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Brandon N. Phillips, Dal Chun; Chorioretinal Macular Disruption Following High-Velocity Non-Penetrating Combat Ocular Trauma. Invest. Ophthalmol. Vis. Sci. 2011;52(14):5626.
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To describe the chorioretinal macular findings following high-velocity non-penetrating combat ocular trauma in soldiers injured during Operations Iraqi and Enduring Freedom.
A retrospective chart review from February 2003 to March 2010 of all soldiers with high-velocity non-penetrating ocular injuries with fundus findings of trauma on exam sustained in OEF and OIF was completed. Data collected included age, gender, mechanism of injury, initial and final visual acuity, ocular injuries at initial exam, optical coherence tomography (OCT) and fluorescein angiography (FA) if completed and length of follow-up at Walter Reed Army Medical Center (WRAMC). The location of exam findings were correlated with OCT and FA if available. For eyes with retinal atrophy on OCT, it was classified as inner, outer or full thickness. Subfoveal photoreceptor inner segment/outer segment (IS/OS) junction integrity was determined. Open-globe injuries were excluded.
There were 38 eyes that met the inclusion criteria. 6/38 eyes (15.8%) had only retinal pigment epithelium (RPE) disruption with no atrophy or subfoveal IS/OS disruption on correlating OCT. Visual acuity ranged from 20/15 to 20/25. 1/6 eyes had a history of commotio, 1/6 had choroidal rupture and 1/6 had both. 16/38 eyes (42.1%) had RPE disruption with macular atrophy on correlating OCT. 6/16 eyes (37.5%) with macular atrophy had an intact subfoveal IS/OS junction. Visual acuity ranged from 20/20 to 20/30. 1/6 eyes had a history of commotio, 1/6 had sclopetaria and 1/6 had commotio and choroidal rupture. 10/16 eyes (62.5%) with macular atrophy had disruption of the subfoveal IS/OS junction. Visual acuity ranged from 20/50 to LP. 2/10 eyes had a history of commotio, 3/10 had sclopetaria and 3/10 had both. 11/38 eyes (28.9%) had macular scarring on exam but no correlating OCT. Vision ranged from 20/20 to NLP. Clinical characteristics were similar to those with atrophy on OCT. 9/11 eyes had a history of sclopetaria and 2/11 had commotio and sclopetaria. 4/38 eyes (10.5%) had a macular hole. 1/38 eyes (2.6%) developed phthisis bulbi.
High-velocity non-penetrating ocular trauma resulted in a spectrum of chorioretinal macular disruption. Sclopetaria and commotio injuries occurred frequently. Sclopetaria led to increased incidence of full-thickness macular atrophy and disruption of the subfoveal IS/OS junction. The integrity of the subfoveal IS/OS junction was the most important factor in determining visual potential. Macular holes occurred less frequently.
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