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Farhad Safi, Marcus H. Colyer, Michael J. Mines, Michael P. Smith, Dal W. Chun; Characteristics Of Closed Globe Injury to Zones I and II as a Result of Combat Ocular Trauma in Patients Injured During Operations Iraqi and Enduring Freedom. Invest. Ophthalmol. Vis. Sci. 2011;52(14):5588.
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© ARVO (1962-2015); The Authors (2016-present)
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.
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.
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.
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.
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