Vlasov Anton, Ryan Denise S, Ludlow Spencer, Coggin Andrew, Weichel Eric D, Stutzman Richard D, Bower Kraig S, Colyer Marcus H
Department of Ophthalmology, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda MD 20889.
Warfighter Refractive Eye Surgery Program and Research Center, Fort Belvoir Community Hospital, 9300 DeWitt Loop, Fort Belvoir, VA 22060.
Mil Med. 2017 Mar;182(S1):114-119. doi: 10.7205/MILMED-D-16-00041.
To examine the incidence and the etiology of corneal and corneoscleral injuries in the setting of combat ocular trauma, and to determine what effect these injuries have on overall visual impairment from combat ocular trauma.
Retrospective, noncomparative, interventional case series, analyzing U.S. service members who were evacuated to the former Walter Reed Army Medical Center (WRAMC). Primary outcome measures were types of corneal injuries, length of follow-up at WRAMC, globe survival, and anatomical causes of blindness. Secondary outcome measures included surgical procedures performed, use of eye protection, source of injury, and visual outcomes.
Between 2001 and 2011, there were 184 eyes of 134 patients with corneal or corneoscleral injuries. The average age was 26 years (range, 18-50); 99.3% were male, 31.9% had documented use of eye protection. The average follow-up was 428.2 days (3-2,421). There were 98 right-eye and 86 left-eye injuries. There were 169 open-globe and 15 closed-globe injuries with corneal lacerations occurring in 73 eyes with injuries to Zone I. Most injuries were attributable to an intraocular foreign body (IOFB; 48%), followed by penetrating (19.6%) and perforating (16.3%) injuries. The most common presenting visual acuity was hand motion/light perception (45.7%), yet, at the end of the study, visual acuity improved to 20/40 or better (40.8%). The majority of injuries in eyes with visual acuity worse than 20/200 involved the cornea and retina (58%). Injuries solely to the cornea accounted for only 19% of all injuries sustained.
Ocular injuries in military combat have led to significant damage to ocular structures with a wide range of visual outcomes. The authors describe corneal and corneoscleral injuries in combat ocular trauma by classifying injuries by the anatomical site involved and identifying the main source of decreased visual acuity. In combat ocular trauma, corneal or corneoscleral injuries are not the sole etiology for poor vision. A cohesive approach among multiple ophthalmic subspecialties is needed when treating combat ocular trauma.
研究战斗性眼外伤中角膜及角巩膜损伤的发生率和病因，并确定这些损伤对战斗性眼外伤所致整体视力损害的影响。
回顾性、非对照、干预性病例系列研究，分析被疏散至原沃尔特·里德陆军医疗中心（WRAMC）的美国军人。主要观察指标为角膜损伤类型、在WRAMC的随访时间、眼球存活情况及失明的解剖学原因。次要观察指标包括所实施的外科手术、眼部防护用品的使用、损伤来源及视力转归。
2001年至2011年间，134例患者的184只眼发生角膜或角巩膜损伤。平均年龄为26岁（范围18 - 50岁）；99.3%为男性，31.9%有使用眼部防护用品的记录。平均随访时间为428.2天（3 - 2421天）。右眼损伤98例，左眼损伤86例。开放性眼球损伤169例，闭合性眼球损伤15例，73只眼发生角膜裂伤且损伤位于I区。大多数损伤归因于眼内异物（IOFB；48%），其次为穿透伤（19.6%）和穿孔伤（16.3%）。最常见的初始视力为手动/光感（45.7%），然而，在研究结束时，视力提高到20/40或更好（40.8%）。视力低于20/200的眼中，大多数损伤累及角膜和视网膜（58%）。单纯角膜损伤仅占所有损伤的19%。
军事战斗中的眼外伤导致眼结构严重受损，视力转归范围广泛。作者通过按受累解剖部位对损伤进行分类并确定视力下降的主要原因，描述了战斗性眼外伤中的角膜及角巩膜损伤。在战斗性眼外伤中，角膜或角巩膜损伤并非视力不佳的唯一病因。治疗战斗性眼外伤时，多个眼科亚专业需要采取综合治疗方法。
