title: Perforating globe injuries during operation Iraqi Freedom.
abstract: OBJECTIVE
  To report the injury patterns associated with perforating (through-and-through) injuries of the globe and the visual impact of these injuries on patients with combat ocular trauma (COT) seen at Walter Reed Army Medical Center (WRAMC) from March 2003 through October 2006.
  
  
  METHODS
  Retrospective, noncomparative, interventional case series.
  
  
  METHODS
  Sixty-five eyes of 61 United States military soldiers deployed during Operation Iraqi Freedom sustaining perforating globe injuries and treated subsequently at WRAMC.
  
  
  METHODS
  Principal procedures included enucleation and 20-gauge 3-port pars plana vitrectomy with or without intraocular foreign body removal.
  
  
  METHODS
  Final visual acuity and rates of proliferative vitreoretinopathy, enucleation, and endophthalmitis.
  
  
  RESULTS
  Average patient age was 29 years, with an average of 200 days of postinjury follow-up (median, 97 days; range, 4-1023 days). Nineteen patients confirmed the use of eye protection at the time of injury, whereas 25 patients did not use eye protection. The median presenting visual acuity at WRAMC was no light perception (range, no light perception to hand movements). Twenty-five patients underwent primary enucleation, 1 was eviscerated, and 12 patients underwent secondary enucleation within 2 weeks of surgery. Of 19 patients undergoing pars plana vitrectomy, median visual acuity at presentation was light perception and the median final visual acuity was counting fingers, whereas 4 eyes (21%) achieved final visual acuity of better than 20/200, and in 11 (61%) of 17, proliferative vitreoretinopathy developed over a follow-up of at least 6 months. There were no cases of endophthalmitis or sympathetic ophthalmia. Neither mechanism of injury nor timing of surgery correlated with favorable outcomes. However, entry and exit wounds localized to the anterior half of the globe were associated with favorable anatomic outcome (P<0.005, Fisher exact test, 2-tailed) and visual outcome (P = 0.041, Fisher exact test, 2-tailed).
  
  
  CONCLUSIONS
  Perforating globe injuries associated with COT generally result in poor visual and anatomic outcomes despite surgical intervention. Prophylactic measures, such as eye protection, are helpful in reducing the likelihood of perforating injuries; however, novel surgical and pharmacologic therapies will be required to improve the functional and anatomic outcomes of these devastating injuries.
authors.affiliation: Ophthalmology Service, Walter Reed Army Medical Center, Washington, DC, USA.
authors.forename: Marcus H
authors.initials: MH
authors.lastname: Colyer
authors.forename: Dal W
authors.initials: DW
authors.lastname: Chun
authors.forename: Kraig S
authors.initials: KS
authors.lastname: Bower
authors.forename: John S B
authors.initials: JS
authors.lastname: Dick
authors.forename: Eric D
authors.initials: ED
authors.lastname: Weichel
mesh_terms: D000328:Adult; D001753:Blast Injuries / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery; D015353:Eye Enucleation; D017234:Eye Evisceration; D005129:Eye Foreign Bodies / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery; D015807:Eye Injuries, Penetrating / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery; D005500:Follow-Up Studies; D006801:Humans; D054542:Iraq War, 2003-2011; D008297:Male; D008875:Middle Aged; D008889:Military Personnel; D012189:Retrospective Studies; D014481:United States; D014792:Visual Acuity / Q000502:physiology; D014821:Vitrectomy; D014857:Warfare; D055815:Young Adult