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BACKGROUND: Ocular and ocular adnexal injuries, both combat-related and accidental, are common during wartime. In a combat setting, the eye is particularly vulnerable to serious injury from tiny flying particles that might minimally affect other parts of the body. The purpose of this study is to examine the incidence of serious ocular and ocular adnexal injuries that occurred during Operations Desert Shield and Desert Storm. METHODS: The authors retrospectively reviewed serious ocular and ocular adnexal injuries treated by United States Army and Navy ophthalmologists that occurred during Operations Desert Shield and Desert Storm. Only those injuries that resulted in, or would have resulted in, hospital admission because of the ocular or ocular adnexal injury alone are presented. RESULTS: During Desert Shield, 20 patients (23 eyes) suffered serious ocular or ocular adnexal injuries compared with 160 patients (198 eyes) in Desert Storm. During Desert Storm, 78% of all serious injuries were caused by blast fragmentation from munitions. More than one third of the 98 globe lacerations reported in this article were 10 mm or less in size. Of 35 enucleations performed during Desert Storm, 94% were the result of munitions fragments. CONCLUSIONS: During Operation Desert Storm, fragmentation wounds from munitions were the most common cause of ocular and ocular adnexal morbidity. The authors' findings indicate that polycarbonate ballistic protective eyewear could have prevented many of the ocular injuries that they report.

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A young male with intraocular foreign body (IOFB) and clear media had successful removal of the IOFB but sustained macular damage and permanent loss of vision secondary to operating microscope phototoxicity. Light damage to the eye can be thermal, mechanical, or photochemical and is dependent on source and wavelength of light, filters, and host factors. Removal of IOFB is important, but surgeons must be aware of potential light damage to the macula in lengthy surgical procedures and take appropriate precautions.

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In a prospective evaluation of 154 consecutive retinal detachment procedures, the incidence of choroidal detachment was 39.6%. The age of the patient, drainage of subretinal fluid, and vortex compression by the explant seem to be the most important correlative factors. Scleral explants up to one quadrant in circumferential length produced a minimal incidence (7.7%) of choroidal detachment. Posterior positioning of the explant also affected the incidence of choroidal detachment. After follow-up, ranging from six to 48 months, postoperative visual acuity was recorded for "macula-on" as well as "macula-off" retinal detachments. In the macula-on group, 78.6% of the patients with choroidal detachment retained a visual acuity of 20/50 or better compared with 82.8% of the patients without choroidal detachment. In the macula-off group, 43.2% of the patients with choroidal detachment achieved a visual acuity of 20/50 or better compared with 55.1% of the patients without choroidal detachment. The final anatomic success rate was 86.5% for eyes with choroidal detachment and 92.3% for eyes without choroidal detachment.

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Aqueous levels of topically applied vidarabine monophosphate, trifluridine, and acyclovir were determined following topical administration in patients with normal corneas prior to cataract extraction. Meager levels in aqueous were found for vidarabine monophosphate, and none for trifluridine. Substantial levels of acyclovir were detected that were well within the therapeutic range of herpes simplex susceptibility.

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In a rural mountain setting 20 patients with blinding ocular opacities were treated surgically with modern vitrectomy techniques. There were no intraoperative or postoperative complications unique to the isolated environment. Because of its compact portability, the VISC X proved to be an ideal vitrectomy instrument. In addition to plastic lid procedures, cataract extraction, and strabismus surgery, repair of retinal detachment and vitrectomy in selected cases has been added to the armamentarium of surgeons who are seriously involved in exporting ophthalmology to remote places.

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Optic nerve hypoplasia is an uncommon congenital defect of the optic nerve and retina, although recent studies show it occurs more frequently than previously thought. It is characterized by a small, pale optic disc, normal appearing retinal vasculature, and marked visual impairment. This condition may be unilateral or bilateral and familial cases have been described. It may be associated with other defects of the central nervous system but also occurs in otherwise normal individuals. It is different from aplasia of the optic nerve in which there is complete absence of the optic disc and retinal vasculature, usually in a badly malformed eye. The purpose of this communication is to describe the clinical and fluorescent appearance of an infant with bilateral optic nerve hypoplasia and the unilateral abnormality of retinal vessels.

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A 47-year-old woman with a diagnosis of myelogenous leukemia presented with poor vision secondary to bilateral exudative retinal detachments. Chemotherapy improved her leukemia status and her vision improved but her retinal pigment epithelium became diffusely mottled and irregular, presumably because of a toxic effect from the exudative subretinal fluid. Clinical and fluorescein findings are presented.

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Retrolental fibroplasia is more accurately referred to as retinopathy of prematurity. Host factors most clearly incriminated are the maturity of the infant and the time in oxygen therapy. A continuum of retinopathy ranges from abnormal arborization of terminal retinal vessels to a detached retina incorporated in a cicatrix behind the lens. Every high-risk infant should be examined by indirect ophthalmoscopy prior to discharge from the nursery. A thorough knowledge of the natural course of the disease is essential because many cases will resolve spontaneously.

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To remove preretinal blood from the posterior pole, balanced salt solution is irrigated into the eye through a 21-gauge needle. The needle previously used for infusion is used as a port of exit. I have treated seven patients with this method without harmful effects.

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Fourteen eyes of 12 infants with acute retrolental fibroplasia were treated with cryotherapy. In only one or possibly two cases was treatment considered to be of positive value. Treatment in the remaining 12 cases was either ineffective or deleterlous. Surgical treatment is rarely, if ever, indicated and spontaneous resolution of retinopathic changes is still the most common course of the natural history of the disease. The role of the ophthalmologist in the perinatal intensive care nursery remains one of advisor to pediatricians and informant to parents of affected children.

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Reticular dystrophy of the retinal pigment epithelium is characterized by a posterior pattern of pigment clumping like a "fishnet with knots." Four patients in three successive generations were seen with typical reticular dystrophy. A fifth patient had abnormal dark adaptation. In this family reticular dystrophy was characterized by the typical reticular pigmentary pattern, good visual acuity, normal electroretinographic findings, abnormal electro-oculographic findings, and abnormal dark adaptation. The pedigree indicates autosomal dominance as the inheritance pattern.

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