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

Updates on the clinical management of intraocular foreign body (IOFB)

This review aims to summarise recent literature in the past decade, focusing on new insights, management strategies, and technique modifications for intraocular foreign body (IOFB) cases. We discuss the latest epidemiological data, diagnostic assessments, and challenging presentations of IOFB. Imaging, particularly non-contrast helical computed tomography with thin cuts, is a valuable diagnostic adjunct. The administration of perioperative prophylactic systemic and intravitreal antibiotics may be useful in reducing infective endophthalmitis risk. We recommend same stage IOFB removal with primary repair within 24 hours whenever feasible. Furthermore, the latest updates on surgical planning, techniques, and instrumentation for IOFB removal, including crystalline lens management, IOFB extraction routes, and intraoperative adjuncts such as perfluorocarbon liquid, cohesive viscoelastic, and mitomycin-C are described. Various IOFB removal techniques including magnet-based, scaffold, suture-based, aspiration and bimanual methods, specialised and innovative instruments are also discussed. This review compiles the most recent advancements and techniques, offering a comprehensive update on the clinical management and surgical removal of IOFB.

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.