Use of preoperative imaging in open globe injury management: a systematic review
Mair, Joanna Bush, Lana Halliday, Sophia McMaster, David Sellon, Edward Colyer, Marcus H McClellan, Scott F Justin, Grant A Hoskin, Annette K Cavuoto, Kara M
Mair, Joanna
Bush, Lana
Halliday, Sophia
McMaster, David
Sellon, Edward
Colyer, Marcus H
McClellan, Scott F
Justin, Grant A
Hoskin, Annette K
Cavuoto, Kara M
Affiliation
Princess Alexandra Eye Pavilion; University of Birmingham; Queen's University Belfast; Imperial College Healthcare NHS Trust; Imperial College London; Oxford University Hospitals NHS Foundation Trust; Uniformed Services University of the Health Sciences; Defence Health Agency J-9; US Army Brooke Army Medical Center; The University of Sydney Save Sight Institute; Lions Eye Institute; Bascom Palmer Eye Institute; Sydney Eye Hospital; Consultorios Oftalmologicos Benisek Ascarza; Johns Hopkins Hospital; Naval Aerospace Medical Institute; White River Junction Veterans Administration Medical Center; Dartmouth-Hitchcock Medical Center; Guy's and St Thomas' NHS Foundation Trust; Manchester University NHS Foundation Trust; Moorfields Eye Hospital NHS Foundation Trust; UCL Institute of Ophthalmology; University Hospitals Birmingham NHS Foundation Trust; National University Health System Singapore; Helen Keller Foundation for Research and Education; Worcestershire Acute Hospitals NHS Trust; Sydney Eye Hospital; University of Sydney; Northumbria University; National Healthcare Group Eye Institute Singapore; Royal Centre for Defence Medicine
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Publication date
2025-12-21
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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.
Citation
Mair J, Bush L, Halliday S, McMaster D, Sellon E, Colyer MH, McClellan SF, Justin GA, Hoskin AK, Cavuoto KM, Leong J, Rousselot A, Woreta F, Miller KE, Gensheimer WG, Williamson TH, Dhawahir-Scala FE, Shah P, Sundar G, Mazzoli RA, Kuhn F, Woodcock M, Watson S, Gomes RSM, Agrawal R, Blanch RJ. Use of preoperative imaging in open globe injury management: a systematic review. Br J Ophthalmol. 2025 Dec 21:bjo-2025-327387. doi: 10.1136/bjo-2025-327387. Epub ahead of print.
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Article