafting in these select group of patients may prove valuable.
Collapse
Affiliation(s)
- Francisco Figueiredo
- Department of Ophthalmology, Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Bioscience Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.
- Department of Ophthalmology, Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.
| | - Jas Sandhu
- Department of Ophthalmology, Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Bioscience Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Michael Shaw
- Department of Ophthalmology, Gozo General Hospital, Gozo, Malta
| |
Collapse
|
2
|
Mura M, Iannetta D, Pellegrini M, Engelbrecht LA, Sarti L, Parmeggiani F, Badawi A, Dhibi H, Al Sulaiman S. Long-term functional and structural outcomes after large chorioretinectomy for ruptured globe following blunt trauma. Int J Retina Vitreous 2023; 9:52. [PMID: 37653531 PMCID: PMC10472549 DOI: 10.1186/s40942-023-00492-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 08/18/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND The purpose of this study was to present a modified surgical technique involving pars plana vitrectomy with large chorioretinectomy for eyes with rupture of the globe due to severe ocular blunt trauma. METHODS This retrospective study included consecutive patients with rupture of the globe due to blunt trauma who were treated at the King Khaled Eye Specialist Hospital (Riyadh, Saudi Arabia). All patients underwent 25-gauge pars plana vitrectomy with large chorioretinectomies involving all the tissue around the posterior scleral wounds. Outcome measures included best-corrected visual acuity (BCVA), anatomical success and globe survival, rates of complications. RESULTS 15 eyes of 15 patients were included. Mean BCVA was 2.88 ± 0.13 logMAR at presentation, and significantly improved to 0.83 ± 0.28 logMAR (P < 0.001), with 10 patients (67%) achieving a final BCVA ≥ 20/200. Anatomical success and globe survival were achieved in 11 (73%) and 15 (100%) of eyes, respectively. Postoperative complications included retinal detachment in 6 eyes (40%), epiretinal membrane in 6 (40%), hypotony in 4 (26%), PVR in 2 (13%). CONCLUSIONS Pars plana vitrectomy with large chorioretinectomy is an effective treatment for globe rupture following severe blunt trauma, yielding good visual outcomes and anatomical success rates.
Collapse
Affiliation(s)
- Marco Mura
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy.
- Vitreoretinal Division, King Khaled Eye Specialist Hospital, Riyadh, Kingdom of Saudi Arabia.
- St. Anna University Hospital, Via A. Moro 8, 44124, Cona (Ferrara), Italy.
| | - Danilo Iannetta
- Ophthalmology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Marco Pellegrini
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - Leonore A Engelbrecht
- Vitreoretinal Division, King Khaled Eye Specialist Hospital, Riyadh, Kingdom of Saudi Arabia
| | - Laura Sarti
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | | | - Abdulrahman Badawi
- Vitreoretinal Division, King Khaled Eye Specialist Hospital, Riyadh, Kingdom of Saudi Arabia
| | - Hassan Dhibi
- Vitreoretinal Division, King Khaled Eye Specialist Hospital, Riyadh, Kingdom of Saudi Arabia
| | - Sulaiman Al Sulaiman
- Vitreoretinal Division, King Khaled Eye Specialist Hospital, Riyadh, Kingdom of Saudi Arabia
| |
Collapse
|
3
|
Patil NS, Hanna NG, Khan Y. Globe Rupture Secondary to a Spontaneous Suprachoroidal Hemorrhage in a Blind Glaucomatous Eye: A Case Report. J Curr Ophthalmol 2023; 35:199-202. [PMID: 38250494 PMCID: PMC10795807 DOI: 10.4103/joco.joco_270_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 12/08/2022] [Accepted: 12/09/2022] [Indexed: 01/23/2024] Open
Abstract
Purpose To report a rare case of globe rupture following a spontaneous expulsive suprachoroidal hemorrhage without a predisposing event. Methods Case report. Results A 40-year-old man presented with a 3-week history of episodic eye pain, likely associated with uncontrolled glaucoma, and a spontaneous clot exuding from his right eye without a predisposing event. Notably, the patient had a remote past ocular history of posttraumatic glaucoma and untreated retinal detachment from childhood. He underwent uncomplicated evisceration of the right eye with polymethyl methacrylate implantation. Conclusions Spontaneous expulsive suprachoroidal hemorrhage without a predisposing event is an exceedingly rare phenomenon, with only six previously reported cases. It is possible that eyes with a history of trauma, possibly diseased eyewalls, and eyes with high intraocular pressure may be the most susceptible to spontaneous suprachoroidal hemorrhage and consequent globe rupture.
