Intraocular foreign bodies extracted by pars plana vitrectomy: clinical characteristics, management, outcomes and prognostic factors

Application of ophthalmic magnets in the removal of magnetic intraocular foreign bodies

The aim of this study was to explore a new surgical method for removing magnetic intraocular foreign bodies(IOFB). We systematically reviewed 48 patients (48 affected eyes; 44 males and 4 females; aged 23-74 years, with a mean age of 44.8 ± 12.3 years) with magnetic IOFBs who were admitted to the Department of Ocular Trauma of Hebei Eye Hospital from January 2024 to June 2024. The most common cause of injury was ferrous foreign bodies resulting from working with metallic tools. Thirty-seven of the injuries were sustained in the patient's workplace, and 11 injuries occurred domestically. The patients presented to the clinic 40 min to 60 days after injury. The time from injury to surgery ranged from 1 h to 14 d. In the preoperative examinations and postoperative routine follow-ups, the basic conditions of the patients' eyes were evaluated through visual acuity examination using an international standard chart, slit lamp microscopic examination, anterior and posterior segment examinations with anterior slit lamp lenses, and intraocular pressure measurements. Before surgery, the foreign bodies were properly localized via horizontal and coronal localization CT scans, and type-B ultrasound scans were performed for patients with closed wounds. Ophthalmic magnets were used to remove magnetic IOFBs from 48 cases (48 eyes); in 44 cases, the foreign body was removed successfully during the stage I operation, representing a success rate of 91.7%. Among the included cases, 10 cases of anterior chamber IOFBs and crystalline lens IOFBs were all successfully removed during stage I surgery, for a success rate of 100%; in 38 cases of intravitreal IOFBs, 34 were successfully removed during stage I surgery via pars plana vitrectomy, and 4 cases failed to be removed in stage I surgery and were subsequently removed via stage II vitrectomy, for a stage I surgery success rate of 89.5%. Owing to their strong magnetic force, ophthalmic magnets have been demonstrated to be effective tools for the removal of magnetic IOFBs, enabling simple and time-conserving surgical procedures that are associated with less surgically induced trauma and fewer complications.

Clinical findings and management of intraocular foreign bodies (IOFB) in third-world country eye hospital

PURPOSE

To describe the demoFigurey and clinical characteristics of intraocular foreign body as open globe injury type at National Eye Center Cicendo Eye Hospital.

METHODS

This descriptive-retrospective study is based on medical records of patients admitted to National Eye Center Cicendo Eye Hospital diagnosed with intraocular foreign bodies from January 2019 to June 2023.

RESULTS

A total of twenty-one cases of ocular trauma specifically intraocular foreign bodies were recorded based on medical records. A total of 20 cases (95.2%) were male. The incidence of 15 cases (71.4%) of trauma in outdoor activities with the whole mechanism (100%) of penetrations. Most cases were referred cases (57.1%). 11 cases had surgery under 24 h prior to trauma (52.4%). The entry site of the foreign body was on the cornea (17 cases, 81%). Metallic foreign bodies account for 16 (76.2%); most locations are found on the retina (71.4%). More than three fourths of patients had single IOFB (76.2%). Visual acuity is mostly present between counting fingers- 0.1 Snellen. Patients showed to have had retinal breaks (61.9%).

CONCLUSION

The majority of IOFB patients were working-age males. The nature of IOFBs is mostly metallic and retained in the posterior segment.

Intraocular Foreign Body: Etiology, Management, and Clinical Outcomes

BACKGROUND

The aim of this study was to evaluate patients with intraocular foreign bodies (IOFBs) treated in our center, which is a tertiary care general hospital, and to investigate the parameters affecting the final outcome.

PATIENTS AND METHODS

Patients aged 18 years and older who underwent surgery for IOFB between October 2023 and November 2024 were included in the study. The variables analyzed were age, gender, location and anatomic regions of trauma, IOFB material and counts, initial and final (1 month after the last surgery) best corrected visual acuity and intraocular pressure.

RESULTS

A total of 116 patients (7.3%) were diagnosed with open globe injury and 17 patients (14.7%) had IOFBs. All patients were male with a mean age of 36.9±10.4 years. In univariate and multivariate analysis, IOFB size >4.0 mm and corneal injury were associated with poor visual acuity, whereas an initial visual acuity of 0.3 logMAR or above was associated with good visual acuity.

CONCLUSION

In conclusion, the presence of IOFB is important in the management of open globe injury patients. Patients with IOFB often require surgery more than once. Most of the injuries are work-related and preventable accidents. The use of appropriate protective eyewear during work should be encouraged to avoid the risk of serious eye injuries and vision loss.

The trends and future projections of intraocular foreign bodies among children and adolescents: a global analysis

Objective

The aim was to evaluate the disease burden of intraocular foreign bodies (IOFBs) among children and adolescents globally based on the Global Burden of Disease, Injury, and Risk Factor Study 2021 (GBD 2021).

Methods

Data were extracted from the GBD 2021. The incidence and DALYs number and rate with 95% uncertainty interval (UI) and estimated annual percent change (EAPC) of IOFBs were estimated by age, sex and socio-demographic index (SDI) region. A Bayesian age-period-cohort (BAPC) analysis model was used to predict trends in the next ten years.

Results

Globally, it is estimated that the incidence number of IOFBs among children and adolescents increased from 5842769.65 in 1990 to 6154651.76 in 2021, while the age-specific incidence rate decreased from 258.69 in 1990 to 233.50 in 2021, with a EAPC being -0.54. The 15-19 years group had the highest incidence and DALYs number, while 0-4 years group had the lowest. The projective model indicates that the burden for IOFBs will rise sharply in the next ten years.

Conclusion

The global incidence and disease burden of blindness and vision loss in children and adolescents due to IOFB have shown a slight decline from 1990 to 2021. However, there may be a significant upward trend in the future, which requires the vigilant attention of policymakers.

Clinical outcomes and characterization of intraocular foreign body injuries from a Canadian centre: a 20-year retrospective study and literature review

OBJECTIVE

To analyse assessment and management patterns of intraocular foreign body (IOFB) injuries in an urban Canadian setting, providing valuable clinical insights to contextualize management.

