Weichel Eric D, Colyer Marcus H, Bautista Charisma, Bower Kraig S, French Louis M
Ophthalmology Service, Walter Reed Army Medical Center, 6900 Georgia Ave, Washington, DC 20307, USA.
J Head Trauma Rehabil. 2009 Jan-Feb;24(1):41-50. doi: 10.1097/HTR.0b013e3181956ffd.
To determine the impact of traumatic brain injury (TBI) on visual outcomes in combat ocular trauma (COT) and determine the association between TBI severity and types of ocular injuries.
One hundred fifty-two US casualties sustained 207 globe/oculoplastic combat injuries.
Retrospective, hospital-based cross-sectional study of US service members injured during Operations Iraqi Freedom and Enduring Freedom were treated by the Ophthalmology Service at Walter Reed Army Medical Center and screened for TBI by the Defense and Veterans Brain Injury Center from August 2004 to October 2006.
The main outcome measure was best-corrected visual acuity (BCVA). Secondary outcome measures included the severity and frequency of TBI with globe, oculoplastic, and/or neuro-ophthalmic injury.
The frequency of COT with positive TBI screening was 101 of 152 cases (66%) in comparison with negative TBI screening, which was 51 of 152 (34%) cases. The Defense and Veterans Brain Injury Center found TBI with concomitant ocular trauma in 101 of 474 (21%) consecutive casualties. Explosive fragmentary munitions accounted for 79% of TBI-associated COT. The median follow-up was 185 days. Traumatic brain injury severity did not correlate with worse final BCVA (Spearman coefficient, r = 0.12). The odds that BCVA worse than 20/200 was present with TBI was not statistically significant (OR: 1.5; 95% CI, 0.9-2.6; P = .10). The presence of TBI in COT was not associated with worse visual outcome (Mann-Whitney U test, P = .10). Globe injuries were more common than oculoplastic or neuro-ophthalmic injury. Closed-globe injuries were more likely to have TBI than open-globe injuries (OR: 2.17; 95% CI, 1.12-4.21; P = .03). Traumatic brain injury severity associated with COT included mild TBI (31%), moderate TBI (30%), severe TBI (25%), and penetrating TBI (14%). Severe TBI is more frequently associated with COT.
Traumatic brain injury occurs in two thirds of all COT and ocular trauma is a common finding in all TBI cases. Closed-globe injuries are at highest risk for TBI while TBI does not appear to lead to poorer visual outcomes. Every patient with COT needs TBI screening. Those service members who are screened TBI positive need a referral to a TBI rehabilitation specialist.
确定创伤性脑损伤（TBI）对战斗性眼外伤（COT）视觉预后的影响，并确定TBI严重程度与眼外伤类型之间的关联。
152名美国伤员遭受了207次眼球/眼整形战斗性损伤。
对2004年8月至2006年10月期间在伊拉克自由行动和持久自由行动中受伤、由沃尔特里德陆军医疗中心眼科进行治疗并由国防和退伍军人脑损伤中心进行TBI筛查的美国军人进行基于医院的回顾性横断面研究。
主要观察指标为最佳矫正视力（BCVA）。次要观察指标包括伴有眼球、眼整形和/或神经眼科损伤的TBI的严重程度和发生率。
与TBI筛查阴性（152例中的51例，占34%）相比，TBI筛查阳性的COT发生率为152例中的101例（占66%）。国防和退伍军人脑损伤中心在474例连续伤员中的101例（占21%）中发现了伴有眼外伤的TBI。爆炸碎片弹药占与TBI相关的COT的79%。中位随访时间为185天。TBI严重程度与最终较差的BCVA无关（Spearman系数，r = 0.12）。TBI患者中BCVA低于20/200的几率无统计学意义（OR：1.5；95%CI，0.9 - 2.6；P = 0.10）。COT中TBI的存在与较差的视觉预后无关（Mann-Whitney U检验，P = 0.10）。眼球损伤比眼整形或神经眼科损伤更常见。闭合性眼球损伤比开放性眼球损伤更易发生TBI（OR：2.17；95%CI，1.12 - 4.21；P = 0.03）。与COT相关的TBI严重程度包括轻度TBI（31%）、中度TBI（30%）、重度TBI（25%）和穿透性TBI（14%）。重度TBI与COT的关联更频繁。
三分之二的COT患者发生TBI，而眼外伤在所有TBI病例中是常见发现。闭合性眼球损伤发生TBI的风险最高，而TBI似乎不会导致更差的视觉预后。每位COT患者都需要进行TBI筛查。那些TBI筛查呈阳性的军人需要转诊至TBI康复专家处。