Collapse
Affiliation(s)
- Nikhil S. Patil
- Departsment of Ophthalmology, McMaster University, Hamilton, Ontario, Canada
| | - Najib-Georges Hanna
- Departsment of Ophthalmology, McMaster University, Hamilton, Ontario, Canada
| | - Yasser Khan
- Departsment of Ophthalmology, McMaster University, Hamilton, Ontario, Canada
| |
Collapse
|
4
|
Pelletier J, Koyfman A, Long B. High risk and low prevalence diseases: Open globe injury. Am J Emerg Med 2023; 64:113-120. [PMID: 36516669 DOI: 10.1016/j.ajem.2022.11.036] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 11/20/2022] [Accepted: 11/29/2022] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Open globe injury (OGI) is a rare but serious condition that carries with it a high rate of morbidity. OBJECTIVE This review highlights the pearls and pitfalls of OGI, including presentation, diagnosis, and management in the emergency department (ED) based on current evidence. DISCUSSION OGI refers to full-thickness injury to the layers of the eye. OGI can be caused by blunt or sharp trauma, and subtypes include penetration, perforation, intraocular foreign body (IOFB), globe rupture, or mixed types. OGI is more common in males and usually secondary to work-related injury, but in women it is most commonly associated with falls. Emergency clinicians should first assess for and manage other critical, life-threatening injuries. Following this assessment, a thorough eye examination is necessary. Computed tomography (CT) may suggest the disease, but it cannot definitively exclude the diagnosis. While point-of-care ultrasound (POCUS) is highly sensitive and specific for some findings in OGI, its use is controversial due to potential globe content extrusion. Management includes protecting the affected eye from further injury, preventing Valsalva maneuvers that could extrude ocular contents, updating tetanus vaccination status, administering broad-spectrum antibiotics, and ophthalmology consultation for surgical intervention to prevent the sequelae of blindness and endophthalmitis. CONCLUSION An understanding of OGI can assist emergency clinicians in diagnosing and managing this sight-threatening traumatic process.
Collapse
Affiliation(s)
- Jessica Pelletier
- Department of Emergency Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Alex Koyfman
- Department of Emergency Medicine, UT Southwestern, Dallas, TX, USA
| | - Brit Long
- SAUSHEC, Department of Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, TX, USA.
| |
Collapse
|
5
|
Ho H, Foo J, Li YC, Bobba S, Go C, Chandra J, Fung AT. Prognostic factors and epidemiology of adult open globe injuries from Western Sydney: a twelve-year review. BMC Ophthalmol 2021; 21:173. [PMID: 33838650 DOI: 10.1186/s12886-021-01929-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 03/29/2021] [Indexed: 12/02/2022] Open
Abstract
Background To identify prognostic factors determining final visual outcome following open globe injuries. Methods Retrospective case series of patients presenting to Westmead Hospital, Sydney, Australia with open globe injuries from 1st January 2005 to 31st December 2017. Data collected included demographic information, ocular injury details, management and initial and final visual acuities. Results A total of 104 cases were identified. Predictors of poor final visual outcomes included poor presenting visual acuity (p < 0.001), globe rupture (p < 0.001), retinal detachment (p < 0.001), Zone III wounds (p < 0.001), hyphema (p = 0.003), lens expulsion (p = 0.003) and vitreous hemorrhage (p < 0.001). Multivariate analysis demonstrated presenting visual acuity (p < 0.001), globe rupture (p = 0.013) and retinal detachment (p = 0.011) as being statistically significant for predicting poor visual outcomes. The presence of lid laceration (p = 0.197) and uveal prolapse (p = 0.667) were not significantly associated with the final visual acuity. Conclusions Poor presenting visual acuity, globe rupture and retinal detachment are the most important prognostic factors determining final visual acuity following open globe injury.
