Endophthalmitis, Visual Outcomes, and Management Strategies in Eyes with Intraocular Foreign Bodies

Abstract

Purpose Ocular trauma with intraocular foreign body (IOFB) can have devastating visual consequences. Management and antimicrobial strategies remain variable due to the infrequency and heterogeneity of presentation. Our goal was to identify risk factors for endophthalmitis and poor visual outcomes in cases of IOFB and investigate management strategies. Patients and Methods A retrospective chart review was conducted in 88 eyes of 88 patients suffering traumatic injury with IOFB at the University of Michigan between January 2000 and December 2019. Medical records were reviewed to characterize the injuries and IOFBs as well as how clinical presentation and treatment modalities were associated with outcomes. Results Delayed presentation (P=0.016) and organic IOFB (P=0.044) were associated with development of endophthalmitis. Retinal detachment (P=0.012), wound length greater than 5 mm (P=0.041), and poor presenting visual acuity (P=0.003) correlated with poor final visual outcome. Antibiotic prophylaxis was given to all patients, though agents and routes of delivery varied. Endophthalmitis developed in 4.9% of the eyes after initial management, with primary and secondary removal of posterior segment IOFBs associated with similar rates of endophthalmitis (P=1.000). Conclusion Poor presenting visual acuity and severity of injury, as measured by large wound and retinal detachment, correlate with poor visual outcome. Prompt globe closure and antimicrobial prophylaxis are critical for infection prevention. In cases where IOFB removal and globe closure cannot be performed concurrently, primary globe closure with aggressive antibiotic prophylaxis offers a reasonable alternative to prevent endophthalmitis.

Evaluation of the occurrence of endophthalmitis according to the antibiotic prophylaxis treatment in patients with intraocular foreign bodies.

“…Some other studies did not show an increase in the rate of endophthalmitis when appropriate systemic and local antibiotic prophylaxis was used. [22] [21] [23] In the present study all patients received systemic antibiotic prophylaxis. Fluoroquinolone alone or combined with intravenous piperacillin.…”

“…[12] [20] [18] [15]. [21] [22] [23] In addition, most practitioners advocate for a prompt systemic and topical antibiotic therapy. [15] [24] [25] [26] [13] but there is no consensus regarding the performance of treatments using intraocular antibiotics (IOA) such as intravitreal injections (IVIs).…”

Open Globe Injury (OGI) with a Presence of an Intraocular Foreign Body (IOFB)—Epidemiology, Management, and Risk Factors in Long Term Follow-Up

“…Timing of IOFB removal remains a controversy, with inconsistent, often conflicting results [11][12][13][14][15]. As IOFB can present a wide variety of coexisting traumatic wounds and complications, every case is different from the previous one.…”