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Michael P. Smith, Marcus Colyer, Dal Chun, Farhad Safi, Michael Mines; Management of traumatic cataracts during Operations Enduring and Iraqi Freedom. Invest. Ophthalmol. Vis. Sci. 2011;52(14):2799.
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To determine the injury type, concurrent ocular injuries, surgical approach and outcomes of patients who sustained traumatic cataracts from combat trauma in Iraq and Afghanistan.
A retrospective, noncomparative study of United States military personnel who suffered ocular injuries during the global wars on terror in Iraq and Afghanistan from March 2003 to March 2009. The primary outcome measure was visual acuity at 6 months. Secondary outcome was final lens status. The following variables were assessed in patients with traumatic cataracts: injury mechanism, use of eye protection, pre-op vision, other ocular injuries, lens status at presentation (subluxed or dislocated) and surgical intervention
188 eyes of 177 patients were studied. 121 eyes (64%) were injured in explosions, 13 eyes sustained gunshot injuries (7%) while the remainder suffered other war related injuries. 61 eyes (32%) were wearing eye protection. 65 eyes (35%) were not wearing eye armor. Eye protection was not documented or unknown in 61 eyes (32%). Traumatic aphakia occurred in 17 eyes (9%). At presentation, 3 lenses (2%) were subluxed and 14 (7%) were dislocated. Pars plana lensectomy was performed in 84 eyes (45%), phacoemulsification with primary IOL placement in 29 eyes (15%) and 26 eyes (14%) received a secondary IOL. Extracapsular cataract extraction was performed on 1 eye (0.5%). Final lens status was aphakia in 87 eyes (46%), pseudophakia in 57 eyes (30%) and phakia in 21 eyes (11%). 23 eyes (12%) were ultimately enucleated. In pseudophakic patients, 56 eyes (30%) had a PCIOL and 1 (0.5%) had an ACIOL. Pre-op visual acuity (logMAR) in involved eyes was 2.32 ± 1.02. Visual acuity at 6 month follow-up was 0.73 ± 0.80 (paired t-test, p<0.0005). 171 eyes (91%) of 162 patients (92%) had superimposed corneal, retinal or neuro-pathology limiting vision at 6 month follow up.
A high incidence of traumatic cataract occurs in combat ocular trauma. Despite early aggressive interventions, visual outcomes are generally limited by coincident ocular diseases from the trauma, while half of all eyes remain aphakic at final follow-up. Additional research efforts should be made towards optimizing vision in this patient population.
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