Surgical outcomes of the removal of posterior segment metallic intraocular foreign bodies

Abstract

Background: Posterior segment metallic intraocular foreign bodies (IOFBs) are a leading cause of visual morbidity and blindness, especially among young and middle-aged working populations. Here, we aimed to evaluate the surgical outcomes of the removal of such IOFBs that result from injuries. Methods: In this retrospective study, 39 patients injured by metallic posterior segment IOFBs and who underwent primary repair procedures, vitrectomies, and IOFBs removal with or without procedures for traumatic cataract removal, scleral buckling and intraoperative tamponade application from January, 2008 to January, 2019. We analyzed the preoperative, intraoperative and postoperative related factors that affect the final visual outcomes. Results: The mean age of the 39 patients was 40.51 ± 12.48 years with the male being predominent (100%).The mean preoperative vision measured 1.50 [Snellen Equivalent (SE), 20/645] ± 1.12 logMAR with the mean final vision measuring 0.93 (SE, 20/172) ± 1.09 logMAR. The related factors that were determined to affect the final visual outcomes included preoperative vision (P = 0.025), IOFB-related macula injuries (P = 0.001) and the development of postoperative complications (P = 0.005) especially retinal detachment (P = 0.002) with the mean final vision measuring 2.12 (SE, counting finger to hand motion) ±1.23 logMAR. Concerning the preoperative signs, the patients with preoperative endophthalmitis also obtained poor mean final vision measuring 1.30 (SE,20/400) ± 1.40 logMAR. Conclusion: IOFB-related macula injuries and postoperative retinal detachment were important related factors of poor final visual prognoses in cases involving posterior segment metallic IOFBs. Removing IOFB as early as possible may prevent preoperative endophthalmitis which could lead poor final visions even without significance.

Outcomes and Prognostic Factors Following Pars Plana Vitrectomy for Intraocular Foreign Bodies—11-Year Retrospective Analysis in a Tertiary Care Center

“…Young men are more exposed to eye injuries due to the fact that they carry out more risky activities in this regard. The most common factors associated with the production of eye injuries were not wearing goggles and metal hammering [ 1 , 6 , 9 , 14 , 15 , 16 , 18 , 19 , 20 , 22 , 27 , 28 ]. In our case series, none of the subjects wore goggles, which is why we strongly support their crucial role in preventing eye damage.…”

“…Initial poor BCVA was correlated with a poor prognosis throughout our study ( p = 0.018). Previous research indicated that poor BCVA at presentation is a major risk factor for poor visual outcome, mainly because it reflects a higher degree of ocular damage at presentation [ 13 , 14 , 15 , 22 , 26 ]. In contrast, some authors did not find initial BCVA to be correlated with a poor visual prognosis, mentioning that vitreous hemorrhage or traumatic cataract, which can significantly affect initial BCVA, can be successfully resolved by surgery without impacting final BCVA [ 9 , 20 , 27 ].…”

“…Regarding the size of IOFBs, some authors indicated that IOFBs ≥3mm are an important independent risk factor for poor visual outcome, suggesting that the larger the IOFB, the greater the kinetic energy that develops when it penetrates the eye, which increases the risk of retinal damage [ 1 , 9 , 16 , 17 , 18 , 19 , 34 ]. On the other hand, one work of research found that the size of the IOFB had no impact on the visual function [ 14 ]. The explanation lies in the fact that the edge of the foreign body that penetrates the eye and the surface of the retina is not necessarily the largest size of the foreign body.…”

“…Open globe injuries with retained IOFBs offer one of the most challenging scenarios to the ophthalmic surgeon due to their complex presentation. Previous studies have shown that the visual outcome in this type of ocular trauma is directly correlated with some predictive factors such as age, initial best corrected visual acuity (BCVA), wound length, IOFB size and the occurrence of complications such as retinal detachment (RD) and endophthalmitis [ 1 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 ]. In this retrospective case series, we evaluated 56 patients with IOFBs who underwent pars plana vitrectomy (PPV) over an 11-year period, with the aim to outline the prognostic factors with an impact on the visual outcome.…”

Value of Ocular Endoscopy in Extraction of Intraocular Foreign Bodies of Cilia in Patients with Open Ocular Trauma

“…According to a previous report, 6/11 eyes with intraocular cilia were caused by flips of iron wire [ 6 , 7 ]. Intraocular foreign bodies in the posterior segment present more serious prognoses [ 8 , 9 ]. As a type of autogenic biological foreign body, the eyes’ reaction to cilium varies unpredictably.…”