METHODS

Single-surgeon retrospective chart review from January 2002 to January 2023 examining IOFB patient demographics, investigations, treatments, complications, and best-corrected visual acuity (BCVA).

RESULTS

This study evaluated IOFBs in 32 eyes from 31 patients (96.8% male). Sizes ranged from 1 to 12 mm; 28 (87.5%) were metallic and 15 (46.9%) were work-related injuries. For diagnosis, 19 patients (61.3%) underwent computed tomography (CT) imaging, and 8 (25.8%) received B-scans, with CT detecting IOFBs in 100% of cases and B-scan in 87.5%. At final follow-up, 17 eyes (53.1%) achieved BCVA ≥20/40, up from 7 (23.3%) initially. Presenting BCVA ≥20/200 was associated with a final BCVA ≥20/40 (P = 0.027). The IOFB was extracted in 27 eyes (84.4%), retained in 4 (12.5%), and 1 (3.1%) required enucleation. Intravitreal antibiotics were administered in 19 eyes (59.4%), resulting in one presumed case of drug toxicity. Complications were present in 30 eyes (93.8%), totalling 119 recorded overall, with 72 (60.5%) occurring within the first 24 hours. Traumatic cataracts were most common in 27 eyes (84.4%). Less-common complications included siderosis and retinal detachment with proliferative vitreoretinopathy, each occurring in one eye (3.1%). Four eyes (12.5%) developed secondary glaucoma, with 3 cases in retained or delayed extractions.

CONCLUSIONS

The IOFB characteristics and patient demographics are consistent with other regions. CT scans were the most effective investigation tool. Extended follow-up is recommended to monitor complications, particularly in retained or significantly delayed extractions.

Predictive Factors for Structural and Functional Outcomes of 25-Gauge Pars Plana Vitrectomy (PPV) for the Removal of Posterior Intraocular Foreign Bodies (IOFBs): A Retrospective Data Analysis From North India

PURPOSE

To identify predictive factors for structural and functional outcomes of 25-gauge pars plana vitrectomy (25G PPV) for removal of posterior segment intra-ocular foreign body (IOFB).

METHODOLOGY

A retrospective data analysis was performed for patients undergoing 25G PPV for removal of posterior segment IOFB between August 2019 to June 2021. Necessary demographic details and data regarding pre-operative ophthalmic examination were recorded. Similarly, intraoperative surgical details were recorded. Postoperative outcome measures included final best corrected visual acuity (BCVA), retinal status, and epiretinal membrane formation at the last follow-up visit. A univariate analysis was applied to find the association of various independent variables with functional and structural outcomes.

RESULTS

Thirty-nine patients were included in the study, with 37 males and two females. The mean age of the study group was 30.5+10.8 years. The most common zone of open globe injury was zone 1. Most of the impactions of IOFB were seen outside the macular area. Preoperative BCVA was 2.23+0.58 logarithm of the Minimum Angle of Resolution (logMAR), which improved significantly to 1.01+0.53 in the postoperative period (p-value <0.001). Anatomical success was achieved in 92.3% of patients at one year follow-up. The presence of impacted IOFB, associated endophthalmitis and IOFB >4mm were associated with poor visual outcomes (univariate analysis; p-value <0.05). None of the factors affected the anatomical success rates.

CONCLUSION

The presence of impacted IOFB, associated endophthalmitis, and large IOFB (>4mm) were associated with poor visual outcomes with 25G PPV for removal of IOFB.

Comparing forceps and self-assembled intraocular rare earth magnet in removing metallic intraocular foreign bodies in 25-guage vitrectomy

PURPOSE

To compare the efficacy and efficiency of self-assembled intraocular rare earth magnet and forceps in removing intraocular foreign bodies(IOFBs) undergoing 25-gauge(G) pars plana vitrectomy.

METHODS

A total of 30 patients with metallic IOFB underwent 25-G PPV were enrolled into this study. Self-assembled intraocular rare earth magnet were used in 15 patients(bar group), and forceps were used in 15 patients(forceps group). Success rate of removing IOFB, time taken to remove IOFB, incidence of IOFB slippage and fall, iatrogenic retinal damages were compared between the two groups.

RESULTS

There was no significant difference in success rate of removing IOFBs between the groups(93.3% and 100%, P > 0.99). The median time taken of removing FB was significantly shorter in bar group than in forceps group(112 and 295 s, P = 0.001). None of the patients in bar group had IOFB slippage and fall, or related iatrogenic retinal damage in the process of removal. In forceps group, IOFB slippage and fall during removal were observed in 7 of 15(47.6%) patients, related iatrogenic retinal injuries were recorded in 6 of 15(40.0%) patients, both were significantly higher than bar group(P = 0.003 and P = 0.017, respectively).

CONCLUSIONS

Compared with forceps, the assembled intraocular magnet can greatly reduce the possibility of IOFB slippage and fall, prevent related iatrogenic retinal damage, and shorten the time taken to remove IOFB. The assembled intraocular magnet can be an useful tool in removing metallic IOFBs in PPV.

Visual Outcomes of Traumatic Lens Dislocations and Subluxations Managed by Pars Plana Vitrectomy and Lensectomy

AIM

The aim of this study was to evaluate the visual outcome of lens dislocation and subluxation managed by pars plana vitrectomy (PPV) and lensectomy in patients with open (OGIs) or closed globe injuries (CGIs).

METHODS

Medical records of 70 consecutive patients treated by PPV and lensectomy over a period of 11 years (1 January 2010-31 December 2020) were retrospectively reviewed. We collected demographic data, best corrected visual acuity (BCVA) using a Snellen Chart pre- and postoperatively, associated ocular injuries and treatment strategy. Visual outcome was evaluated according to the final BCVA which was defined as poor <0.1 or good ≥0.1.

