Intraocular foreign bodies. Factors influencing final visual outcome

Abstract

ABSTRACT.Purpose: To identify the prognostic factors of poor visual outcome (visual acuityAE6/240) in eyes with intraocular foreign bodies. Methods: The records of 95 consecutive patients were retrospectively reviewed for 6 years (1990-1995). All eyes underwent a primary surgical repair and foreign-body removal (electromagnet or vitrectomy). The mean follow-up period was 25 months (6-72 months). Single analysis and multiple logistic stepwise regression analysis were performed to determine predictors of poor vision. Results: Thirty patients (31.6%) showed 6/240 or worse vision at the end of their follow-up period. Three significant predictive factors had independent and combined effects on post-operative visual outcome: a corneo-scleral entry wound (odds ratio (OR)Ω14.5, pΩ0.001), largest diameter of IOFB (ORΩ1.21, pΩ 0.01) and the presence of secondary retinal detachment (ORΩ9.48, pΩ0.0002). Post-operative complications included traumatic cataracts (51%), retinal detachments (28%) and phthisis bulbi (8%).Conclusion: Using multivariate analysis, corneo-scleral entry wound, largest diameter of foreign body and secondary retinal detachment were found to be predictors of poor visual outcome after intraocular foreign body removal. Our results suggest that patients with high-risk intraocular foreign body trauma should be candidates for pars plana vitrectomy rather than electromagnet procedure.

Surveillance of intraocular foreign bodies in the UK

“…Previous studies have reported that 50-54% of IOFBs are work-related injuries, 3,6,9 and hammering is the most common mechanism of injury (71-80% of cases). 7,[10][11][12] In this study, 62% of injuries occurred during paid employment and the mechanism of injury was hammering in 62% and machine tools in 19%.…”

“…This is a similar anatomical distribution to previous studies where posterior segment IOFBs occurred in 59-88% of cases. 3,[6][7][8]11,12 Anterior segment IOFBs are often directly visible and can be removed with forceps or aspiration. Posterior segment IOFBs can be removed by an external (scleral incision and use of an electromagnet over the incision) or internal approach (pars plana vitrectomy and use of internal magnet or forceps).…”

“…[1][2][3][4] IOFBs frequently cause severe visual loss, with 17-42% resulting in final vision worse than 6/60 in the injured eye. [3][4][5][6][7][8] A high percentage (50-54%) of IOFBs were identified as arising from work-related injuries, 3,6,9 and regardless of the environment in which the injury occurred, hammering was the most common mechanism of injury, accounting for 71-80% of such injuries. 7,[10][11][12] In one large American study, only 6% of persons with IOFBs were wearing protective eyewear.…”

“…3,[6][7][8]11,12 There is debate in the literature regarding the best management of posterior segment IOFBs. Some authors favour an initial attempt of magnetic extraction of the material, 11 whereas others prefer posterior vitrectomy with removal of the IOFB using forceps.…”

“…These include large diameter of IOFB, poor visual acuity on presentation, relative afferent pupil defect (RAPD) on presentation, corneoscleral entry wound, uveal prolapse, vitreous haemorrhage, and presence of a secondary retinal detachment. [6][7][8]10,13,14 The study aimed to determine whether the final visual outcome had improved compared to previous reports and whether previously identified prognostic factors remained predictive of a poor outcome.…”