War-related ocular injuries in Damascus during the Syrian Crisis

Hamzeh, Ammar; Ayoub, Rita; Issa, Sameh; Alhalabi, Nawras; Sawaf, Bisher; Mohsen, Fatima; Issa, Hazem; Mohsen, Mohammad Ayham; M, Khattab; Gabriel, Thomas; Aljammal, Mhd Basher; Shibani, Mosa; Alzabibi, Mhd Amin; Ismail, Hlma; Hamzeh, Farah; Almoree, Osama; Al-Moujahed, Ahmad; Saba, Salim C.

doi:10.1016/j.injury.2020.11.069

Cited by 6 publications

(14 citation statements)

References 29 publications

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“…Rupture and contusion were among the three most common types, and both generally involved zone III. However, the location of general eye injuries or CGI from general causes has been most often reported to be in zone I [ 3 , 19 ] or II [ 27 , 29 ], which is in contrast with our results. This comparison shows to some extent that explosion-related eye injuries predominantly involve the posterior segment (zone III) of the eye and are therefore more serious than general eye injuries from general causes.…”

Section: Discussioncontrasting

confidence: 99%

“…This difference is probably related to the fact that our study included data for various causes of explosive injuries and types of eye injuries from mild to heavy, whereas Feng et al [ 36 ] reported exclusively on eyes with severe explosive injuries that required vitrectomy. Additionally, the high proportion of low VA observed in our study [LP - 4/200: 59.22% (initial); 31.26% (final)] as well as in previous reports [LP - hand moving (HM)/ counting fingers (CF): 34.00–56.47% (initial) [ 3 , 4 , 8 , 28 , 37 ]; 18.0–55.6% (final) [ 3 , 4 , 8 , 13 , 28 , 37 ]] should not be ignored. The challenges of eye trauma treatment require increased clinical focus.…”

Section: Discussionsupporting

confidence: 91%

“…In previous reports, this percentage was only 0.61–10.00% for general or firework-related eye injuries [ 4 – 6 , 12 , 21 , 28 , 33 – 36 ], although it was as high as 11.90–34.46% for injuries caused in war or by bomb or mine blasts [ 2 , 8 , 13 , 26 , 37 , 38 ]. The NLP in our study was 13.32% for the presenting VA and 14.56% for the final VA, which was significantly lower than the values provided in previous reports (initial NLP range 18.7–53.1%) [ 3 , 4 , 7 , 8 , 13 , 28 , 37 ] or the final NLP in 14.04–39.00% [ 3 , 4 , 8 , 12 , 28 , 36 , 37 ] of injuries related to firecrackers, bomb or mine explosions, war or weapon use, or OGI. This difference is probably related to the fact that our study included data for various causes of explosive injuries and types of eye injuries from mild to heavy, whereas Feng et al [ 36 ] reported exclusively on eyes with severe explosive injuries that required vitrectomy.…”

Section: Discussioncontrasting

confidence: 86%

“…OGIs were often associated with worse visual prognosis in relation to highly lethal explosives, which is consistent with our comparison of presenting and final VA levels among injury types. And when compared with CGI, the proportion of patients with a final VA < 0.1 was higher [ 3 ] and the mean VA was lower [ 13 ]. We further compared the classification of different ocular trauma mechanisms based on the proportions of patients with VA levels ≤ 4/200, VA reduction and enucleation rates, and inferred the following.…”

Section: Discussionmentioning

confidence: 99%

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Explosive eye injuries: characteristics, traumatic mechanisms, and prognostic factors for poor visual outcomes

Zhang

Kang

et al. 2023

Military Med Res

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Background Explosions can produce blast waves, high-speed medium, thermal radiation, and chemical spatter, leading to complex and compound eye injuries. However, few studies have comprehensively investigated the clinical features of different eye injury types or possible risk factors for poor prognosis. Methods We retrospectively reviewed all consecutive records of explosive eye injuries (1449 eyes in 1115 inpatients) in 14 tertiary referral hospitals in China over 12 years (between January 2008 and December 2019). Data on demographics, eye injury types, ocular findings, treatments, and factors affecting visual prognosis were extracted from a standardized database of eye injuries and statistically analyzed. Results Mechanical ocular trauma accounted for 94.00% of explosion-related eye injuries, among which intraocular foreign bodies (IOFBs) resulted in 55.17% of open globe injuries (OGIs) and contusion caused 60.22% of close globe injuries (CGIs). Proliferative vitreous retinopathy (PVR) was more common in perforating (47.06%) and IOFB (26.84%) than in penetrating (8.79%) injuries, and more common with laceration (24.25%) than rupture (9.22%, P < 0.01). However, no difference was observed between rupture and contusion. Ultimately, 9.59% of eyes were removed and the final vision was ≤ 4/200 in 45.82% of patients. Poor presenting vision [odds ratio (OR) = 5.789], full-thickness laceration of the eyeball ≥ 5 mm (OR = 3.665), vitreous hemorrhage (OR = 3.474), IOFB (OR = 3.510), non-mechanical eye injury (NMEI, OR = 2.622, P < 0.001), rupture (OR = 2.362), traumatic optic neuropathy (OR = 2.102), retinal detachment (RD, OR = 2.033), endophthalmitis (OR = 3.281, P < 0.01), contusion (OR = 1.679), ciliary body detachment (OR = 6.592), zone III OGI (OR = 1.940), and PVR (OR = 1.615, P < 0.05) were significant negative predictors for poor visual outcomes. Conclusions Explosion ocular trauma has complex mechanisms, with multiple eyes involved and poor prognosis. In lethal level I explosion injuries, eyeball rupture is a serious condition, whereas contusion is more likely to improve. In level II injuries, IOFBs are more harmful than penetrating injuries, and level IV represents burn-related eye injuries. PVR is more associated with penetrating mechanisms than with OGI. Identifying the risk predictors for visual prognosis can guide clinicians in the evaluation and treatment of ocular blast injuries.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionsupporting

confidence: 91%

Section: Discussioncontrasting

confidence: 86%

Section: Discussionmentioning

confidence: 99%

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Explosive eye injuries: characteristics, traumatic mechanisms, and prognostic factors for poor visual outcomes

