Posterior Segment Injuries in Operation Iraqi Freedom and Operation Enduring Freedom: 2001-2011

Retina. 2021 May 27. doi: 10.1097/IAE.0000000000003221. Online ahead of print.

Abstract

Objective: To characterize the nature of posterior segment ocular injuries in combat trauma.

Methods: Eyes in the Walter Reed Ocular Trauma Database were evaluated for the presence of posterior segment injury. Final visual outcomes in open- versus closed-globe injuries and by zone of injury, and the types of posterior segment injuries in open- versus closed-globe injuries were assessed.

Results: 452 of 890 eyes (50.8%) had at least one posterior segment injury. The mechanism of injury was most commonly an improvised explosive device in 280 (62.0%) eyes. 61 (13.5%) patients had a Zone I injury, 50 (11.1%) a Zone II injury and 341 (75.4%) a Zone III injury. Patients with Zone I injuries were more likely to have a final VA of 20/200 or better compared to patients with either a Zone II (p<0.001) or Zone III injury (p=0.007). Eyes with a closed-globe injury were more likely to have a final VA of 20/200 or better compared to those with an open-globe injury (p < 0.001). Further, closed-globe compared to open-globe injury had a lower risk of vitreous hemorrhage (OR 0.32, p < 0.001), proliferative vitreoretinopathy (OR 0.14, p < 0.001), and retinal detachment (OR 0.18, p < 0.001), but higher risk of chorio-retinal rupture (OR 2.82, p < 0.001), and macular hole (OR 3.46, p=0.004).

Conclusions: Patients with combat ophthalmic trauma had similar posterior segment injury patterns to civilian trauma in open- versus closed-globe injuries. Zone II and III injuries were associated with a worse visual prognosis.