RESULTS

The mean age was 57.9 ± 17.6 years. CGIs were present in 49 (70.0%) cases and open OGIs in 21 (30.0%) cases. The dislocation mechanism was zonular lysis in 59 cases (84.3%) and capsular rupture in 11 cases (15.7%). The intraocular lens implant (IOL) was sutured to the sclera in 51 (72.9%) cases or positioned in the capsular bag or in the sulcus in 3 (4.3%) cases and 1 (1.4%) case, respectively, whereas 15 (21.4%) patients remained aphakic. A good BCVA ≥ 0.1 was achieved in 45.71% of the eyes. The presence of retinal detachment (RD) (p = 0.014), iridodonesis (p = 0.011) and initial BCVA (p = 0.000) achieved statistical significance in predicting visual outcome. After treatment, 45.71% of patients achieved a final BCVA ≥ 0.1.

CONCLUSION

RD, iridodonesis and initial BCVA were risk factors for poor visual outcome in our series.

Internal Plugging of a Traumatic Posterior Perforation Site Using Donor Sclera, Human Amniotic Membrane, and Fibrin Glue: A Novel Surgical Technique

Purpose: To describe a novel surgical approach to treat traumatic posterior perforating injuries. Methods: A case and its findings were analyzed. Results: A 21-year-old man presented with bilateral intraocular foreign bodies that were sustained while hammering a metal railway pin. In the left eye, the foreign body was embedded in the posterior scleral wall, resulting in a 2 mm × 6 mm posterior perforation and partial retinal detachment. Silicone oil tamponade could optimize the chances for retinal reattachment; however, there was concern that the silicone oil would migrate through the posterior defect and into the orbit. Therefore, the perforation site was filled using a 3-layer plug consisting of donor sclera, human amniotic membrane, and fibrin glue. The silicone oil was successfully maintained within the globe; however, the final visual acuity was limited due to proliferative vitreoretinopathy. Conclusions: The efficacy and safety of the 3-layer plug technique should be further validated in similar cases.

Intraocular foreign body: Characteristics, visual outcomes, and predictive values of ocular trauma score

Introduction

Retained intraocular foreign body (IOFB) remains an important cause of acquired visual impairment. The visual prognosis following treatments for eyes with retained IOFB was observed to be distinct from other mechanisms of open globe injury due to the specific nature and associated circumstances. This study evaluated the risk behaviors, visual results, and predictive values of Ocular Trauma Score (OTS) in determining visual outcomes in patients with IOFB that were not related to terrorism.

Methods

Medical records of patients who underwent surgical interventions between January 2015 and December 2020 were retrospectively reviewed.

Results

A total of one hundred and sixty-one patients (162 eyes) were recruited. The patients had a mean (standard deviation) age of 47.6 (14.0) years with working male predominance (93.2%). The majority of patients were injured by activities related to grass trimming (63.4%) and metallic objects were the main materials causing injuries (75.7%). Following treatments, the proportion of eyes having vision worse than 20/400 decreased from 126 eyes (77.8%) to 55 eyes (33.9%) at final visit. Ocular trauma score (OTS) had a high potential prediction for final vision in eyes in OTS categories 4 and 5. However, the discordance of final visual acuity distribution was observed in some subgroups of eyes in OTS categories 1 to 3.

Conclusion

This study highlights the significance of IOFB related eye injuries in a tertiary care setting. Decision making on treatments should be carefully considered, particularly in eyes in lower OTS categories, in light of a rise in the proportion of patients who experience improved vision after IOFB removal.

Clinical and imaging characteristics, outcomes and prognostic factors of intraocular foreign bodies extracted by vitrectomy

To investigate the clinical and computer tomography (CT) features and visual prognostic factors of pars plana vitrectomy (PPV) for management of retained posterior segment intraocular foreign body (IOFB). Medical records of 96 patients with IOFB removed by PPV between July 2017 and June 2021 were retrieved. The medical records, including demographic data, initial and final best corrected visual acuity (BCVA) using standard Snellen chart, characteristics of IOFB, CT findings, and surgical details, were reviewed. Outcome was evaluated according to the final BCVA and prognostic factors were obtained. The mean age was 42.31 ± 12.05 years (range 13-71 years) with 94 males (97.9%) and two females (2.1%). CT was sensitive of IOFB in 93.75% (90 eyes) and the locations were consistent with that found during PPV: 20 foreign bodies were located in vitreous, 6 near ciliary body, and 70 on or in retina. Mean diameter of IOFB removed by PPV is 3.52 mm ± 3.01 mm (range 1-22; median 3), and mean area is 6.29 ± 6.48 mm2 (range 0.5-40; median 3), which was statistically associated with the initial VA < 0.1 and endophthalmitis. Endophthalmitis was found in 24 (25.0%) eyes and large wound together with scleral entry site might be related to the endophthalmitis. Visual outcome < 0.1 was associated with relative afferent pupillary defect, initial VA < 0.1, and presence of endophthalmitis. Initial VA ≥ 0.1 was independent predictive factor for a better final BCVA. Relative afferent pupillary defect, initial BCVA < 0.1, and presence of endophthalmitis are poor visual prognostic factors.

Visual Outcomes and Prognostic Factors of Traumatic Endophthalmitis Treated by Pars Plana Vitrectomy: 11 Years Retrospective Analysis

Aim: To evaluate the visual outcome of traumatic endophthalmitis and describe the risk factors associated with poor visual acuity and retinal detachment (RD) development over an 11-year period. Methods: Medical records of 34 patients with traumatic endophthalmitis who underwent PPV over a period of 11 years (1 January 2010−31 December 2020) were reviewed. We extracted details regarding demographic data, initial and final best corrected visual acuity (BCVA) using a standard Snellen chart, wound and IOFB characteristics, ocular associated lesions, and treatment. The outcome was evaluated according to the final BCVA which was defined as poor < 0.1 or good ≥ 0.1 Results: Endophthalmitis rate was 29.8% in open globe injuries. The mean age was 43.6 ± 16.5 years and the majority of patients were males (32 out of 34, 94.1%). All patients received systemic (moxifloxacin) and intravitreal antibiotherapy. We performed pars plana vitrectomy (PPV) in all cases. Poor visual outcome was associated with wound size ≥ 3 mm (p = 0.02), the association of IOFB (p = 0.016), and the development of RD (p = 0.00). The presence of IOFB (p = 0.01) and wound size ≥ 3 mm (p = 0.01) were statistically associated with RD development. After treatment, 47.05% of patients achieved final BCVA ≥ 0.1. Conclusion: Wound size ≥ 3 mm, IOFB and RD were risk factors for poor visual outcomes in traumatic endophthalmitis.

