Risk Factors for Endophthalmitis and Retinal Detachment with Retained Intraocular Foreign Bodies

Abstract

Purpose. To analyze risk factors for endophthalmitis and retinal detachment (RD) in patients with retained intraocular foreign bodies (IOFBs). Design. A retrospective, interventional, consecutive case series. Participants. All patients treated at Bascom Palmer Eye Institute for traumatic IOFBs between 1999 and 2008. Methods. Analysis of visual outcome, mechanism of injury, management, and postoperative course. Results. 108 eyes with IOFBs were identified. Endophthalmitis occurred in 7 eyes (6.4%) at presentation, and risk was higher with vegetable matter exposure (P = 0.003). All eyes with posterior segment IOFBs received intravitreal antibiotics and there were no cases of endophthalmitis after initial management. RD was identified in 6 of 108 eyes (5.5%) at presentation. Risk factors were entry more than 5 mm behind the limbus (P < 0.001) and posterior segment IOFB (P = 0.028). Postoperative RD occurred in 11 of 102 eyes (10.7%). Risk factors for postoperative RD were preoperative endophthalmitis (P = 0.001), posterior segment IOFB (P = 0.008), and retinal impact sites (P = 0.028). Conclusions. Risk factors for endophthalmitis included vegetable matter exposure and delay to initial management. Risk factors for RD were posterior entry site, posterior segment IOFB, endophthalmitis, and retinal impact sites. No eyes developed endophthalmitis after presentation.

25-Gauge Vitrectomy in Open Eye Injury with Retained Foreign Body

“…Noninfectious toxicity is usually associated with metallic IOFBs. More frequently metal is reported in the cases of IOFBs (60% to 88% of IOFBs) [22, 23] as in our case series. Siderosis and chalcosis produce severe inflammation and sterile endophthalmitis hard to manage, so the timing of IOFB removal is an important risk factor for clinical outcome.…”

Posterior Segment Intraocular Foreign Bodies: The Effect of Weight and Size, Early versus Late Vitrectomy, and Outcomes

“…Metallic IOFBs have been reported in 60% to 91% of open globe injuries. [18][19][20][21] Vast majority of posterior segment IOFBs in this study were metal (90%).…”

“…However, timing of removal is controversial. [2,18,[20][21][22][23][24] The general consensus is that a delay in IOFB removal increases the risk for endophthalmitis. [24][25][26][27][28][29] In contrast to this view, Colyer and colleagues [30] have reported prompt wound closure and systemic antibiotics followed by delayed removal with no reported endophthalmitis.…”

Update on the prevention and treatment of endophthalmitis

“…A series of 108 patients with retained intraocular foreign bodies reported endophthalmitis on presentation in 6.4% [39]. Because of the infrequency of these cases, it may be relatively more difficult to design clinical trials to study this category.…”