Collapse
|
6
|
Lee WS, McNamara P, English J, Meusemann R. Ocular trauma associated with falls in older people: A 10-year review from a state trauma service. Injury 2020; 51:2009-15. [PMID: 32690213 DOI: 10.1016/j.injury.2020.07.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 06/23/2020] [Accepted: 07/10/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Falls are the leading cause of injury-related emergency presentations, hospital admissions and deaths in Victorians over the age of 65. While there is extensive literature analysing traumatic injuries resulting from falls in older patients, there is little data on ocular injuries in this patient group. METHODOLOGY A retrospective audit of all patients over 65 years referred to the Ophthalmology Department of a tertiary hospital following fall from standing height between January 2009 and December 2018 to determine the demographics, injury setting, ophthalmic injuries, interventions and outcomes of ocular trauma secondary to falls. RESULTS Two hundred and seventy patients (F = 155, M = 115) were included, with a mean age of 81 years. 180 falls (66.7%) occurred in a residential environment. The most common reason for referral was orbital fracture (n = 155). Severe ocular injuries included globe rupture (n = 23), retro-bulbar haematoma (n = 22), retinal detachment (n = 6) and traumatic optic neuropathy (n = 6). Forty patients (14.8%) presented with a visual acuity (VA) below 6/60 while 34 patients (12.5%) had a non-assessable VA secondary to delirium or intubation. Of these 34, 9 had a significant ocular injury. A total of 28 patients (10.4%) were permanently blinded by their injuries. Twenty-three patients (8.5%) required admission to ICU and 16 patients (5.93%) died during their in-hospital stay. Thirty-six injuries were referred beyond the 24-hour mark, including a globe rupture and a case of traumatic optic neuropathy. With the exception of the missed globe rupture, all other injuries requiring emergency surgery were operated on within 24 h. CONCLUSION Falls in older people may be associated with sight-threatening ocular injuries which are common and easy to miss in this population demographic. The presence of ocular injuries in this patient group is associated with significant rates of in-hospital mortality and poor functional outcomes. It is therefore essential for trauma practitioners to perform a detailed and systematic assessment in order to identify sight-threatening ocular injuries and allow for expedient sight-saving intervention to be performed.
Collapse
|
7
|
Ojuok E, Uppuluri A, Langer PD, Zarbin MA, Thangamathesvaran L, Bhagat N. Predictive factors of enucleation after open globe injuries. Graefes Arch Clin Exp Ophthalmol 2020; 259:247-255. [PMID: 32567040 DOI: 10.1007/s00417-020-04794-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 05/24/2020] [Accepted: 06/06/2020] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND Trauma is the leading cause of enucleations in the USA. Current information regarding open globe injuries (OGI) is based mainly on data from individual tertiary care centers across the country which might skew the findings towards the population served by these level-one trauma centers. The aim of this study is to evaluate the demographics, characteristics, and risk factors of traumatic enucleations in a large data sample. METHODS Descriptive cross-sectional observational study using the National Inpatient Sample (NIS) Database from 2002 to 2013. Inpatients with traumatic enucleations were identified using ICD-9 codes. Chi-square and logistic regression analyses were used to identify differences between the enucleated and non-enucleated cohorts and to evaluate the predictive factors of enucleation in OGIs. RESULTS Enucleations were performed in 3020 (6.2%) of 48,563 OGIs identified. The average age in the enucleated cohort for males vs. females was 44.7 vs. 62.2 years. In the USA, the highest number of traumatic enucleations occurred in the 21-40 group (41.8%) and the fewest in the 80+ age group (11.8%). The risk of enucleation decreased across the age groups significantly. Compared with the 21-40 age group, the risk of undergoing enucleation was 15% lower in patients 41 to 60 years of age, 35% in patients 61 to 80, and 40% lower in patients over 80. In total, 5.1% OGIs in women and 6.7% of OGIs in men were enucleated. The risk of enucleation was 29% higher in men than in women. The highest absolute number of enucleations was seen in Whites. Compared with Whites, Blacks had a 63% higher risk of enucleation following an OGI. OGIs with rupture-type injury, endophthalmitis, or phthisis were significantly higher odds to be enucleated. CONCLUSIONS The risk of enucleation following traumatic OGI significantly increased for patients who were in the 21-40 age group, of Black race, or of male gender; the risk also increased if the injury was a rupture-type or associated with endophthalmitis or phthisis. The risk of depression was 75% higher in enucleated patients versus non-enucleated patients.