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

The purpose of the study was to evaluate visual outcomes and consider management strategies in the eyes with an intraocular foreign body (IOFB). In a single-center, retrospective case-control study, 36 eyes of 36 patients who suffered from open globe injury (OGI) with IOFB were admitted to the Department of Vitreoretinal Surgery of Medical University of Lublin, Poland from January 2015 to December 2020. Most frequent primary procedure was the pars plana vitrectomy (PPV) with IOFB removal (n = 28). Retinal detachment (RD) developed in nine eyes soon after injury or as a further complication. Recurrent retinal detachment occurred in eight of these nine cases. Final VA 0.1 or better was observed in 21 eyes (58%). Fifteen patients had BCVA of less than 0.1. One eye was not included in the final VA assessment due to the short follow-up period. In 25 out of 28 patients who underwent any kind of pars plana vitrectomy (ppV) a BCVA of <0.4 was observed. The prognosis after an IOFB injury is uncertain due to multiple factors in a peri- and postoperative period. Factors predisposing to poor visual outcomes are: IOFB localization in the posterior segment, retinal detachment, vitreous hemorrhage and prolonged silicone oil tamponade.

Intraoperative Optical Coherence Tomography-guided 25G Microamount Trajectory Vitrectomy for the Treatment of Penetrating Ocular Injury Caused by a Foreign Body in the Right Eye: A Case Study

BACKGROUND

Optical coherence tomography (OCT) is a real-time three-dimensional tomography optical imaging technology that uses near-infrared waves to take cross-sectional pictures of the retina and other tissues. A few studies have reported the use of intraoperative OCT navigation for the removal of foreign bodies from the eyeball during surgery. The objective is to present a single case with a small foreign body (not embedded in the retina) treated with intraoperative OCT guided 25G micro-amount trajectory vitrectomy.

CASE PRESENTATION

The examination of a 25-year-old man, who suffered from right eye pain, suggested the following: the visual acuity was 20/250, the intraocular pressure was 8 mmHg, a scleral penetrating wound was visible at 3 mm behind the limbus at 7 o' clock, and Tyn (+). The vitreous showed some flocculent turbidity, the retina was flat, and the foreign body was visible at 10 o' clock. On the day of admission, the patient underwent a micro-amount vitrectomy with the removal of the foreign body. The vitreous body affected by the foreign body was then removed through the original wound track by using intraoperative OCT navigation.

CONCLUSION

The final follow-up showed the best-corrected vision of the right eye as 20/25 andno occurrence of complications. The intraoperative OCT-guided 25G micro-amount trajectory vitrectomy could be used as an accurate, useful, and safe method for foreign body extraction.

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

Aim: To evaluate the visual outcome of penetrating ocular injuries with a retained intraocular foreign body (IOFB) managed by pars plana vitrectomy (PPV) and to describe the risk factors associated with poor visual acuity and retinal detachment (RD) development. Methods: Medical records of 56 patients with IOFB that were removed by PPV over a period of 11 years (1 January 2010−31 December 2020) were reviewed. We extracted the demographic data, initial and final best corrected visual acuity (BCVA) using standard Snellen chart, IOFB characteristics, complications and surgical details. Outcome was evaluated according to the final BCVA: poor <0.1, good 0.1−<0.5 or excellent ≥0.5. Results: The mean age was 36.1 ± 14.1 (range, 16−71) years and the majority of patients were males (55 out of 56, 98.2%). IOFB was retinal in 27 (48.2%) cases and intravitreal in 29 cases (51.8%). IOFB size was ≤3mm in 26 (46.4%) cases and >3mm in 30 (53.6%) cases. Preoperative RD was identified in 12 (21.4%) cases and endophthalmitis in 17 cases (30.4%). IOFBs larger than 3 mm and retinal location were associated with RD development. Poor visual outcome was associated with initial BCVA, retinal location, RD and endophthalmitis. Conclusion: Initial BCVA, retinal foreign body, RD and endophthalmitis were risk factors for poor visual outcome.

Exploring Minimum Secondary Injury for the Treatment of Ocular Trauma With Giant Intraocular Foreign Bodies

Purpose

To investigate the clinical therapy for giant intraocular foreign bodies (IOFBs) and evaluate the best treatment method with minimum secondary injury.

Methods

We retrospectively analyzed the data of 73 eyes of 73 patients with ocular trauma caused by giant IOFBs between January 2016 and December 2018. The IOFB size, localization, shape, and magnetic properties were recorded. The best corrected visual acuity (BCVA), ocular tissue injuries, entrance wound, interval time from injury to second phase surgery, silicone oil removal, and globe recovery were also observed. The cases were divided into three groups based on the following IOFB extraction paths: limbus path, the pars plana path, and the entrance wound path. The BCVA, IOFB size and shape, the wound, endophthalmitis, and silicone oil removal were compared among the three groups.

Results

The IOFBs were 46 cases of magnetic and 27 cases of nonmagnetic, with a shape of thin flat in 19 cases, thick flat in 12 cases, long in seven cases, and irregular in 35 cases. Multiple damages were caused by the giant IOFBs, mainly involving the severe cornea, lens, and retina injuries. The postoperative BCVA increased compared with the preoperative BCVA (z = −6.06, P &lt; 0.01). The rate of recovery from blindness was 40.85% (29/71). The thin flat IOFB and long IOFB resulted in a better postoperative BCVA than the other two IOFB shapes (all P &lt; 0.05). The irregular IOFB had a poorer silicone oil removal rate than the other three IOFB shapes (all P &lt; 0.05). The IOFB extraction followed the limbus path in 18 cases, pars plana path in 27 cases, and entrance wound path in 28 cases. The IOFB length and width in the pars plana path group were significantly lower than that in the limbus path group (all P &lt; 0.05), the preoperative BCVA of the pars plana path group was superior to that of the limbus path group (P &lt; 0.05), and the IOFB length, width, and entrance wound length in the pars plana path group were significantly lower than in the entrance wound path group (all P &lt; 0.05). But the postoperative BCVA in the pars plana path group was not better than that in the other two groups (all P &gt; 0.05). The postoperative BCVA of the entrance wound path group was significantly superior to that of the limbus path group (z = −2.01, P = 0.04), while there was no difference between the two groups in IOFB length, width, entrance wound length, or preoperative BCVA (all P &gt; 0.05).

