Traumatic Retinal Detachments in Operation Iraqi Freedom and Operation Enduring Freedom from 2002-2010

Abstract

 

Purpose

 

To evaluate the number of traumatic retinal detachments that occurred in Operation Iraqi Freedom and Operation Enduring Freedom, and to determine the cause of injury, type of injury, type of surgical intervention, final visual acuity, and reattachment rates.

 

Methods

 

Retrospective, noncomparative, interventional case series. Participants included 80 United States military personnel and local nationals (82 eyes) with a traumatic retinal detachment during Operation Iraqi Freedom and Operation Enduring Freedom treated at Walter Reed Army Medical Center (WRAMC) between 2002 and 2010. Interventions included pars plana vitrectomy, sclera buckle placement, observation, and additional surgical procedures as the clinical situation dictated. The primary outcome measure was final visual acuity while anatomic reattachment was a secondary outcome measure.

 

Results

 

The authors identified 80 patients (82 eyes) who were evaluated for a traumatic retinal detachment between 2002-2010 at WRAMC. 10% of eyes had a final visual acuity of 20/40 or better, 15% had a final visual acuity between 20/40 and 20/200, 11% had a final visual acuity between 19/200 and 1/200, 34% had a final visual acuity of LP or HM, 29% had a final visual acuity of NLP, and 1 patient was lost to follow up before final visual acuity could be obtained. 63% of eyes had either a perforating, penetrating, or intraocular foreign body (IOFB) injury. The final attachment rate was 67%. 37% of eyes required a second surgery for redetachment and 5% of eyes required 3 or more surgeries.

 

Conclusions

 

Unlike traumatic retinal detachments in the civilian sector, traumatic retinal detachments during military operations tend to be perforating or penetrating in nature vs. blunt force injuries often seen in the civilian sector. Due to lack of availability of specialty care in the combat theatre, definitive treatment is often delayed in the military setting. Open globe injuries often lead to severe loss of retinal tissue complicating retinal detachment repair. The above limitations have lead to a lower final visual acuity and anatomic reattachment rate than typically reported in the civilian literature.

 

 

Intraocular foreign body removed from a patient following an improvised explosive device injury.

 

 

Pie chart depicting the injury patterns sustained in eyes treated for traumatic retinal detachments.

 

Keywords: 697 retinal detachment • 742 trauma