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S. E. Ludlow, D. W. Chun, E. D. Weichel; Risk Factors for Poor Visual Outcome of Posterior Segment Injuries From Combat Ocular Trauma. Invest. Ophthalmol. Vis. Sci. 2008;49(13):4667.
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© ARVO (1962-2015); The Authors (2016-present)
To determine the prognostic factors leading to poor visual outcome from ocular injuries with posterior segment involvement sustained during Operations Iraqi and Enduring Freedom treated at Walter Reed Army Medical Center from March 2003 to September 2006.
Retrospective consecutive case series of posterior segment injuries following open/closed globe and adnexal trauma of 387 United States military personnel. The primary outcome measure was the final best-corrected visual acuity (BCVA). Each eye was assigned into Group 1 (BCVA better than or equal to 20/200) or Group 2 (BCVA worse than 20/200) and compared. Statistical analysis was performed using SPSS (ver. 15.0) and all primary enucleations were excluded from the results.
Median follow-up was 163 days (range 3-1247). Of the 491 eyes analyzed 226 (46%) had Zone 3 involvement (as defined by The Ocular Trauma Classification Group) of which 114 were closed globe (50%) and 112 were open globe (50%). Posterior segment risk factors associated with final BCVA worse than 20/200 (Group 2) were choroidal hemorrhage involving the macula (odds ratio [OR] = 83.7; 95% confidence interval [CI], 19.8-353.7; P < 0.005), sclopetaria involving the macula (OR = 40.4; 95% CI, 5.23-310.8; P < 0.005), choroidal hemorrhage not involving macula (OR = 35.4; 95% CI, 16.1-77.9; P < 0.005), retinal detachment (OR = 23.3; 95% CI, 12.0-45.3; P < 0.005), subretinal hemorrhage within the macula (OR = 12.2; 95% CI, 6.26-23.9; P < 0.005), retinal tear (OR = 7.98; 95% CI, 4.89-13.0; P < 0.005), penetrating wound in Zone 3 (OR = 7.2; 95% CI 3.8-13.8; P < 0.005), vitreous hemorrhage (OR = 4.7 ; 95% CI, 2.97-7.43; P < 0.005), and traumatic macular hole (OR = 3.9; 95% CI, 1.4-10.5; P = 0.01). When eyes without Zone 3 involvement were excluded, open globe injuries had an increased risk of final BCVA of worse than 20/200 when compared to closed globe injuries (OR = 15.3; 95% CI, 7.59-30.8; P < 0.005).
Choroidal hemorrhage involving the macula is associated with the highest likelihood of poor final visual outcome in combat ocular trauma. Sclopetaria involving the macula, choroidal hemorrhage without involvement of the macula, retinal detachment, and subretinal hemorrhage within the macula are risk factors that significantly increase the likelihood of poor final visual outcome.
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