Conclusion

The entrance wound path would benefit to minimize secondary injury in giant IOFB extraction procedure, compared with the limbus and pars plana path.

Clinical Characteristics and Visual Outcomes in Patients with Intralenticular Foreign Bodies with Self-Sealing Corneal Penetrating Wounds

Purpose

Siderosis bulbi may occur as a result of retained intralenticular foreign bodies (ILFBs) that were missed during examination in patients with self-sealing wounds and without a significant decrease in visual acuity. This study aimed to explore the clinical characteristics and visual outcomes of ILFBs with self-sealing corneal penetrating wounds.

Methods

Fifteen eyes of 15 patients with ILFBs and self-sealing corneal penetrating wounds, seen between October 2014 and September 2019, were retrospectively analyzed. Data regarding the patient demographics, clinical features, surgical procedure, and initial and final best-corrected visual acuity (BCVA) were analyzed.

Results

All patients were male with a mean age of 41 years. The foreign bodies passed through the cornea, sometimes through the iris, through the anterior capsule, and finally localized in the lens. All ILFBs were pointed and metallic objects and were successfully removed with phacoemulsification and posterior chamber intraocular lens (IOL) implantation. Anterior capsule violation was found in three eyes, but no posterior capsule rupture was found. The IOL was placed in a capsule bag in all the cases. The BCVA ranged from 20/200 to 20/25 preoperatively and improved to between 20/32 and 20/20 at the last follow-up visit. The IOLs were well-centered. Apart from posterior capsule opacity in four eyes, no other postoperative complications were found.

Conclusions

In patients with a pointed metallic ILFB and self-sealing corneal penetrating wounds (with or without cataracts), early diagnosis and removal of the metallic ILFB combined with lens removal and IOL implantation may avoid late complications and achieve good visual outcomes.

Clinical characteristics and prognostic factors for visual outcome in 669 patients with intraocular foreign bodies

AIM

To describe the clinical characteristics and analyze prognostic factors that influence visual outcome in 669 patients with intraocular foreign bodies (IOFBs).

METHODS

Medical records of 669 patients with IOFBs from West China Hospital were reviewed. Best corrected visual acuity (BCVA) values were recorded using standard Snellen acuity chart and were converted to logarithm of the minimum angle of resolution (logMAR) scale for statistical analysis. The visual outcome was defined by the final BCVA (excellent visual outcome: final BCVA of 20/40 or better; poor visual outcome: final BCVA less than 20/200). Statistical analysis of collected data was performed using IBM SPSS Statistics version 23. A 2-tailed P value of less than 0.05 was considered statistically significant throughout the study.

RESULTS

The average age ranged from 1 to 79 years old (mean age, 34.8±12.7 SD) and the majority of patients were men (626, 93.6%). The major cause of ocular injury was hammering (383, 57.2%). Almost all the patients (97.8%) underwent surgeries (97.8%) and the average time interval between injury and surgery was 26.4±322.3d (0-7300), while 327 patients received surgeries within 24h (48.9%) and 590 patients received surgeries within seven days (88.2%) after IOFBs injury. The poor BCVA was associated with older age (P=0.013), larger IOFBs size (P<0.001), presence of complications (P<0.001) and worse presenting BCVA (P<0.001). On the contrary, younger age (P=0.005), smaller IOFBs size (P<0.001), absence of complications (P<0.001) and better presenting BCVA (P<0.001) were considered to relate to excellent BCVA.

CONCLUSION

Multiple prognostic factors may influence the final visual outcome, including age, size of IOFBs, complications and presenting BCVA. Meanwhile, further education and promotion on eye protection should be taken for the improvement on self-protection and self-health awareness.

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

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.

Long-Term Outcome of Pars Plana Vitrectomy for Retained Posterior Segment Intraocular Foreign Body Secondary to Gunshot Injury

Purpose

To report the long-term outcome of pars plana vitrectomy (PPV) for management of retained posterior segment intraocular foreign body (IOFB) secondary to gunshot injury.

Methods

This is a retrospective interventional case series including consecutive patients who had PPV for retained posterior segment IOFB secondary to gunshot injury. Main outcome measures were final best-corrected visual acuity (BCVA), long-term globe survival and detection of complications. Spearman correlation analyzed relationships between numerical data. Kruskal–Wallis test compared differences in initial BCVA and final BCVA across variables. Categorical variables were tested using Chi square or Fisher’s exact test. P value is significant at 0.05.

Results

The study included 103 eyes of 103 patients. Mean baseline BCVA was 0.01 decimal unit (2 logMAR). Mean duration from primary repair to PPV was 3 weeks. Mean duration of post-operative follow-up was 60 months. Mean final BCVA was 0.04 decimal unit (1.3 logMAR), p 0.001. Post-operatively, BCVA improved in 58.2% of patients. Nineteen patients (18%) gained ≥2 lines of vision, and 15 patients (14.5%) achieved final BCVA of 0.4 decimal unit (logMAR 0.4). All complications were related to the original injury. These included macular scar (19%), macular pucker (6%), recurrent retinal detachment (4%), subretinal fibrosis (3%), consecutive optic atrophy (3%), and PVR (3%). Phthisis bulbi or sympathetic ophthalmia did not develop in any case.

Conclusion

PPV for removal of IOFB caused by gunshot injury yielded long-term favorable functional outcome with excellent globe survival. Poor initial BCVA, location of IOFB in the posterior pole, associated lens injury and retinal detachment are significant adverse prognostic factors for final BCVA but not for globe survival.

