Diagnostic assessment of computed tomography (CT) in open globe injuries: a systematic review and meta-analysis

Abstract

Accurate and timely diagnosis of Open Globe Injuries (OGIs) is crucial for implementing appropriate interventions. The goal of the present systematic review study is to evaluate the accuracy of CT in detecting OGI, especially in patients which conducting a detailed ophthalmologic examination or emergent surgical exploration is unavailable. The results of this study can aid clinicians in better management and pre-operative decision-making for patients with OGI's. We systematically searched PubMed, Web of Science, and Scopus for relevant English papers up to August 2024. Included studies must report at least one or more of the following clinical outcomes: specificity, sensitivity, NPV, and PPV of CT scan for detecting OGIs. The details of each study regarding the value of CT in the diagnosis determination of OGI were extracted. Using Stata software version 15, analyses were conducted on sensitivity, specificity, positive and negative predictive values, and the frequency of each CT finding. Twelve published articles were included in the study. The articles encompassed a total of 937 patients. The pooled sensitivity and specificity of CT in diagnosing OGI were 75 (95 CI: 0.65, 0.85, I2: 93.5, p-value < 0.001) and 83 (95 CI: 0.76, 0.90, I2: 84, p-value < 0.001), respectively. The pooled positive and negative predictive values of CT were 90 (95 CI: 0.84, 0.96, I2: 91.3, p value < 0.001) and 79 (95 CI: 0.71, 0.88, I2: 85.6, p value < 0.001), respectively. The most frequent findings were a change in globe contour, scleral injury, corneal injury, and vitreous hemorrhage, in order. The highest diagnostic sensitivity of CT scan findings was observed for shallow anterior chamber changes and lens dislocation or destruction. Lens dislocation and intraocular foreign body had the highest specificity in CT findings, with a specificity of 100. Our results supporting the utility of CT scanning in the diagnostic workflow for OGIs, particularly for detecting structural abnormalities and anterior chamber changes, have significant practical implications. They can inform clinical practice and guide the diagnostic approaches in suspected open globe injuries, empowering medical professionals to make informed decisions.