Corps étrangers intraoculaires (CEIO) du segment postérieur : analyse rétrospective et prise en charge à propos de 57 cas

Wang

Journal of Ophthalmology

et al. 2019

Aim. To describe epidemiologic and clinical characteristics and prognostic factors influencing visual outcome after intraocular foreign bodies (IOFBs) injury. Methods. Medical records of 370 patients (373 eyes) with IOFBs were reviewed to identify the factors influencing visual acuity by univariate and multivariate analyses. Results. The majority of patients (97.0%) were men, with a mean age of 38.1 years. The most common cause of ocular injury was hammering (52.6%); magnetic IOFBs occurred in 84.7% of these cases. Factors associated with poor visual outcome (defined as <1.3 logMAR) included the following: age ≥50 years (P=0.046); worse presenting visual acuity (P<0.001); complications of retinal breaks (P=0.006) and endophthalmitis (P=0.032); vitrectomy (P=0.035); and intraocular C3F8 gas tamponade (P=0.038). Excellent visual outcome (defined as ≥0.5 logMAR) was associated with age <50 years (P=0.003); better presenting visual acuity (PVA) (P<0.001); wound length <4 mm (P=0.005); absence of vitreous hemorrhage (P=0.026) and retinal breaks (P<0.001); nonvitrectomy surgery (P=0.043); and use of balanced saline (P=0.029). Conclusions. Multiple prognostic factors were identified that may predict visual outcome and globe survival after IOFBs injury. Age, initial presenting visual acuity, wound length, complications (vitreous hemorrhage, retinal breaks, and endophthalmitis), surgical approach, and intraocular tamponade were significant predictors of visual outcome.

Section: Discussionsupporting

confidence: 91%

Intraocular Foreign Bodies: Clinical Characteristics and Prognostic Factors Influencing Visual Outcome and Globe Survival in 373 Eyes

Wang

Journal of Ophthalmology

et al. 2019

“…This is a rather late surgery [13], even if with some tangible advantages: the intraoperative conditions start to resemble those of an elective vitrectomy, placing the surgeon in a more comfortable situation in terms of the intraoperative challenges. However, retinal detachment may already have occurred [9] and PVR started, and the risk of postoperative complications is also increased.…”

Section: Open-globe Traumamentioning

confidence: 99%

The Timing of Reconstruction in Severe Mechanical Trauma

Kuhn

2013

Ophthalmic Res

Serious ocular trauma involving the posterior segment remains rather common and, despite many technological advances in recent years, continues to represent a significant management challenge to the ophthalmologist. One of these challenges is to identify the most optimal timing for the ultimate reconstruction, namely vitrectomy. While it is fairly obvious that suture-closure of the wound of open-globe injuries should be done as soon as possible, it is less clear whether vitrectomy should be performed in the same surgical session (primary comprehensive reconstruction) or be deferred (staged approach), and if so for how long. In this review, 4 options for staging are offered: early (days 2-4); delayed (days 5-7); late (days 8-14), and very late (past 2 weeks). The earlier the vitrectomy, the higher the risk of intraoperative complications. Conversely, the later the vitrectomy, the higher the incidence and severity of postoperative complications, of which proliferative vitreoretinopathy is the most damaging.

Journal of Ophthalmology

“…There was no significant association between entry site and visual prognosis. In contrast, an earlier study reported better visual prognosis with a scleral or corneoscleral entry site than a corneal site [ 19 ].…”

Section: Discussionmentioning

confidence: 87%

“…We found a significant association with iris traumas, which was not identified in previous studies due to low incidence limiting statistical power [ 1 , 9 , 13 , 14 ]. Retinal detachment at presentation is also associated with poor visual outcome with development of PVR [ 8 – 10 , 19 , 21 ]. In this study, this did not reach statistical significance ( p = 0.08), but the extent of retinal detachment could differ between outcome groups.…”

Section: Discussionmentioning

confidence: 99%

Clinical Characteristics and Prognostic Factors of Posterior Segment Intraocular Foreign Body: Canadian Experience from a Tertiary University Hospital in Quebec

Rozon

Lavertu

Hébert

et al. 2021

Purpose. To identify predictive factors for visual outcomes of patients presenting with a posterior segment intraocular foreign body (IOFB). Methods. A retrospective chart review was performed for all consecutive patients operated for posterior segment IOFB removal between January 2009 and December 2018. Data were collected for patient demographics, clinical characteristics at presentation, IOFB characteristics, surgical procedures, and postoperative outcomes. A multiple logistic regression model was built for poor final visual acuity (VA) as an outcome (defined as final VA 50 letters or worse [Snellen equivalent: 20/100]). Results. Fifty-four patients were included in our study. Ninety-three percent of patients were men, with a mean age of 40.4 ± 12.6 years. Metallic IOFB comprised 88% of cases with a mean ± standard deviation (SD) size of 5.31 ± 4.62 mm. VA improved in 70% of patients after IOFB removal. Predictive factors for poor VA outcome included poor baseline VA, larger IOFB size, high number of additional diagnoses, an anterior chamber extraction, a second intervention, the use of C3F8 or silicone tamponade, and the presence of vitreous hemorrhage, hyphema, and iris damage. Predictive factors for a better visual outcome included first intention intraocular lens (IOL) implantation and the use of air tamponade. In the multiple logistic regression model, both baseline VA ( p = 0.009) and number of additional complications ( p = 0.01) were independent risk factors for a poor final VA. Conclusions. A high number of concomitant complications and poor baseline VA following posterior segment IOFB were significant predictive factors of poor visual outcome.