Intraocular Foreign Body: Diagnostic Protocols and Treatment Strategies in Ocular Trauma Patients

Intraocular foreign bodies (IOFBs) are critical ophthalmic emergencies that require urgent diagnosis and treatment to prevent blindness or globe loss. This study aimed to examine the various clinical presentations of IOFBs, determine the prognostic factors for final visual outcomes, establish diagnostic protocols, and update treatment strategies for patients with IOFBs. We retrospectively reviewed patients with IOFBs between 2005 and 2019. The mean age of the patients was 46.7 years, and the most common mechanism of injury was hammering (32.7%). The most common location of IOFBs was the retina and choroid (57.7%), and the IOFBs were mainly metal (76.9%). Multivariate regression analysis showed that poor final visual outcomes (<20/200) were associated with posterior segment IOFBs (odds ratio (OR) = 11.556, p = 0.033) and retinal detachment (OR = 4.781, p = 0.034). Diagnosing a retained IOFB is essential for establishing the management of patients with ocular trauma. To identify IOFBs, ocular imaging modalities, including computed tomography or ultrasonography, should be considered. Different strategies should be employed during the surgical removal of IOFBs depending on the material, location, and size of the IOFB.

Predictors for Visual Outcomes in Eye Injuries with Intraocular Foreign Body

Objective

To study the visual outcomes and identify the predictive factors for visual outcomes in patients with eye injuries and retained intraocular foreign bodies (IOFBs).

Patients and Methods

The medical records of 359 consecutive patients with eye injuries and retained IOFBs were retrospectively reviewed during 2009-2018. Demographic data, clinical findings, treatment and visual outcomes were studied. Univariate and multivariate analyses were used to identify the predictive factors.

Results

Most of the patients were male and the average age was 36.4 years old. The three most common causes of eye injuries were grass trimming (25.07%), chiseling (23.12%) and hammering (13.93%). Most of the patients (79.39%) presented with poor initial best-corrected visual acuity (BCVA) (<3/60). Pars plana vitrectomy with IOFB removal was done in 273 eyes (76.04%). After treatment, eyes with poor BCVA (<3/60) decreased from 79.39% to 62.95% and eyes with good BCVA (≥3/60) increased from 20.61% to 37.05%. Poor initial best-corrected visual acuity (odds ratio 23.39, P<0.001), rhegmatogenous retinal detachment (odds ratio 9.91, P<0.001) and the presence of infectious endophthalmitis (odds ratio 2.06, P=0.02) were statistically significant predictive factors for poor visual outcome.

Conclusion

Most patients with eye injuries and IOFBs usually have poor final BCVA. Poor presenting BCVA, retinal detachment and endophthalmitis are significant predictive factors for poor visual outcomes. These factors can be used to inform the visual prognosis and plan prompt surgical intervention for the patients. Causes of IOFBs were mostly work-related and could be preventable. Education and activation of using appropriate protective safety glasses during work are necessary to avoid serious eye injuries and blindness.

Clinical outcomes and epidemiology of intraocular foreign body injuries in Cork University Hospital, Ireland: an 11-year review

BACKGROUND/AIMS

To describe the epidemiology, outcomes, and prognostic factors of intraocular foreign body (IOFB) injuries at a tertiary ophthalmic referral centre in Cork University Hospital, Ireland.

METHODS

A retrospective review of 23 eyes with IOFB that presented to Cork University Hospital (CUH) from January 2009 to December 2019 was performed. The mechanism and characteristics of IOFB injury were all noted. This data was collated and analysed to ascertain the epidemiology of IOFB injury in CUH and to describe the prognostic factors affecting visual outcome following IOFB injury.

RESULTS

There was a 100% male prevalence. The mean age was 37.4 years. The majority of IOFBs were metal in nature and were acquired by hammering, often while working and frequently in the absence of personal protective equipment (PPE). The route of entry for the IOFB was via the cornea in 70% of cases. Fifty-two percent of cases were clinically detectable and 43% of cases were only identifiable on CT (computed tomography) imaging. Eighty-seven percent of cases underwent surgery on the same day as presentation. There was no incidence (0%) of endophthalmitis. Seventeen percent of cases developed post-operative retinal detachment (RD). The mean pre-operative VA was 0.79 LogMAR (6/38 Snellen equivalent-SE) compared to a mean VA of 0.58 LogMAR (6/24 SE) following surgery.

CONCLUSIONS

This review provides important epidemiological data for IOFB injuries in Ireland. It also adds some useful information to the literature in relation to prognostic factors and lens status post IOFB injury.

Transscleral Extraction of an Intraocular Foreign Body from the Posterior Segment of the Eye without Pars Plana Vitrectomy

PURPOSE

Penetrating eye trauma with an intraocular foreign body is very frequent, especially in men in their productive age. Pars plana vitrectomy would be the standard surgical method at our department. However, in indicated cases (metallic intraocular bodies in the posterior eye segment in young patients with well transparent ocular media without detached ZSM and without any evident vitreoretinal traction) transscleral extraction of the intraocular foreign body is performed using the exo magnet, eventually endo magnet with a minimal PPV without PVD induction under the visual control of endo-illumination.

MATERIALS AND METHODS

Between June 2003 and June 2018, 66 eyes of 66 patients diagnosed with a penetrating eye trauma caused by an intraocular foreign body located in the posterior eye segment were treated. In 18 eyes (27,3 %) with a metallic foreign body in vitreous (body) or in retina, no PPV or a minimal PPV without PVD was used as a surgical method. In the remaining 48 eyes (72,7 %), a standard 20G, respectively 23G PPV method were used together with PVD induction and the foreign body extraction via endo or exo magnet.

CONCLUSIONS

As demonstrated by our survey/study, in the cases of a thoroughly considered indication an experimented vitreoretinal surgeon can perform a safe NCT transscleral extraction from the posterior eye segment via exo magnet, eventually endo magnet under the visual control of a contact display system with a minimal PPV. Thereby, the surgeon can enhance the patient´s chance to preserve their own lens and its accommodative abilities as well as reduce the risk of further surgical interventions of the afflicted eye.

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

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.

Effect of Partial Pars Plana Vitrectomy in Two Cases: Removal of Intraocular Foreign Body and Intraocular Lens Dropped Into Vitreous

The aim of this case study was to present the effect of partial pars plana vitrectomy (PPV) in two cases that is due to the presence of an intraocular foreign body (IOFB) and intraocular lens (IOL) that has dropped into the intravitreal area. The first case was a 30-year-old man with IOFB in the right eye, and the second case was a 34-year-old woman whose IOL was dropped into vitreous after trauma. In cases, IOFB and IOL were extracted from vitreous performed by partial PPV without complication. Partial PPV was effective despite without complete vitrectomy. With minimal/partial vitrectomy approach, most of the vitreous tissues was left in place. We believe that this approach will reduce the rate of complications, such as cataract and retinal detachment.

