Intracerebral bleed, retinal detachment, cataract removal, and intraocular lenses in an Army aviator.

A 54-yr-old U.S. Army Reserve helicopter pilot was evaluated at Brooks AFB, TX for a flying waiver with a history of intracerebral hematoma, superior oblique palsy, rhegmatogenous retinal detachment and bilateral cataract extractions with intraocular lens replacements. The USAF has waivered flyers with category 5 severe head injury (includes intracerebral bleed) in 7 (44%) of 16 cases evaluated and submitted after a 5-yr uneventful observation period, but never with an intracerebral bleed (0 of 3). Flyers with rhegmatogenous retinal detachment have been cleared for a waiver by ophthalmologists in 40 (89%) of 45 cases: the USAF ultimately granted 28 (62%) of the 45 flyers waivers with the others denied for additional diagnoses. Of the 45 detachments, 17 (38%) were asymptomatic and discovered during routine eye evaluation. Increased "G" exposure has not been shown to increase the risk of either retinal detachment or intraocular lens displacement. Of 54 intraocular lenses in the USAF Study Group, 50 (93%) are located in the posterior chamber. Waivers have been granted for 38 (86%) of 44 flyers with intraocular lens replacements; only 3 (7%) of 44 have been denied waivers for ophthalmological complications. The preferred cataract surgery for aviators is extracapsular cataract extraction with placement of a posterior chamber intraocular lens, yielding the best visual results with fewest complications. This pilot was denied waiver recommendation because his neurological observational period had not yet lasted 5 yr, although he would have received a favorable recommendation for his ophthalmological diagnoses.