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Prediction of substantial closed-globe injuries in orbital wall fractures

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Abstract

Purpose

To determine risk factors for substantial closed-globe injuries in orbital fractures (SCGI) and to develop the best multivariate model for the prediction of SCGI.

Methods

A retrospective study was performed on patients diagnosed with orbital fractures at Farabi Hospital between 2016 and 2022. Patients with a comprehensive ophthalmologic examination and orbital CT scan were included. Predictive signs or imaging findings for SCGI were identified by logistic regression (LR) analysis. Support vector machine (SVM), random forest regression (RFR), and extreme gradient boosting (XGBoost) were also trained using a fivefold cross-validation method.

Results

A total of 415 eyes from 403 patients were included. Factors associated with an increased risk of SCGI were reduced uncorrected visual acuity (UCVA), increased difference between UCVA of the traumatic eye from the contralateral eye, older age, male sex, grade of periorbital soft tissue trauma, trauma in the occupational setting, conjunctival hemorrhage, extraocular movement restriction, number of fractured walls, presence of medial wall fracture, size of fracture, intraorbital emphysema and retrobulbar hemorrhage. The area under the curve of the receiver operating characteristic for LR, SVM, RFR, and XGBoost for the prediction of SCGI was 57.2%, 68.8%, 63.7%, and 73.1%, respectively.

Conclusions

Clinical and radiographic findings could be utilized to efficiently predict SCGI. XGBoost outperforms the logistic regression model in the prediction of SCGI and could be incorporated into clinical practice.

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Availability of data and materials

The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.

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Acknowledgements

The authors would like to thank the Farabi Eye Hospital staff for their kind assistance during this study.

Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

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Authors and Affiliations

  1. Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin Square, Tehran, Iran

    Farhad Salari, Seyed Mohsen Rafizadeh, Hanieh Fakhredin, Mohammad Taher Rajabi & Mehdi Yaseri

  2. Department of Health Information Technology and Management, Shahid Beheshti University of Medical Sciences, Tehran, Iran

    Farhang Hosseini

  3. International Network for Photo Medicine and Photo Dynamic Therapy (INPMPDT), Universal Scientific Education and Research, Network (USERN), Tehran, Iran

    Reza Fekrazad

  4. Orthodontics Department, Faculty of Dentistry, Tehran Medical Sciences, Islamic Azad University, Shariati St, Tehran, Iran

    Behzad Salari

Authors
  1. Farhad Salari
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  3. Hanieh Fakhredin
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  4. Mohammad Taher Rajabi
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Contributions

BS, RF, MTR, MR, and FS contributed to the design of the study. FS and HF reviewed medical records. FS evaluated CT scans. MTR and RF interpreted the data. MY performed statistical analyses. FH developed machine learning models. FS wrote the original draft of the paper. MR and BS revised the manuscript and supervised the study. All authors read and approved the final manuscript.

Corresponding authors

Correspondence to Seyed Mohsen Rafizadeh or Behzad Salari.

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Conflict of interest

The authors have no relevant financial or non-financial interests to disclose.

Ethical approval

This study was conducted under approval from institutional review boards at the Tehran University of Medical Sciences (IR.TUMS.FARABIH.REC.1401.028). This study was performed according to the principles of the Declaration of Helsinki.

Consent to participate

As this study was a retrospective study without direct contact with the subjects, the Ethics Committee of Tehran University of Medical Sciences waived the requirement for informed consent.

Consent for publication

As this study was a retrospective study without direct contact with the subjects, the Ethics Committee of Tehran University of Medical Sciences waived the requirement for informed consent.

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Salari, F., Rafizadeh, S.M., Fakhredin, H. et al. Prediction of substantial closed-globe injuries in orbital wall fractures. Int Ophthalmol 44, 219 (2024). https://doi.org/10.1007/s10792-024-03113-w

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