Modern principles of ophthalmic surgery for combat trauma: analysis of experience from the Special Military Operation

Combat ocular trauma presents a complex medical and tactical challenge in modern armed conflicts, it is characterized by a high frequency of combined injuries and requires a specialized system of care. The experience of the Special Military Operation (SMO) provides unique clinical material for analysis and for developing modern surgical principles. This review describes the specific features of combat ocular trauma in the context of the SMO: the predominance of multiple radiolucent orbital foreign bodies, extensive lacrimal drainage system injuries, and a pronounced contusion component. The article systematizes an adaptive model of staged treatment with delayed primary surgical care and rapid evacuation to specialized centers, and demonstrates the effectiveness of a strategy of multistage combined optical reconstructive surgery, including vitrectomy, keratoplasty, and orbital reconstruction. Comparative analysis confirmed global trends (the role of blast injury and the importance of treatment timelines), and identified specific features of the SMO that require adaptation of protocols. The SMO experience confirms the evolution of military field ophthalmic surgery toward early, technology-based, anatomically targeted reconstruction. Integrating Russian experience with international data makes it possible to formulate universal principles of care aimed at maximizing preservation of visual function and improving the quality of life of the wounded. Further development of the rehabilitation system and establishment of national trauma registries are necessary.