Hyphema in Open-Globe Versus Closed-Globe Injuries in Operation Iraqi Freedom and Enduring Freedom: 2001–2011

Abstract

Introduction The goal of this study is to update the incidence of hyphema in Operation Iraqi (OIF) and Enduring Freedom (OEF). We wanted to assess associated ocular injuries and final visual acuity (VA) in open-globe versus closed-globe injuries with a hyphema. Materials and Methods We performed a retrospective review of the Walter Reed Ocular Trauma Database (WRTOD) to identify U.S. Service members and DoD civilians with hyphema who were evacuated to Walter Reed Army Medical Center between 2001 and 2011. Primary outcome measures were the final VA and differences in concomitant ocular injuries in open-globe hyphema and closed-globe hyphema. Results 168 of 890 eyes (18.9%) in the WROTD had a hyphema. Closed-globe injuries were noted in 64 (38.1%) eyes and open-globe injuries in 104 (61.9%) eyes. A final VA of less than 20/200 was noted in 88 eyes (51.8%). Eyes with hyphema were more likely to have traumatic cataract formation (odds ratio (OR) 6.2, 95% confidence interval (CI) 4.2–9.2, P < 0.001), retinal detachment (OR 4.2, CI 2.8–6.4, P < 0.001), angle recession (OR 8.1, CI 2.9–24.3, P < 0.001), and final VA of less than 20/200 (OR 3.7, CI 2.6–5.4, P < 0.001). Traumatic cataract formation (OR 7.4, CI 2.9–18.7, P < 0.001), retinal detachment (OR 6.1, CI 2.1–17.5, P < 0.001), and a final VA less than 20/200 (OR 6.1, CI 2.4–15.4 P < 0.001) were statistically more likely to occur with an open-globe hyphema than with a closed-globe hyphema. Conclusions Close follow-up in patients with hyphema is important due to the associated development of traumatic cataract and retinal detachment and poor final visual outcome.

Predictors of Long-term Ophthalmic Complications after Closed Globe Injuries Using the IRIS® Registry (Intelligent Research in Sight)

“…A retrospective review of 168 eyes with hyphema (64 from closed globe ocular trauma and 104 from OGI) noted an association with traumatic cataract formation, with 78 eyes ultimately requiring either pars plana lensectomy or phacoemulsification for cataract removal. 6 Another review of 44 patients with traumatic hyphema solely from closed globe ocular trauma described cataract in 20.6% of patients; however, the need for surgical intervention was not included in this study. 43 …”

“…Open globe injuries are generally more severe than closed globe ocular trauma, with longer hospitalizations and worse visual prognosis, 5 and an extensive body of literature has further characterized associated complications such as traumatic hyphema, 6 vitreous hemorrhage, 7 endophthalmitis, 8 traumatic cataract, 9 , 10 and need for additional surgical intervention. 11 Quantitative tools such as the Ocular Trauma Score and the Retinal Detachment after Open Globe Injury Score have been developed to predict visual outcomes and likelihood of retinal detachment (RD) after OGI, respectively.…”

“…While OGIs often portend worse visual outcomes, closed globe ocular trauma is more common and can also result in severe loss of vision, as the force of injury is largely transmitted to the structures of the eye without an opportunity for release. 16 This subsequent compression and expansion of the globe can damage the anterior segment, causing hyphema, 6 , 17 , 18 , 19 injury to the iris–angle 17 , 20 and traumatic cataract, 9 , 21 and the posterior segment, resulting in vitreous hemorrhage, 7 , 22 , 23 retinal hemorrhage, 24 retinal tears and detachments, 25 choroidal injury, 24 and traumatic optic neuropathy. 20 Compared with OGIs, far fewer studies have evaluated closed globe ocular trauma in a systematic fashion, with the existing literature largely confined to military and pediatric populations.…”

Creation of a New Explosive Injury Equipment to Induce a Rabbit Animal Model of Closed Globe Blast Injury via Gas Shock

“…Persistent blood accumulated indicated damage or obstruction to the anterior chamber angle, which could result in the elevation of IOP followed by optic nerve damage, especially in the older patients ( 27 ). Moreover, retrospective study about traumatic hyphema from combat ocular injury recorded in Walter Reed Ocular Trauma Database (WRTOD) demonstrated that traumatic hyphema were highly associated with the traumatic cataract formation, retinal detachment, angle recession, and final VA of <20/200 ( 28 ). Although none of the rabbit model showed cataract, which may come out as observation prolonged.…”

Epidemiology and outcomes of hyphema: a single tertiary centre experience of 180 cases

“…Current strategies focus on prompt evaluation and treatment of complications, particularly rebleeding, but there are no clear indications regarding the duration and frequency of follow‐up, especially in uncomplicated cases. Furthermore, recent studies regarding hyphema have either focused on defined populations (such as children) or were performed internationally (Al Ali, Al Mass & Bener 2012; Soohoo et al 2013; Boese et al 2018; Miller et al 2019; Richards et al 2019; Galvis et al 2020). As such, most large‐scale studies performed in the United States are outdated (Coles 1968; Edwards & Layden 1973; Witteman et al 1985; Thomas, Parrish & Feuer 1986; Kennedy & Brubaker 1988; Spoor et al 1990) and do not reflect current preferred patterns of management.…”