Collapse
Affiliation(s)
- Effy Ojuok
- Rutgers New Jersey Medical School, Institute of Ophthalmology and Visual Science, Rutgers University, 90 Bergen Street, Newark, NJ, 07103, USA
| | - Aditya Uppuluri
- Rutgers New Jersey Medical School, Institute of Ophthalmology and Visual Science, Rutgers University, 90 Bergen Street, Newark, NJ, 07103, USA
| | - Paul D Langer
- Rutgers New Jersey Medical School, Institute of Ophthalmology and Visual Science, Rutgers University, 90 Bergen Street, Newark, NJ, 07103, USA
| | - Marco A Zarbin
- Rutgers New Jersey Medical School, Institute of Ophthalmology and Visual Science, Rutgers University, 90 Bergen Street, Newark, NJ, 07103, USA
| | - Loka Thangamathesvaran
- Rutgers New Jersey Medical School, Institute of Ophthalmology and Visual Science, Rutgers University, 90 Bergen Street, Newark, NJ, 07103, USA
| | - Neelakshi Bhagat
- Rutgers New Jersey Medical School, Institute of Ophthalmology and Visual Science, Rutgers University, 90 Bergen Street, Newark, NJ, 07103, USA.
| |
Collapse
|
8
|
Nakai T, Kimura M, Yoshiyama K, Matono T. Endogenous endophthalmitis caused by Streptococcus agalactiae: An ophthalmologic emergency. IDCases 2019; 15:e00499. [PMID: 30775242 PMCID: PMC6365811 DOI: 10.1016/j.idcr.2019.e00499] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Revised: 01/27/2019] [Accepted: 01/27/2019] [Indexed: 11/04/2022] Open
Abstract
Here, we present a 76-year-old diabetic man who was diagnosed as having endogenous endophthalmitis caused by Streptococcus agalactiae that finally developed globe rupture, which is a rare endogenous endophthalmitis complication. This case highlight that endogenous endophthalmitis is an ophthalmological emergency with poor prognosis, thereby requiring prompt diagnosis and aggressive intervention.
Collapse
Affiliation(s)
- Takehiro Nakai
- Department of General Internal Medicine, Iizuka Hospital, Fukuoka, Japan
| | - Masahiro Kimura
- Department of General Internal Medicine, Iizuka Hospital, Fukuoka, Japan
| | - Keizo Yoshiyama
- Department of Ophthalmology, Iizuka Hospital, Fukuoka, Japan
| | - Takashi Matono
- Department of General Internal Medicine, Iizuka Hospital, Fukuoka, Japan
| |
Collapse
|
9
|
Moskowitz EE, Siegel-Richman YM, Hertner G, Schroeppel T. Aerial drone misadventure: A novel case of trauma resulting in ocular globe rupture. Am J Ophthalmol Case Rep 2018; 10:35-37. [PMID: 29780910 PMCID: PMC5956627 DOI: 10.1016/j.ajoc.2018.01.039] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 01/18/2018] [Accepted: 01/22/2018] [Indexed: 11/29/2022] Open
Abstract
Purpose The purpose of this case report is to present the novel findings of a drone causing such a traumatic ocular injury and provide recommendations for how it might be prevented. Observations We report on a recent case where a child presented to our Emergency Department after incurring a blow to the face by the propeller of a remote controlled drone. The patient suffered significant trauma including rupture of the right globe. Conclusions As drone sales continue to rise, it is important that physicians be prepared to treat the potential injuries that may result from using these devices. Furthermore, in an attempt to reduce the number of visits associated with remote controlled drones, physicians should be prepared to provide advice as to how patients can reduce the risks of injury. Importance We hope that the framework and recommendations below will help physicians decrease adverse outcomes related to this unusual injury pattern.
