Visual Impairment and Dysfunction in Combat-injured Servicemembers With Traumatic Brain Injury
Visual Impairment and Dysfunction in Combat-injured Servicemembers With Traumatic Brain Injury
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DOI：
10.1097/opx.0b013e3181adff2d
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发表时间：
2009-07-01
影响因子：
1.4
通讯作者：
Goodrich, Gregory L.
中科院分区：
文献类型：
--
作者：
Brahm, Karen D.;Wilgenburg, Heidi M.;Goodrich, Gregory L.
目的。本研究的目的是确定患有创伤性脑损伤 (TBI) 的战伤多发伤康复中心 (PRC) 住院患者和多发伤网络站点 (PNS) 门诊军事人员中视力障碍和功能障碍的频率。方法。对 VA Palo Alto 医疗保健系统 68 名患有中度至重度 TBI 的 PRC 住院患者和 124 名患有轻度 TBI 的 PNS 门诊患者的视力筛查数据进行了回顾性分析。结果。 84% 的 PRC 住院患者和 90% 的 PNS 门诊患者患有与爆炸事件相关的 TBI。 PRC 和 PNS 人群中的大多数患者的视力均为 20/60 或更高（77.8% PRC，98.4% PNS）。视觉功能障碍（例如，会聚、调节和动眼神经功能障碍）在 PRC 和 PNS 人群中都很常见。在 PRC 住院患者中，发现视力下降 20/100 至无光感 (13%) 和视野缺损 (32.3%)。在 PNS 门诊人群中，很少发现视力下降 20/100 至无光感 (1.6%) 和视野缺损 (3.2%)。在 PRC 和 PNS 人群中，视野缺损比非急变事件更常与急变事件相关。结论。爆炸事件是战斗受伤军人中与 TBI 相关的最常见的伤害机制。视力研究结果表明，暴露于爆炸而导致轻度 TBI 的作战部队面临视觉功能障碍的风险，而遭受多发伤的作战部队则面临视觉功能障碍和/或视觉障碍的风险。此类损伤的视觉后果需要进一步研究，并支持对所有严重程度的 TBI 进行适当评估和治疗的必要性。 （光学可见科学 2009 年；86：817-825）
Purpose. The purpose of this study was to determine the frequencies of visual impairment and dysfunction among combat-injured Polytrauma Rehabilitation Center (PRC) inpatient and Polytrauma Network Site (PNS) outpatient military personnel with traumatic brain injury (TBI).Methods. A retrospective analysis of data from vision screenings of 68 PRC-inpatients with moderate to severe levels of TBI and 124 PNS-outpatients with mild TBI at the VA Palo Alto Health Care System was conducted.Results. Eighty-four percent of PRC-inpatients and 90% of PNS-outpatients had TBIs associated with a blast event. The majority of patients in both the PRC and PNS populations had visual acuities of 20/60 or better (77.8% PRC, 98.4% PNS). Visual dysfunctions (e.g., convergence, accommodative, and oculomotor dysfunction) were common in both PRC and PNS populations. In the PRC-inpatient population, acuity loss of 20/100 to no light perception (13%) and visual field defects (32.3%) were found. In the PNS-outpatient population, acuity loss of 20/100 to no light perception (1.6%) and visual field defects (3.2%) were infrequently found. In both the PRC and PNS populations, visual field defects were more often associated with blast than non-blast events.Conclusions. Blast events were the most frequent mechanism of injury associated with TBI in combat-injured service-members. The vision findings suggest that combat troops exposed to blast with a resulting mild TBI are at risk for visual dysfunction, and combat troops with polytrauma injuries are at risk for visual dysfunction and/or visual impairment. The visual consequences of such injuries necessitate further study and support the need for appropriate evaluation and treatment in all severities of TBI. (Optom Vis Sci 2009;86:817-825)