TRAFFIC ACCIDENT-RELATED OPEN GLOBE INJURIES

PURPOSE

To evaluate the clinical characteristics and visual outcomes of patients with traffic accident-related open globe injuries, and to examine preoperative factors influencing the visual prognosis after pars plana vitrectomy, as compared with common open globe injuries.

METHODS

Patients with open globe injuries, who underwent pars plana vitrectomy, were identified. Patients' demographic and clinical data were entered into a computerized database for review and analysis; data included age, sex, initial visual acuity, duration between onset of injury and surgery, information about the type and cause of injury, wound location and length, presence of ocular complications, and final visual acuity.

RESULTS

Of the 355 open globe injuries, 14 were sustained during a traffic-related accident; the average age was 50.4 years (range: 20-85) and most (78.6%) were men. Of these 14 patients, 9 (64.3%) presented with rupture and 5 (35.7%) with laceration. Injuries were caused while driving (6 eyes; 42.9%), riding a bicycle (5 eyes; 35.7%), involved in car accident while walking (2 eyes; 14.3%), and riding a motorbike (1 eye; 7.1%). Initial visual acuity was significantly related to final visual acuity (P = 0.003, R = 0.80). The final visual acuity in patients with traffic accident-related open globe injuries was significantly better than that of the total group (P = 0.01).

CONCLUSION

Traffic accident-related open globe injuries had better visual outcomes than common open globe injuries. Visual outcomes in patients with traffic accident-related open globe injuries were related to the initial visual acuity. No eyes developed endophthalmitis in patients with traffic accident-related open globe injuries.

Optimal timing of vitrectomy for severe mechanical ocular trauma: A retrospective observational study

Mechanical ocular trauma could lead to disastrous visual outcomes. There has been a controversy regarding the timing of vitrectomy for such cases. This study aimed to find out the optimal timing of vitrectomy for severe mechanical ocular trauma. Patients with severe mechanical ocular trauma who had undergone vitrectomy were enrolled and followed up for at least 6 months. Clinical data were collected including ocular trauma score (OTS), the timing of vitrectomy upon injury, visual acuity, vitrectomy results, post-operation complications and etc. All cases were classified according to the timing of vitrectomy upon injury into 3 groups: group A 1–7 days, group B 8–14 days, group C more than 14 days. A total of 62 cases were enrolled, including 20 eyes in group A, 25 eyes in group B, and 17 eyes in group C. No significant differences were shown of the gender, age or OTS among the 3 groups. Both functional success rate and visual outcome were optimal in group B, then in group A, and worst in group C. These results suggested that the best timing of vitrectomy for severe mechanical ocular trauma is 8–14 days upon injury; second best is 1–7 days; worst is after 14 days.

Visual Outcomes and Prognostic Factors of Intralenticular Foreign Bodies in a Tertiary Hospital in North China

Purpose

The aim of this study is to describe the epidemiological and visual outcomes and to identify the main prognostic factors of intralenticular foreign body (ILFB) injuries.

Methods

We performed a retrospective review of 21 patients (21 eyes) referred to Hebei Eye Hospital in North China from January 2012 to December 2017, who underwent surgical removal of ILFBs and associated ocular trauma repairs. Data regarding the patient demographics, cause of the injury, nature of the ILFB, clinical features, time interval between the injury and the ILFB removal, time interval between the presentation and the surgery, and the initial and final best-corrected visual acuities (BCVAs) were analyzed, and the main prognostic factors were identified.

Results

Male adults were most affected by ILFBs (90.5%). The mean age of the patients was 41.5 years (median: 46 years, range: 21 to 60 years). None of the patients were wearing goggles at the time of the injury. The most common ILFB cause was hammering the metal (57.1%), and most of the ILFBs were metallic (71.4%). After medical treatment, the final BCVA was improved significantly (Z = 2.49, P=0.015). There was a significant association between the ILFBs with posterior segment injuries and the final BCVA (χ² = 10.03, P=0.01). Those factors showing no statistical association with the final BCVA included the age (χ² = 0.36, P=1.0), gender (χ² = 0.52, P=1.0), nature of the ILFB (χ² = 1.11, P=0.54), entrance wound location (χ² = 2.85, P=0.25), and time interval between the injury and the ILFB removal (χ² = 1.87, P=0.23).

Conclusion

This is the first local study to explore the epidemiology of ILFB injuries and to identify the main prognostic factors. There was a significant association between the ILFBs with posterior segment injuries and the final BCVA. Improved public awareness and strengthened education regarding safety are the key approaches to reduce the incidence of eye injuries.

Chandelier-assisted scleral buckling in an eye with longstanding inert foreign body with fresh rhegmatogenous retinal detachment

Intraocular foreign bodies (IOFBs) present in varied manners which in turn necessitate their removal in majority of the cases. A stone foreign body can remain inert inside the eye for years. Retinal detachment in eyes following penetrating trauma with an IOFB is common, but a combination of fresh rhegmatogenous retinal detachment in an eye with a longstanding inert stone foreign body is extremely rare. We report a case of a 50-year-old male with rhegmatogenous retinal detachment with a longstanding stone foreign body, where we managed such a scenario with a chandelier-assisted, sutureless, scleral buckle without removing the stone foreign body.

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

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.

Clinical characteristics and prognostic factors of posterior segment intraocular foreign body in a tertiary hospital

Background

To identify the clinical characteristics, prognostic factors and visual outcomes in posterior segment IOFBs patients managed by PPV in a tertiary hospital.

Methods

A retrospective chart review was performed for 56 patients, who had PPV for IOFBs removal between November 2013 and November 2015. The mechanisms of injury, the nature of the IOFBs, the BCVA before and after the surgery, the penetrating site and the complications of the surgery were all collected. Univariate analyses were conducted to evaluate the prognostic factors.