Collapse
Affiliation(s)
- Eliza E Moskowitz
- Department of Surgery, University of Colorado Health-South, Memorial Hospital, 1400 E Boulder St, Colorado Springs, CO 80909, United States.,Department of Surgery, University of Colorado School of Medicine, 12631 E. 17th Avenue, C-305, Aurora, CO 80045, United States
| | - Yonaton M Siegel-Richman
- Department of Emergency Medicine, University of Colorado Health-South, Memorial Hospital, 1400 E Boulder St, Colorado Springs, CO 80909, United States
| | - George Hertner
- Department of Emergency Medicine, University of Colorado Health-South, Memorial Hospital, 1400 E Boulder St, Colorado Springs, CO 80909, United States
| | - Thomas Schroeppel
- Department of Surgery, University of Colorado School of Medicine, 12631 E. 17th Avenue, C-305, Aurora, CO 80045, United States
| |
Collapse
|
10
|
Ting Yl J, Faisal HA, Pan SW. Spontaneous expulsive suprachoroidal haemorrhage in an asymptomatic elderly patient: a case report. Int Ophthalmol 2019; 39:203-6. [PMID: 29197945 DOI: 10.1007/s10792-017-0774-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2017] [Accepted: 11/22/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE To describe a rare case of spontaneous expulsive suprachoroidal haemorrhage (SESCH) in an asymptomatic elderly patient. METHOD This is a case report of a 76-year-old Chinese female, presented as an emergency with spontaneous left eye bleeding. She had underlying uncontrolled hypertension, no other systemic illness and not on anticoagulant. She has a history of right eye cataract operation, right eye angle-closure glaucoma and left eye absolute glaucoma complicated with painless left blind eye. Ocular examination over left eye showed no light perception and demonstrated presence of fresh bleed, expulsion of lens and prolapsed uveal contents, while right eye examination was unremarkable. Patient subsequently underwent evisceration and was uneventful. RESULTS Routine blood investigations including coagulation profile came back as normal. Surgical findings include perforated cornea more than three-fourths with prolapsed uveal contents and fragile conjunctiva. No other significant macroscopic conditions were noted. Histology and culture came back with growth of Pseudomonas aeuroginosa with no evidence of malignancy. DISCUSSION SESCH is a rare but serious sight-threatening ocular condition associated with multiple risk factors including arteriosclerosis, vascular disease, glaucoma, diabetes, intraocular malignancy and diseased eye wall. The predisposing factors involved in this case include advanced age, glaucoma with persistent high intraocular pressure, uncontrolled hypertension and presence of infection.
Collapse
|
11
|
Chou C, Lou YT, Hanna E, Huang SH, Lee SS, Lai HT, Chang KP, Wang HMD, Chen CW. Diagnostic performance of isolated orbital CT scan for assessment of globe rupture in acute blunt facial trauma. Injury 2016; 47:1035-41. [PMID: 26944178 DOI: 10.1016/j.injury.2016.01.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 09/27/2015] [Accepted: 01/16/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVES We determine the diagnostic performance of emergent orbital computed tomography (CT) scans for assessing globe rupture in patients with blunt facial trauma. METHODS We performed a retrospective cohort study based on prospectively collected trauma registry and acute care surveillance data in a tertiary-care hospital. Patients aged at least 18 years who underwent isolated orbital CT scanning for assessing potential ocular trauma were examined. Analyses were performed to evaluate the magnitude of agreement between diagnosis by CT scanning and ophthalmic assessment, including globe rupture. RESULTS Our study cohort comprised 136 patients, 30% of whom (41 patients) sustained orbital wall fractures. Concordance for orbital CT diagnosis and the ophthalmic assessment of globe rupture was substantial (k=0.708). The relative risk of globe rupture was 0.692 (95% confidence interval (CI): 0.054-8.849) for superior wall fractures, 0.459 (95% CI: 0.152-1.389) for inferior wall fractures, 2.286 (95% CI: 1.062-4.919) for lateral wall fractures, and 0.637 (95% CI: 0.215-1.886) for medial wall fractures. According to multivariate analysis, lateral wall fractures were an independent risk factor for globe ruptures (adjusted odds ratio (OR)=12.01, P=0.011), and medial or inferior wall fracture was a protective factor (adjusted OR=0.14, P=0.012). In the stratified analysis of diagnostic performance of CT scan, specificity was highest among patients with orbital wall fractures (97.2%), followed by negative predictive volume (NPV, 97%), and accuracy (95.1%). CONCLUSION Among patients with blunt facial trauma who underwent isolated orbital CT scanning as part of ocular trauma assessment, the diagnostic performance of CT in detecting globe rupture is more accurate in patients with orbital wall fractures. Nevertheless, isolated orbital CT alone does not have a sufficiently high diagnostic performance to be reliable to rule out all globe ruptures. Lateral orbital wall fractures in blunt facial trauma patients, in particular, should prompt thorough evaluation by an ophthalmologist.
Collapse
Affiliation(s)
- Chieh Chou
- Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Plastic Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
| | - Yun-Ting Lou
- Department of Ophthalmology, EDA Hospital, I-Shou University, Kaohsiung, Taiwan.
| | - Eissa Hanna
- Department of Ophthalmology, University to Washington, Seattle, WA, USA.
| | - Shu-Hung Huang
- Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Plastic Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
| | - Su-Shin Lee
- Department of Plastic Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
| | - Hsin-Ti Lai
- Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Plastic Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
| | - Kao-Ping Chang
- Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Plastic Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
| | - Hui-Min David Wang
- Department of Fragrance and Cosmetic Science, Kaohsiung Medical University, Kaohsiung, Taiwan.
| | - Chao-Wen Chen
- Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Emergency Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
| |
Collapse
|