To characterize the nature of posterior segment ocular injuries in combat trauma.
Eyes in the Walter Reed Ocular Trauma Database were evaluated for the presence of posterior segment injury. Final visual outcomes in open- versus closed-globe injuries and by zone of injury, and the types of posterior segment injuries in open- versus closed-globe injuries were assessed.
452 of 890 eyes (50.8%) had at least one posterior segment injury. The mechanism of injury was most commonly an improvised explosive device in 280 (62.0%) eyes. 61 (13.5%) patients had a Zone I injury, 50 (11.1%) a Zone II injury and 341 (75.4%) a Zone III injury. Patients with Zone I injuries were more likely to have a final VA of 20/200 or better compared to patients with either a Zone II (p<0.001) or Zone III injury (p=0.007). Eyes with a closed-globe injury were more likely to have a final VA of 20/200 or better compared to those with an open-globe injury (p < 0.001). Further, closed-globe compared to open-globe injury had a lower risk of vitreous hemorrhage (OR 0.32, p < 0.001), proliferative vitreoretinopathy (OR 0.14, p < 0.001), and retinal detachment (OR 0.18, p < 0.001), but higher risk of chorio-retinal rupture (OR 2.82, p < 0.001), and macular hole (OR 3.46, p=0.004).
Patients with combat ophthalmic trauma had similar posterior segment injury patterns to civilian trauma in open- versus closed-globe injuries. Zone II and III injuries were associated with a worse visual prognosis.