Results

The mean age of the patients was 36.4 years. The nature of IOFBs was mainly metal. Most injuries were commonly caused by hammering the metal. The mean preoperative VA was 2.30 logMAR, and mean final VA was 0.92 logMAR. From univariate analysis, good visual outcome was correlated with the good visual acuity before surgery and poor visual outcome was correlated with the macular break and multiple surgeries.

Conclusions

In a tertiary hospital of eastern China, most cases of IOFBs were work-related. The prognosis of the patients was really well in the patients with good presenting visual acuity. Nevertheless the prognosis was not good for those patients who had macular injury or underwent several surgeries because of retinal detachment, epiretinal membrane or proliferative vitreous retinopathy. Good facilities for eye protection are urgently in demand for the workers indeed.

Secondary Sulcus-Fixed Foldable IOL Implantation with 25-G Infusion in Patients with Previous PPV after Open-Globe Injury

PURPOSE

To evaluate the safety and efficacy of secondary sulcus-fixed foldable intraocular lens (IOL) implantation through a clear corneal incision with 25-G infusion in patients with previous pars plana vitrectomy (PPV) after open-globe injury, and to analyze postoperative outcomes and prognostic factors of treatment.

METHODS

Clinical data of 89 eyes of 89 patients with open-globe injury who underwent secondary sulcus-fixed foldable IOL implantation through a clear corneal incision with 25-G infusion after vitrectomy in our hospital between January 2008 and June 2015 were retrospectively analyzed. The examinations before IOL implantation mainly included visual acuity, slit-lamp examination, direct and indirect ophthalmoscope, visual electrophysiology, corneal endothelium, B scan, ultrasound biomicroscope, and intraocular pressure. Five eyes underwent suturing of peripheral iris and 7 eyes underwent suturing of iris laceration simultaneously. The mean follow-up was 18 months with a range from 6 months to 8 years.

RESULTS

The mean interval between secondary sulcus-fixed foldable IOL implantation and vitrectomy was 2.8 months with a range from 2 to 6 months. The uncorrected visual acuity improved in all patients with a well-centered IOL ranging from 0.1 to 0.8 with the best-corrected visual acuity from 0.1 to 1.0 after secondary IOL implantation. The postoperative complications mainly included mild anterior chamber exudates in 10 eyes (11%), temporary IOP elevation in 12 eyes (13%), and recurrent retinal detachment in 5 eyes (6%), which were subsequently managed by surgery.

CONCLUSIONS

The interval of 2.8 months between vitrectomy and secondary IOL implantation is an appropriate and safe option to correct aphakia in patients receiving vitrectomy for open-globe injury.

Efficacy and Safety of 23-Gauge Pars Plana Vitrectomy/Silicone Oil Tamponade Combination for Treatment of Pediatric Post-Traumatic Endophthalmitis

PURPOSE

To determine (i) the etiology, epidemiology, mechanism of injury, and risk factors associated with open globe injuries (OGIs) in children and (ii) visual outcomes of pediatric patients with post-traumatic endophthalmitis following 23-gauge pars plana vitrectomy (PPV) combined with silicone oil tamponade (SOT).

METHODS

A total of 107 consecutive patients, <15 years of age, who had been diagnosed with post-traumatic endophthalmitis between September 2009 and October 2015, were included in this 6-year retrospective study. All patients had undergone a combined PPV and SOT procedure. We reviewed records and analyzed several parameters, including age, gender, wound anatomy, intraocular foreign body characteristics, best-corrected visual acuity (BCVA), and anatomic re-attachment of the vitreous. Visual acuity (VA) was evaluated by comparing the Ocular Trauma Scores (OTS) system with BCVA (as assessed by Fisher's exact test).

RESULTS

Patients included 70 (65.42%) boys and 37 (34.58%) girls (mean, 7.84 ± 2.31 years). Mean follow-up time was 13.31 ± 3.15 months. Zone-1 injuries accounted for 15 of 107 (14.02%) cases, while Zones-2 and -3 accounted for 69 of 107 (64.49%), and 23 of 107 (21.50%) cases, respectively. Lens trauma was noted in 53 of 107 (49.53%) eyes. Our analysis showed that the 6-month BCVA, as assessed by OTS, differed significantly between groups OTS-1 (p = 0.001) and OTS-2 (p = 0.012). No significant difference was observed in group OST-3 (p = 1.000). Total retinal attachment was achieved in 99 of 107 eyes (92.52%).

CONCLUSIONS

Following combined PPV/SOT for post-traumatic endophthalmitis, VAs were not only favorable, but also often better than those predicted by OTS. Increased awareness of the very serious nature of endophthalmitis is expected to help in the development of a comprehensive strategy designed to educate both parents and children, and to minimize the number of preventable pediatric OGIs.

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

Purpose. Ocular trauma with retained foreign body is an important cause of visual impairment in working-age population. Clinical status impacts on the timing and planning of surgery. In the last year small gauge vitrectomy has become safer and more efficient, extending the range of pathologies successfully treated. Aims. To evaluate the safety and outcomes in patients with open eye injury with retained foreign body that underwent early 25-gauge vitrectomy. Methods. In this retrospective, noncomparative, interventional case series, we performed 25-gauge vitrectomy on 10 patients affected by open globe injuries with retained foreign body, over 3 years. We analyzed age, wound site, foreign body characteristics, ocular lesions correlated, relative afferent pupillary defect, visual acuity, and intraocular pressure. Follow-up evaluations were performed at 1, 3, and 6 months. According to the clinical status we performed other procedures to manage ocular correlated lesions. Results. The median age of patients was 37 years. The foreign body median size was 3.5 mm (size range, 1 to 10 mm). 25-gauge vitrectomy was performed within 12 hours of trauma. Foreign body removal occurred via a clear corneal or scleral tunnel incision or linear pars plana scleral access. Visual acuity improved in all patients. Endophthalmitis was never reported. Only two cases reported postoperative ocular hypertension resolved within the follow-up. Retinal detachment recurred in one case only. Conclusions. 25-gauge vitrectomy could be considered as early approach to manage open globe injuries with a retained posterior segment foreign body in selected cases with good outcomes and low complication rate.