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Introduction: Currently ocular combat injuries are complex and associated with poor visual outcomes. Our objective is to characterize the military population that suffer land mine combat ocular trauma in Colombia and indentify the type of wound, treatment and visual outcomes.

Methods: Retrospectively review of medical history of soldiers evaluated in Pablo Tobon Uribe Hospital, whom had land mine trauma during January of 2004 and December 2012.

Results: 635 soldiers had land mine trauma, 153 of them had ocular trauma (226 eyes).  Open ocular trauma was observed in 29.6%. The Ocular Trauma Score was calculated in 183 eyes, the initial visual acuity was not possible to be reported in the rest of them; the 45% of the eyes were classified in category 3. Three patients had no light perception in both eyes. 97.3% of the eyes received medical treatment and 49.1% had surgery also. Primary evisceration was made in 5.8% and enucleation in 1.8%. Intraocular foreign body was observed by ultrasonography in 11.1% and in 5.8% by orbital tomography. Eleven patients were legally blind at discharge.

Conclusions: The ocular trauma related to a landmine is highly destructive at an ocular level.  The treatments associated with better visual outcomes are primary closure of globe and systemic antibiotics; although the characteristics of the wound itself are the main prognostic factor. The Ocular trauma score is a useful tool for determining visual outcome in combat ocular trauma.

 

Liliana Moreno, Universidad Pontificia Bolivariana y Hospital Pablo Tobon Uribe

Residente de oftalmología Universidad Pontificia Bolivariana

Luis Fernando Velasquez, Universidad Pontificia Bolivariana y Hospital Pablo Tobon Uribe

Residente de oftalmología Universidad Pontificia Bolivariana

Carlos Alberto Restrepo, Universidad Pontificia Bolivariana y Hospital Pablo Tobon Uribe

Oftalmólogo cirujano, jefe del departamento de oftalmología Hospital Pablo Tobón Uribe

Jose David Paulo, Universidad Pontificia Bolivariana y Hospital Pablo Tobon Uribe

Oftalmólogo cirujano, glaucomatólogo Hospital Pablo Tobón Uribe; profesor de post-grado Universidad Pontificia Bolivariana

Jorge Hernando Donado, Universidad Pontificia Bolivariana y Hospital Pablo Tobon Uribe

Medico cirujano, Msc epidemiología, jefe de investigaciones Universidad Pontificia Bolivariana y Hospital Pablo Tobón Uribe

Marta Lucía Muñoz, Universidad Pontificia Bolivariana

Oftalmóloga cirujana, neuro-oftalmóloga profesora post-grado Universidad Pontificia Bolivariana

John Jairo Aristizabal, Universidad Pontificia Bolivariana

Oftalmólogo cirujano profesor post-grado Universidad Pontificia Bolivariana

Weichel ED, Colyer MH. Combat ocular trauma and systemic injury. Curr Opin Ophthalmol. 2008 Nov,19(6):519–25 DOI: https://doi.org/10.1097/ICU.0b013e3283140e98

Weichel ED, Colyer MH, Ludlow SE, Bower KS, Eiseman AS. Combat ocular trauma visual outcomes during operations iraqi and enduring freedom. Ophthalmology. 2008 Dec;115(12):2235–45 DOI: https://doi.org/10.1016/j.ophtha.2008.08.033

Colyer MH, Chun DW, Bower KS, Dick JSB, Weichel ED. Perforating globe injuries during operation Iraqi Freedom. Ophthalmology. 2008 Nov;115(11):2087–93 DOI: https://doi.org/10.1016/j.ophtha.2008.05.013

Kuhn F, Maisiak R, Mann L, Mester V, Morris R, Witherspoon CD. The Ocular Trauma Score (OTS). Ophthalmol Clin North Am. 2002 Jun;15(2):163–5, vi DOI: https://doi.org/10.1016/S0896-1549(02)00007-X

Schmidt GW, Broman a T, Hindman HB, Grant MP. Vision survival after open globe injury predicted by classification and regression tree analysis. Ophthalmology. 2008 Jan;115(1):202–9 DOI: https://doi.org/10.1016/j.ophtha.2007.04.008

Abrames E, Folio L. CT severity spectrum of penetrating eye injuries from blasts. Mil Med. 2012 Feb;177(2):169–73 DOI: https://doi.org/10.7205/MILMED-D-11-00118

Kuhn F, Morris R, Witherspoon CD. Birmingham Eye Trauma Terminology (BETT): terminology and classification of mechanical eye injuries. Ophthalmol Clin North Am. 2002 Jun;15(2):139–43, v DOI: https://doi.org/10.1016/S0896-1549(02)00004-4

Lima-Gómez V, Razo Blanco-Hernández DM R-DJ. Ocular trauma score para la evaluación inicial del trauma ocular. Cir Cir. 2010;78(3):209–13

