TY - JOUR
T1 - Traumatic brain injury associated with combat ocular trauma
AU - Weichel, Eric D.
AU - Colyer, Marcus H.
AU - Bautista, Charisma
AU - Bower, Kraig S.
AU - French, Louis M.
PY - 2009/1
Y1 - 2009/1
N2 - Purpose: To determine the impact of traumatic brain injury (TBI) on visual outcomes in combat ocular trauma (COT) and determine the association between TBI severity and types of ocular injuries. Participants: One hundred fifty-two US casualties sustained 207 globe/oculoplastic combat injuries. Methods: Retrospective, hospital-based cross-sectional study of US service members injured during Operations Iraqi Freedom and Enduring Freedom were treated by the Ophthalmology Service at Walter Reed Army Medical Center and screened for TBI by the Defense and Veterans Brain Injury Center from August 2004 to October 2006. Main Outcome Measures: The main outcome measure was best-corrected visual acuity (BCVA). Secondary outcome measures included the severity and frequency of TBI with globe, oculoplastic, and/or neuro-ophthalmic injury. Results: The frequency of COT with positive TBI screening was 101 of 152 cases (66%) in comparison with negative TBI screening, which was 51 of 152 (34%) cases. The Defense and Veterans Brain Injury Center found TBI with concomitant ocular trauma in 101 of 474 (21%) consecutive casualties. Explosive fragmentary munitions accounted for 79% of TBI-associated COT. The median follow-up was 185 days. Traumatic brain injury severity did not correlate with worse final BCVA (Spearman coefficient, r ≤ 0.12). The odds that BCVA worse than 20/200 was present with TBI was not statistically significant (OR: 1.5; 95% CI, 0.9-2.6; P ≤ .10). The presence of TBI in COT was not associated with worse visual outcome (Mann-Whitney U test, P ≤ .10). Globe injuries were more common than oculoplastic or neuro-ophthalmic injury. Closed-globe injuries were more likely to have TBI than open-globe injuries (OR: 2.17; 95% CI, 1.12-4.21; P ≤ .03). Traumatic brain injury severity associated with COT included mild TBI (31%), moderate TBI (30%), severe TBI (25%), and penetrating TBI (14%). Severe TBI is more frequently associated with COT. Conclusion: Traumatic brain injury occurs in two thirds of all COT and ocular trauma is a common finding in all TBI cases. Closed-globe injuries are at highest risk for TBI while TBI does not appear to lead to poorer visual outcomes. Every patient with COT needs TBI screening. Those service members who are screened TBI positive need a referral to a TBI rehabilitation specialist.
AB - Purpose: To determine the impact of traumatic brain injury (TBI) on visual outcomes in combat ocular trauma (COT) and determine the association between TBI severity and types of ocular injuries. Participants: One hundred fifty-two US casualties sustained 207 globe/oculoplastic combat injuries. Methods: Retrospective, hospital-based cross-sectional study of US service members injured during Operations Iraqi Freedom and Enduring Freedom were treated by the Ophthalmology Service at Walter Reed Army Medical Center and screened for TBI by the Defense and Veterans Brain Injury Center from August 2004 to October 2006. Main Outcome Measures: The main outcome measure was best-corrected visual acuity (BCVA). Secondary outcome measures included the severity and frequency of TBI with globe, oculoplastic, and/or neuro-ophthalmic injury. Results: The frequency of COT with positive TBI screening was 101 of 152 cases (66%) in comparison with negative TBI screening, which was 51 of 152 (34%) cases. The Defense and Veterans Brain Injury Center found TBI with concomitant ocular trauma in 101 of 474 (21%) consecutive casualties. Explosive fragmentary munitions accounted for 79% of TBI-associated COT. The median follow-up was 185 days. Traumatic brain injury severity did not correlate with worse final BCVA (Spearman coefficient, r ≤ 0.12). The odds that BCVA worse than 20/200 was present with TBI was not statistically significant (OR: 1.5; 95% CI, 0.9-2.6; P ≤ .10). The presence of TBI in COT was not associated with worse visual outcome (Mann-Whitney U test, P ≤ .10). Globe injuries were more common than oculoplastic or neuro-ophthalmic injury. Closed-globe injuries were more likely to have TBI than open-globe injuries (OR: 2.17; 95% CI, 1.12-4.21; P ≤ .03). Traumatic brain injury severity associated with COT included mild TBI (31%), moderate TBI (30%), severe TBI (25%), and penetrating TBI (14%). Severe TBI is more frequently associated with COT. Conclusion: Traumatic brain injury occurs in two thirds of all COT and ocular trauma is a common finding in all TBI cases. Closed-globe injuries are at highest risk for TBI while TBI does not appear to lead to poorer visual outcomes. Every patient with COT needs TBI screening. Those service members who are screened TBI positive need a referral to a TBI rehabilitation specialist.
KW - Closed-globe
KW - Ocular trauma
KW - Open-globe
KW - Operation Iraqi Freedom
KW - Traumatic brain injury
UR - http://www.scopus.com/inward/record.url?scp=66849099661&partnerID=8YFLogxK
U2 - 10.1097/HTR.0b013e3181956ffd
DO - 10.1097/HTR.0b013e3181956ffd
M3 - Article
C2 - 19158595
AN - SCOPUS:66849099661
SN - 0885-9701
VL - 24
SP - 41
EP - 50
JO - Journal of Head Trauma Rehabilitation
JF - Journal of Head Trauma Rehabilitation
IS - 1
ER -