Comparing the Management of Eye Injuries by Coalition Military Surgeons during the Iraq and Afghanistan Conflicts
Comparing the Management of Eye Injuries by Coalition Military Surgeons during the Iraq and Afghanistan Conflicts
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DOI：
10.1016/j.ophtha.2019.10.014
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发表时间：
2020-04-01
期刊：
影响因子：
13.7
通讯作者：
Powers, David B.
中科院分区：
文献类型：
--
作者：
Breeze, John;Blanch, Richard J.;Powers, David B.
目的：比较伊拉克和阿富汗冲突中美国和英国军人以及东道国平民的发病率、眼损伤类型和治疗情况，为未来的军事外科训练要求和军事医疗规划提供信息。美国定期部署眼科医生，而英国则不然。设计：美国和英国军事联合战区创伤登记处的回顾性队列研究。参与者：2003 年 3 月至 2011 年 10 月期间在部署的军事治疗设施中接受治疗的所有眼外伤患者。方法：使用剜除或取出内脏和初次开眼修复术作为因变量以及伤员国籍、地点和存在情况，进行调整后的多元逻辑回归模型主要结果指标：眼球摘除（摘除或取出内脏）或开放性眼球损伤初次修复的发生率。结果：67 586 名幸存者（8%）中，有 5,719 名（8%）幸存者或因伤口死亡的人被记录患有眼部损伤。最常见的眼部损伤是无眼内异物的开放性眼球损伤（3201/5719 [56%]）。 5719 名患者中有 1265 名 (22%) 记录了附件损伤（眼睑撕裂和泪道损伤）。东道国平民因开放性损伤而接受内脏摘除或摘除的几率最高（比值比 [OR]，9.23；P < 0.001），但没有证据表明美国和英国军人伤亡之间存在差异（P = 0.38）。眼外科医生的存在（OR，16.3；P < 0.001）显着影响眼球摘除的几率。结论：眼外伤更有可能在美国医疗机构 (MTF) 中得到明确治疗，这反映出大多数部署的英国 MTF 中没有眼科医生。伊拉克和阿富汗冲突以联军空中优势而闻名。未来冲突的形式可能会要求延迟疏散，这可能会对视力结果产生负面影响，特别是如果开放性损伤患者的初步修复被延迟。这项研究提供了证据，支持在部署的联盟机动特遣队中维持专科眼科手术能力以应对未来的冲突。 (C) 2019 年美国眼科学会
Purpose: To compare incidences, ocular injury types, and treatment performed on United States and United Kingdom military service members and host nation civilians within the Iraq and Afghanistan conflicts to inform future military surgical training requirements and military medical planning. The United States routinely deployed ophthalmologists, whereas the United Kingdom did not.Design: Retrospective cohort study of the United States and United Kingdom military Joint Theatre Trauma Registries.Participants: All patients with eye injuries treated at a deployed Military Treatment Facility between March 2003 and October 2011.Methods: An adjusted multiple logistic regression model was performed using enucleation or evisceration and primary open-globe repair as dependent variables and casualty nationality, location, and the presence of an ophthalmic surgeon as independent variables.Main Outcome Measures: Incidence of eye removal (enucleation or evisceration) or primary repair for open globe injury.Results: Five thousand seven hundred nineteen of 67 586 (8%) survivors or those who died of wounds were recorded to have sustained eye injuries. The most common eye injuries were open-globe injury without intraocular foreign body (3201/5719 [56%]). Adnexal injuries (eyelid lacerations and damage to lacrimal apparatus) were recorded in 1265 of 5719 patients (22%). The odds of undergoing evisceration or enucleation for open-globe injury was highest in host nation civilians (odds ratio [OR], 9.23; P < 0.001), but there was no evidence of a difference between United States and United Kingdom military service member casualties (P = 0.38). The presence of an ophthalmic surgeon (OR, 16.3; P < 0.001) significantly affected the odds of eye removal.Conclusions: Eye injuries were more likely to have been treated definitively in United States Medical Treatment Facilities (MTFs), reflecting the absence of ophthalmologists in most deployed United Kingdom MTFs. The Iraq and Afghan conflicts were notable for coalition air dominance; the shape of future conflicts may mandate delays in evacuation, which may affect visual outcomes negatively, particularly if primary repair of patients with open-globe injuries is delayed. This study provides evidence to support the maintenance of specialist ophthalmic surgical competencies in deployed coalition MTFs for future conflicts. (C) 2019 by the American Academy of Ophthalmology