Zhang

Kang

et al. 2023

Military Med Res

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“…This might be explained by the fact that Damascus, unlike other governorates, did not endure any open eld battles, and many of the attacks targeted residential neighborhoods, schools and markets (39). Overall, the similarities between our sample and other studies published from Syrian hospitals (39)(40)(41), and the minimization of presentation delay and selectivity in centers abroad, may have made this study more representative of the full spectrum of war-related brain injuries during the SAC.…”

Section: Discussionmentioning

confidence: 81%

War-related traumatic brain injuries during the Syrian armed conflict in Damascus 2014-2017: a cohort study and a literature review

Hanafi

Munder

AHMAD

et al. 2022

Preprint

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Background: The decade-long Syrian armed conflict killed or injured more than 11% of the Syrian population. Head and neck injuries are the most frequent cause of war-related trauma, about half of which are brain injuries. Reports about Syrian brain trauma victims were published from neighboring countries; However, none are available from Syrian hospitals. This study aims to report war-related traumatic brain injuries from the Syrian capital.Methods: We conducted a retrospective cohort study between 2014 and 2017 at Damascus Hospital, the largest public hospital in Damascus, Syria. Target patients were the victims of combat-related traumatic brain injuries who arrived alive and were admitted to the neurosurgery department or to another department but followed by the neurosurgery team. The collected data included the mechanism, type, and site of injury based on imaging findings; types of invasive interventions; intensive-care unit (ICU) admissions; as well as neurological status at admission and discharge including several severity scales.Results: Our sample consisted of 195 patients; Ninety-six of them were male young adults, in addition to 40 females and 61 children. Injuries were caused by shrapnel in 127 (65%) cases, and by gunshots in the rest, and most of them (91%) were penetrating. Sixty-eight patients (35%) were admitted to the ICU, and 56 (29%) underwent surgery. Neurological impairment was reported in 49 patients (25%) at discharge, and the mortality rate during hospitalization was 33%. Mortality and neurological impairment associated significantly with higher values on clinical and imaging severity scores.Conclusions: This study captured the full spectrum of war-related brain injuries of civilians and armed personnel in Syria without the delay required to transport patients to neighboring countries. Although the clinical presentation of injuries at admission was not as severe as that in previous reports, the inadequate resources (i.e., ventilators and operation rooms) and the lack of previous experience with similar injuries might have resulted in the higher mortality rate. Clinical and imaging severity scales can provide a handy tool in identifying cases with low probability of survival especially with the shortage of personal and physical resources.

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Combat-related ocular injuries in the Israel Defense Forces during the years 2013 to 2019

Shakarchy-Kaminsky

Megreli

Kaminsky

et al. 2021

J Trauma Acute Care Surg

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BACKGROUND:Ocular injuries account for up to 13% of battle injuries, despite the implementation of advanced protective eyewear (PE). The aim of this study was to describe the extent of ocular injuries over the last years among Israel Defense Forces soldiers and to examine the change in PE policy introduced in 2013 and the effect of a high-intensity conflict on ocular injury characteristics. METHODS:This retrospective registry-based analysis derived data from the Israel Defense Forces Trauma Registry and included soldiers who sustained combat-related ocular injuries between the years 2013 and 2019. Demographic data and injury characteristics of casualties, as well as information regarding the use of PE, were collected and analyzed. RESULTS:A total of 2,312 military casualties were available for this study; the incidence of combat-related ocular injuries was 8.9% (n = 113). Ocular injuries occurred among male soldiers (98.2%) with a mean ± SD age of 22.7 ± 4.6 years; mechanism of injury was penetrating in 59.3% of the casualties and blunt in 22.1% of the casualties, ocular injury was isolated in 51.3% of the casualties, and others sustained concomitant injuries including head (32.7%), upper extremity injury (17.7%), lower extremity (15.9%), torso (8.0%), neck (6.2%), and other (5.9%) injuries. Ocular injuries rate was similar among casualties who used PE (11.2%) and those who did not use PE (13.0%) while injured (p = 0.596). Rate of open globe injuries was 9.1% in casualties who used PE and 39.5% (p = 0.002) in casualties who did not. CONCLUSION:Eye protection may significantly reduce ocular injuries severity. Education of the combatants on the use of PE and guidance of medical teams on proper assessment, initial treatment, and rapid evacuation of casualties are needed to improve visual outcomes of the casualties further.

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War-related ocular injuries in Damascus during the Syrian Crisis

Cited by 6 publications

References 29 publications

Explosive eye injuries: characteristics, traumatic mechanisms, and prognostic factors for poor visual outcomes

Explosive eye injuries: characteristics, traumatic mechanisms, and prognostic factors for poor visual outcomes

War-related traumatic brain injuries during the Syrian armed conflict in Damascus 2014-2017: a cohort study and a literature review

Combat-related ocular injuries in the Israel Defense Forces during the years 2013 to 2019

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