Causes of combat ocular trauma-related blindness from Operation Iraqi Freedom and Enduring Freedom

Vlasov, Anton; Ryan, Denise S.; Ludlow, Spencer; Weichel, Eric D.; Colyer, Marcus H.

doi:10.1097/ta.0000000000000666

Cited by 38 publications

(18 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The relatively high ER rate (29.5%) in this study was consistent with the literature 7. In a report analysing visual loss in combat ocular trauma, the uppermost type of surgery was reported as enucleation (40.7%) 8…”

Section: Discussionsupporting

confidence: 91%

Surgical rehabilitation of terror-related open globe injuries in the Turkish Military: long-term results

Güven

2020

BMJ Mil Health

View full text Add to dashboard Cite

IntroductionThe purpose of this study is to evaluate the factors affecting multiple surgeries, worse visual outcome, eye removal (ER) and vitrectomy requirement in terror-related open-globe injuries (OGI) in the Turkish Military. Secondary purpose is to specify surgery and injury characteristics of terror-related OGI.MethodsA total of 372 eyes of 251 patients with OGI that occurred during terroristic attacks between January 1996 and January 2016 were included in the study. A retrospective investigation of the preoperative variables associated with further surgeries, visual outcome, vitrectomy requirement and evisceration/enucleation was achieved.ResultsA total of 1118 separate operative sessions with a median of 2 (1–14) surgeries were performed to 372 eyes. Preoperative factors predicting follow-up surgery included visual acuity (VA) <20/200, lens injury, vitreous haemorrhage (VH), presence of vitreous prolapse. Baseline VA <20/200, initial retinal detachment and ruptured globe injury were the independent factors of worse visual result. Ruptured globe injury (p:0.000) and initial vitreous prolapse (p:0.001) were significantly linked to ER surgery. Patients required vitrectomy significantly tend to have VH (p:0.000) and zone 3 injury (p:0.000) compared with non-vitrectomy group. Single surgery cases tend to have significantly better baseline (p:0.000) and final VA (p:0.007) and shorter follow-up period (p:0.000) compared with multiple surgery group.ConclusionsTerror-related OGI necessitate remarkable surgical follow-up and multiple surgery sessions with a relatively higher evisceration/enucleation rate than other types of OGI. A comprehensive surgical approach with multiple surgery types is needed to treat terror-related OGI.

show abstract

Section: Discussionsupporting

confidence: 91%

Surgical rehabilitation of terror-related open globe injuries in the Turkish Military: long-term results

Güven

2020

BMJ Mil Health

View full text Add to dashboard Cite

show abstract

“…Damage to the retina and ON (traumatic optic neuropathy, TON) is associated with worse visual outcomes 1 , 2 . The incidence of TON in US traumatic brain injury (TBI) patients range from 0.5 to 5% 3 , 4 .…”

Section: Introductionmentioning

confidence: 99%

“…The incidence of TON in US traumatic brain injury (TBI) patients range from 0.5 to 5% 3 , 4 . The incidence of TON in the military may be as high as 15%, but rates are confounded by referral bias, additional injuries, and limited information 1 . Nearly 2/3 of the service members with eye injuries also have TBI 5 .…”

Section: Introductionmentioning

confidence: 99%

Antioxidants prevent inflammation and preserve the optic projection and visual function in experimental neurotrauma

et al. 2018

View full text Add to dashboard Cite

We investigated the role of oxidative stress and the inflammasome in trauma-induced axon degeneration and vision loss using a mouse model. The left eyes of male mice were exposed to over-pressure air waves. Wild-type C57Bl/6 mice were fed normal, high-vitamin-E (VitE), ketogenic or ketogenic-control diets. Mice lacking the ability to produce vitamin C (VitC) were maintained on a low-VitC diet. Visual evoked potentials (VEPs) and retinal superoxide levels were measured in vivo. Tissue was collected for biochemical and histological analysis. Injury increased retinal superoxide, decreased SOD2, and increased cleaved caspase-1, IL-1α, IL-1β, and IL-18 levels. Low-VitC exacerbated the changes and the high-VitE diet mitigated them, suggesting that oxidative stress led to the increase in IL-1α and activation of the inflammasome. The injury caused loss of nearly 50% of optic nerve axons at 2 weeks and astrocyte hypertrophy in mice on normal diet, both of which were prevented by the high-VitE diet. The VEP amplitude was decreased after injury in both control-diet and low-VitC mice, but not in the high-VitE-diet mice. The ketogenic diet also prevented the increase in superoxide levels and IL-1α, but had no effect on IL-1β. Despite this, the ketogenic diet preserved optic nerve axons, prevented astrocyte hypertrophy, and preserved the VEP amplitude. These data suggest that oxidative stress induces priming and activation of the inflammasome pathway after neurotrauma of the visual system. Further, blocking the activation of the inflammasome pathway may be an effective post-injury intervention.

show abstract

“…30,31 Injuries to the retina, optic nerve, and brain occur in boxers, civilians (as a result of a variety of mechanisms), and blast-exposed military service members. [30][31][32][33][34][35] The brain and neural retina are connected by the optic nerve, which is composed of the axons of the retinal ganglion cells. The axons of the optic projection are directly affected by trauma and are also a good model for other long axons, which are thought to be particularly susceptible to neurotrauma.…”

Section: Introductionmentioning

confidence: 99%

Rapid Repeat Exposure to Subthreshold Trauma Causes Synergistic Axonal Damage and Functional Deficits in the Visual Pathway in a Mouse Model

Bernardo-Colón

Watkins

Kim

et al. 2019

Journal of Neurotrauma

View full text Add to dashboard Cite

We examined the effect of repeat exposure to a non-damaging insult on central nervous system axons using the optic projection as a model. The optic projection is attractive because its axons are spatially separated from the cell bodies, it is easily accessible, it is composed of long axons, and its function can be measured. We performed closed-system ocular neurotrauma in C57Bl/6 mice using bursts of 15 or 26-psi (pounds per square inch) overpressure air that caused no gross damage. We quantified the visual evoked potential (VEP) and total and degenerative axons in the optic nerve. Repeat exposure to a 15-psi air blast caused more axon damage and vision loss than a single exposure to a 26-psi air blast. However, an increased VEP latency was detected in both groups. Exposure to three 15-psi air blasts separated by 0.5 sec caused 15% axon degeneration at 2 weeks. In contrast, no axon degeneration above sham levels was detected when the interinjury interval was increased to 10 min. Exposure to 15-psi air blasts once a day for 6 consecutive days caused 3% axon degeneration. Therefore, repeat mild trauma within an interinjury interval of 1 min or less causes synergistic axon damage, whereas mild trauma repeated at a longer interinjury interval causes additive, cumulative damage. The synergistic damage may underlie the high incidence of traumatic brain injury and traumatic optic neuropathy in blast-injured service members given that explosive blasts are multiple injury events that occur in a very short time span. This study also supports the use of the VEP as a biomarker for traumatic optic neuropathy.

show abstract

Causes of combat ocular trauma-related blindness from Operation Iraqi Freedom and Enduring Freedom

Abstract: Prognostic/epidemiologic study, level V.

Cited by 38 publications

References 10 publications

Surgical rehabilitation of terror-related open globe injuries in the Turkish Military: long-term results

Surgical rehabilitation of terror-related open globe injuries in the Turkish Military: long-term results

Antioxidants prevent inflammation and preserve the optic projection and visual function in experimental neurotrauma

Rapid Repeat Exposure to Subthreshold Trauma Causes Synergistic Axonal Damage and Functional Deficits in the Visual Pathway in a Mouse Model

Contact Info

Product

Resources

About