Harris Justin P, Justin Grant A, Brooks Daniel I, Woreta Fasika A, Agrawal Rupesh V, Ryan Denise S, Weichel Eric D, Colyer Marcus H
Department of Ophthalmology, Brooke Army Medical Center, San Antonio, TX, USA.
Department of Surgery, Uniformed Services University of the Health Science, Bethesda, MD, USA.
Acta Ophthalmol. 2021 Dec;99(8):904-908. doi: 10.1111/aos.14790. Epub 2021 Feb 10.
To determine the rates and types of open-globe wounds in soldiers admitted to Walter Reed Army Medical Center from 2001 to 2011 after sustaining combat injuries.
Data were collected in the Walter Reed Ocular Trauma Database. Inclusion criteria were patients who suffered open-globe injuries. Open-globe injuries were classified by type of wound: corneal, corneo-scleral or scleral, or type of open-globe injury: perforating, rupture, penetrating or intraocular foreign body. The primary analysis assessed the effect on final visual acuity (VA) and the risk of enucleation.
In this study, 285 (32.02%) open-globe injuries were recorded in 890 eyes in the data set. Corneal wounds were noted in 127 (44.56%) eyes, corneo-scleral wounds in 78 (27.37%) and scleral wounds in 129 (45.26%) eyes. The involvement of both the corneal and sclera was associated with poorer visual outcome (BCVA < 20/200) compared to injuries with an injury confined to either the cornea or scleral alone (p = 0.038). At a wound length of greater than approximately 14 mm, patients had 75% chance of having a poor final VA. Enucleation was performed in 64 (22.46%) eyes of patients with wounds. The type of wound was not found to be predictive of enucleation in multivariate analysis, but rather the type of open-globe injury was predictive. Perforating (OR: 1.58, 95% CI: 1.43-1.72) and globe rupture injuries (OR: 1.49, 95% CI: 1.33-1.66) were more likely to undergo enucleation.
Open-globe injuries occur frequently in combat ocular trauma. Poor final VA was noted most with corneo-scleral wounds with approximately 50% of patients having a final VA less than 20/200.
确定2001年至2011年期间因战斗受伤而入住沃尔特里德陆军医疗中心的士兵开放性眼球损伤的发生率和类型。
从沃尔特里德眼外伤数据库收集数据。纳入标准为遭受开放性眼球损伤的患者。开放性眼球损伤按伤口类型分类：角膜、角巩膜或巩膜，或按开放性眼球损伤类型分类：穿孔、破裂、穿透或眼内异物。主要分析评估对最终视力（VA）的影响和眼球摘除的风险。
在本研究中，数据集中890只眼中记录了285例（32.02%）开放性眼球损伤。角膜伤口见于127只眼（44.56%），角巩膜伤口见于78只眼（27.37%），巩膜伤口见于129只眼（45.26%）。与仅局限于角膜或巩膜的损伤相比，角膜和巩膜均受累与较差的视觉预后（最佳矫正视力<20/200）相关（p = 0.038）。当伤口长度大于约14毫米时，患者最终视力差的几率为75%。64只眼（22.46%）的患者接受了眼球摘除术。在多变量分析中，未发现伤口类型可预测眼球摘除，但开放性眼球损伤类型可预测。穿孔伤（比值比：1.58，95%置信区间：1.43 - 1.72）和眼球破裂伤（比值比：1.49，95%置信区间：1.33 - 1.66）更有可能接受眼球摘除术。
开放性眼球损伤在战斗性眼外伤中频繁发生。角巩膜伤口的最终视力最差，约50%的患者最终视力低于20/200。
