Joseph D P, Pieramici D J, Beauchamp N J
The Barnes Retina Institute and Washington University Department of Ophthalmology and Visual Sciences, St. Louis, Missouri, USA.
Ophthalmology. 2000 Oct;107(10):1899-906. doi: 10.1016/s0161-6420(00)00335-3.
Determine sensitivity, specificity, and prognostic signs of orbital and ocular computed tomography (CT) in diagnosing patients with open globe injury.
Randomized masked review of computed tomograms and retrospective clinical correlation of patients with ocular trauma.
Two hundred patients who underwent CT evaluation for ocular trauma between 1989 and 1993.
CTs were read by three masked observers; findings were tabulated and compared for variability among observers; sensitivity and specificity were calculated and CT findings were grouped according to visual outcome retrieved from record review.
In the absence of clinical information, sensitivity and specificity were 75% and 93%, respectively. The positive predictive value ranged from 88% to 97%, with a calculated overall positive predictive value of 95%. Patients who had a poor visual outcome (visual acuity <2/200) or who underwent enucleation had significantly more CT findings than patients with a good visual outcome. Vitreous hemorrhage, absence of lens, and severe distortion of vitreous space are among the most common CT findings associated with poor visual outcome.
CT is not sensitive enough to be solely relied upon for diagnosis of all open globe injuries. CT findings only complement clinical findings, increasing the clinician's overall ability to make an accurate diagnosis of open globe injury, and may provide useful prognostic information regarding visual outcome.
确定眼眶及眼部计算机断层扫描（CT）在诊断开放性眼球损伤患者时的敏感性、特异性及预后指标。
对计算机断层扫描图像进行随机盲法评估，并对眼外伤患者进行回顾性临床相关性分析。
1989年至1993年间接受眼部创伤CT评估的200例患者。
由三名盲法观察者解读CT图像；将结果列表并比较观察者之间的差异；计算敏感性和特异性，并根据从记录回顾中获取的视力结果对CT结果进行分组。
在缺乏临床信息的情况下，敏感性和特异性分别为75%和93%。阳性预测值范围为88%至97%，计算得出的总体阳性预测值为95%。视力预后差（视力<2/200）或接受眼球摘除术的患者的CT表现明显多于视力预后良好的患者。玻璃体出血、晶状体缺失和玻璃体腔严重变形是与视力预后差相关的最常见CT表现。
CT对于诊断所有开放性眼球损伤的敏感性不足，不能仅依靠其进行诊断。CT表现仅作为临床发现的补充，提高临床医生对开放性眼球损伤的准确诊断能力，并可能提供有关视力预后的有用预后信息。
