title: Corneal and Corneoscleral Injury in Combat Ocular Trauma from Operations Iraqi Freedom and Enduring Freedom.
abstract: 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.
authors.affiliation: Department of Ophthalmology, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda MD 20889.
authors.forename: Anton
authors.initials: A
authors.lastname: Vlasov
authors.affiliation: Warfighter Refractive Eye Surgery Program and Research Center, Fort Belvoir Community Hospital, 9300 DeWitt Loop, Fort Belvoir, VA 22060.
authors.forename: Denise S
authors.initials: DS
authors.lastname: Ryan
authors.affiliation: Eyecare Associates, 2715 SW Willetta St. Professional Plaza Suite B, Albany, OR 97321.
authors.forename: Spencer
authors.initials: S
authors.lastname: Ludlow
authors.affiliation: Department of Ophthalmology, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda MD 20889.
authors.forename: Andrew
authors.initials: A
authors.lastname: Coggin
authors.affiliation: Retina Group of Washington, 7501 Greenway Center Drive, Greenbelt, MD 20770.
authors.forename: Eric D
authors.initials: ED
authors.lastname: Weichel
authors.affiliation: Department of Ophthalmology, George Washington University, 2150 Pennsylvania Avenue NW, Suite 2B, Washington, DC 20037.
authors.forename: Richard D
authors.initials: RD
authors.lastname: Stutzman
authors.affiliation: The Wilmer Eye Institute, Green Spring Station, Pavilion II, Suite 455, Baltimore, MD 21093.
authors.forename: Kraig S
authors.initials: KS
authors.lastname: Bower
authors.affiliation: Department of Ophthalmology, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda MD 20889.
authors.forename: Marcus H
authors.initials: MH
authors.lastname: Colyer
mesh_terms: D000293:Adolescent; D000328:Adult; D055826:Afghan Campaign 2001-; D015331:Cohort Studies; D003315:Cornea / Q000503:physiopathology*; D005131:Eye Injuries / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology*; D005260:Female; D006801:Humans; D054542:Iraq War, 2003-2011; D008297:Male; D008875:Middle Aged; D008887:Military Medicine / Q000379:methods / Q000706:statistics & numerical data; D012042:Registries / Q000706:statistics & numerical data; D012189:Retrospective Studies; D014792:Visual Acuity; D014947:Wounds and Injuries / Q000150:complications / Q000503:physiopathology / Q000601:surgery