Department of Ophthalmology, Brooke Army Medical Center, San Antonio, Texas; Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland.
Department of Ophthalmology, Walter Reed National Military Medical Center, Bethesda, Maryland.
Ophthalmology. 2018 Nov;125(11):1675-1682. doi: 10.1016/j.ophtha.2018.06.006. Epub 2018 Jul 20.
We update the incidence of intraocular foreign bodies (IOFB) in soldiers admitted to Walter Reed Army Medical Center from 2001 to 2011 after sustaining combat injuries in Operation Iraqi Freedom and Operation Enduring Freedom.
This consecutive retrospective case series included 890 eyes of 652 patients.
Data were collected in the Walter Reed Ocular Trauma Database. Inclusion criteria were any American soldier or Department of Defense civilian with an IOFB injured in Operation Iraqi Freedom/Operation Enduring Freedom. Closed globe injuries with orbital foreign bodies, injury outside of a combat zone, or non-Department of Defense civilian trauma were the exclusion criteria.
Primary outcome measures were final visual outcome and the number, size, and location of IOFBs. Secondary outcome measures included surgical procedures, use of eye protection, associated complications, source of injury and Ocular Trauma Score.
There were 890 eye injuries in 652 patients evacuated to Walter Reed Army Medical Center between 2001 and 2011. IOFBs were found in 166 eyes of 149 patients (18.6%; 95% confidence interval [CI], 16.2%-21.3%). Most patients had a single IOFB (80.7%). An IOFB was positively associated with Ocular Trauma Score grade 1 or 2 (0-65) injuries (odds ratio [OR], 1.58; 95% CI, 1.07-2.38; P = 0.01). There were 130 eyes (78.33%) that had recorded time from initial visual acuity to final visual acuity and it ranged from 8 to 2421 days (mean, 433.24 days). Thirty-eight (25.16%; 95% CI, 18.89%-32.67%) eyes had no change in visual acuity, 98 (64.90%; 95% CI, 57.00%-72.07%) had improved visual acuity, and 15 (9.93%; 95% CI, 6.01%-15.84%) had decreased visual acuity. IOFB was not found to predict final visual acuity of <20/200 in multivariate analysis when other injury features were known (P = 0.1). Pars plana vitrectomy was completed on 124 eyes (74.70%). Removal of IOFB was performed in 118 eyes (71.08%; average of 31.67 days after initial injury) with a delayed procedure occurring after primary closure and antibiotics owing to a lack of surgical capacity in Iraq and Afghanistan. Retinal detachment occurred in 48 eyes (28.92%) and proliferative vitreoretinopathy in 44 eyes (26.5%).
IOFBs occur frequently in combat ocular trauma and are significantly associated with more severe injuries. However, IOFBs were not found to be a significant risk factor for visual acuity of <20/200.
在 2001 年至 2011 年期间，在伊拉克自由行动和持久自由行动中遭受战斗伤害后，更新在沃尔特·里德陆军医疗中心接受治疗的士兵眼内异物（IOFB）的发生率。
这是一项连续的回顾性病例系列研究，共纳入 652 例患者的 890 只眼。
数据收集于沃尔特·里德眼部创伤数据库。纳入标准为任何在伊拉克自由行动/持久自由行动中受伤的美国士兵或国防部平民，伴有 IOFB 的闭合性眼球损伤，眶内异物，损伤部位不在战区或非国防部平民外伤为排除标准。
主要观察指标为最终视力结果以及 IOFB 的数量、大小和位置。次要观察指标包括手术程序、眼部保护的使用、相关并发症、损伤来源和眼部创伤评分。
在 2001 年至 2011 年期间，共有 890 只眼的 652 例患者被送往沃尔特·里德陆军医疗中心。在 149 例患者（18.6%；95%置信区间[CI]，16.2%-21.3%）的 166 只眼中发现 IOFB。大多数患者只有一个 IOFB（80.7%）。IOFB 与眼部创伤评分 1 级或 2 级（0-65）损伤呈正相关（比值比[OR]，1.58；95%CI，1.07-2.38；P=0.01）。有 130 只眼（78.33%）记录了从初始视力到最终视力的时间，范围为 8 至 2421 天（平均 433.24 天）。38 只眼（25.16%；95%CI，18.89%-32.67%）视力无变化，98 只眼（64.90%；95%CI，57.00%-72.07%）视力改善，15 只眼（9.93%；95%CI，6.01%-15.84%）视力下降。当已知其他损伤特征时，IOFB 并未在多变量分析中被发现是预测视力<20/200 的危险因素（P=0.1）。124 只眼（74.70%）行玻璃体切除术。在 118 只眼中（71.08%；平均在初次损伤后 31.67 天）取出 IOFB，由于伊拉克和阿富汗手术能力不足，在初次闭合和使用抗生素后进行延迟手术。发生视网膜脱离 48 只眼（28.92%），发生增殖性玻璃体视网膜病变 44 只眼（26.5%）。
在战斗性眼部创伤中，IOFB 经常发生，与更严重的损伤显著相关。然而，IOFB 并未被发现是视力<20/200 的显著危险因素。
