Abstract
Purpose: :
To describe ocular injury patterns associated with blunt combat ocular trauma (COT) to Zones I and II of the globe and the visual outcome of patients injured during Operations Iraqi and Enduring Freedom.
Methods: :
Retrospective, noncomparative, consecutive case series of 157 eyes of 130 United States military soldiers deployed during Operations Iraqi and Enduring Freedom sustaining closed globe injuries to Zones I and II and treated subsequently at Walter Reed Army Medical Center (WRAMC) between 2003 and 2009. Eyes with any open globe injury and closed globe injury to Zone 3 were excluded, except for 3 eyes with closed globe injury to Zone 3 which had peripheral retinal injuries that were considered non-sight threatening but required glaucoma drainage devices. Two-hundred one ocular trauma variables were collected on each injured soldier. Best-corrected visual acuity (BCVA) was categorized using the Ocular Trauma Score (OTS) grading system and was analyzed by comparing initial and six-month post injury BCVA.
Results: :
Closed globe injury to Zones I and II comprised 16.7% (130/780) of all COT. Average patient age was 27.3 years, with an average of 285 days of post-injury follow-up (median, 90 days; range, 4-1493 days). 32 patients (24.6%) confirmed the use of eye protection at the time of injury, whereas 43 (33.1%) patients did not use eye protection. Use of eye protection was unknown in 57 (43.1%) patients. The median presenting visual acuity was 20/20 (range, 20/15 to light perception). Ten eyes presented with hyphema (6.4%). Eight eyes sustained iris damage (5.1%) including 2 iridodialyses, 5 sphincter tears, and 4 with angle recession. Six eyes (3.8%) developed traumatic cataract, and two (1.3%) had dislocated lenses. 3 eyes (1.9%) required early cataract extraction with posterior chamber intraocular lens implantation. 3 eyes (1.9%) required a glaucoma drainage device. 114 patients (87.7%) had associated injuries such as orbital/facial fractures, TBI, and extremity injuries.
Conclusions: :
Closed globe injuries associated with COT generally result in good visual outcomes. Injuries of the cornea, angle and lens account for most of the visual acuity loss in these patients. A majority of patients with closed globe injuries as a result of COT suffer serious associated trauma. More follow-up is needed to determine long-term visual acuity, rates of glaucoma development and cataract formation.
Keywords: trauma • anterior segment