Restrepo AC, Lópe JA. Clinical and microbiological profiles of anti-personnel mine injuries in the Medellín area of northwestern Colombia. Biomédica. 2010;30(3):338–44 DOI: https://doi.org/10.7705/biomedica.v30i3.267

Vicipresidencia de la República (Colombia). Situación por MAP y MUSE. Colombia: Derechos Humanos y DIH; 2008. Available from: http://www.derechoshumanos.gov.co/Prensa/destacados/documents/2010/eventos.pdf

Barak A, Elhalel A, Pikkel J, Krauss E, Miller B. Incidence and severity of ocular and adnexal injuries during the Second Lebanon War among Israeli soldiers and civilians. Graefes Arch Clin Exp Ophthalmol. 2011 Dec;249(12):1771–4 DOI: https://doi.org/10.1007/s00417-011-1659-z

Janković S, Zuljan I, Sapunar D, Buća A, Plestina-Borjan I. Clinical and radiological management of wartime eye and orbit injuries. Mil Med.; 1998 Jun;163(6):423–6 DOI: https://doi.org/10.1093/milmed/163.6.423

Nguyen QD, Kruger EF, Kim AJ, Lashkari MH, Lashkari K. Combat eye trauma: intraocular foreign body injuries during the Iran-Iraq war (1980-1988). Int Ophthalmol Clin. 2002 Jan;42(3):167–77 DOI: https://doi.org/10.1097/00004397-200207000-00018

Plestina-Borjan I, Medvidovic-Grubisic M, Zuljan I, Lakos V, Miljak S, Markovic I, et al. Wartime open globe eye injuries. Graefes Arch Clin Exp Ophthalmo. 2010 Mar;248(3):305–12 DOI: https://doi.org/10.1007/s00417-009-1172-9

Sobaci G, Mutlu FM, Bayer a, Karagül S, Yildirim E. Deadly weapon-related open-globe injuries: outcome assessment by the ocular trauma classification system. Am J Ophthalmol. 2000 Jan;129(1):47–53 DOI: https://doi.org/10.1016/S0002-9394(99)00254-8

Sobaci G, Akýn T, Mutlu FM, Karagül S, Bayraktar MZ. Terror-related open-globe injuries: a 10-year review. Am J Ophthalmol. 2005 May;139(5):937–9 DOI: https://doi.org/10.1016/j.ajo.2004.11.009

Coupland RM, Korver a. Injuries from antipersonnel mines: the experience of the International Committee of the Red Cross. BMJ. 1991 Dec 14;303(6816):1509–12 DOI: https://doi.org/10.1136/bmj.303.6816.1509

Colyer MH, Weber ED, Weichel ED, Dick JSB, Bower KS, Ward TP, et al. Delayed intraocular foreign body removal without endophthalmitis during Operations Iraqi Freedom and Enduring Freedom. Ophthalmology. 2007 Aug;114(8):1439–47 DOI: https://doi.org/10.1016/j.ophtha.2006.10.052

Thach AB, Ward TP, Dick JSB, Bauman WC, Madigan WP, Goff MJ, et al. Intraocular foreign body injuries during Operation Iraqi Freedom. Ophthalmology. 2005 Oct;112(10):1829–33 DOI: https://doi.org/10.1016/j.ophtha.2005.04.024

Ehlers JP, Kunimoto DY, Ittoop S, Maguire JI, Ho AC, Regillo CD. Metallic intraocular foreign bodies: characteristics, interventions, and prognostic factors for visual outcome and globe survival. Am J Ophthalmol. 2008 Sep;146(3):427–33 DOI: https://doi.org/10.1016/j.ajo.2008.05.021

Sobaci G, Akin T, Erdem U, Uysal Y, Karagül S. Ocular trauma score in deadly weapon-related open-globe injuries. Am J Ophthalmol. 2006 Apr;141(4):760–1 DOI: https://doi.org/10.1016/j.ajo.2005.11.002

Parke DW, Pathengay A, Flynn HW, Albini T, Schwartz SG. Risk factors for endophthalmitis and retinal detachment with retained intraocular foreign bodies. J Ophthalmol. 2012 Jan;2012:758526 DOI: https://doi.org/10.1155/2012/758526

Savar A, Andreoli MT, Kloek CE, Andreoli CM. Enucleation for open globe injury. Am J Ophthalmol. 2009 Apr;147(4):595–600.e1. DOI: https://doi.org/10.1016/j.ajo.2008.10.017

Moreno, L., Velasquez, L. F., Restrepo, C. A., Paulo, J. D., Donado, J. H., Muñoz, M. L., & Aristizabal, J. J. (2013). Ocular trauma from land mines among soldiers treated at a University Hospital in Medellín, Colombia. Colombia Medica, 44(4), 218–223. https://doi.org/10.25100/cm.v44i4.1356

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