Elsevier

Ophthalmology

Volume 107, Issue 5, May 2000, Pages 823-828
Ophthalmology

Original Articles
Prognostic factors in ocular injuries caused by intraocular or retrobulbar foreign bodies

https://doi.org/10.1016/S0161-6420(00)00079-8Get rights and content

Abstract

Objective

To evaluate prognostic factors associated with final visual outcome, development of posttraumatic infectious endophthalmitis, and occurrence of proliferative vitreoretinopathy in patients with penetrating ocular injuries caused by intraocular or retrobulbar foreign bodies (FBs).

Design

Clinic-based cross-sectional study.

Participants

One hundred thirty patients presenting with penetrating ocular injuries caused by lacerations from FBs were operated on by one of two surgeons between 1989 and 1997. Follow-up time was an average of 20.84 ± 20.76 months (median: 17.0 months). All FBs were located posterior to the lens.

Interventions

Pars plana vitrectomy; foreign body removal; additional surgical procedures according to the clinical situation.

Main outcome measures

Postoperative visual acuity; posttraumatic infectious endophthalmitis; proliferative vitreoretinopathy.

Results

Occurrence of posttraumatic infectious endophthalmitis developing in seven patients (7/130 = 5.4%) was significantly (P = 0.026) associated with removal of the FB later than 24 hours after the accident and with the type of the FB (P < 0.01). Size (P = 0.37) of the FB, preoperative visual acuity (P = 0.62), presence of traumatic cataract (P = 0.75) or a retinal lesion by the FB (P = 0.16), age (P = 0.39), and gender (P = 0.46) did not show a statistically significant influence on the occurrence of endophthalmitis. Statistically significant risk factors for the development of proliferative vitreoretinopathy occurring in 27 patients (27 of 99 [27.6%] patients with a minimal follow-up of 3 months) were size of the FB (P < 0.001), preoperative visual acuity (P = 0.02), presence of a retinal lesion (P = 0.002), and traumatic cataract (P = 0.03). The time between FB removal and the accident was statistically marginally associated with the development of proliferative vitreoretinopathy (P = 0.07). Postoperative visual acuity depended significantly on size of the FB (P = 0.002), preoperative visual acuity (P < 0.001), presence of a retinal lesion (P = 0.049), and location of the retinal lesion (P < 0.001). Three eyes had to be enucleated because of endophthalmitis or phthisis bulbi.

Conclusions

Prognosis in open-globe injuries with intraocular or retrobulbar foreign bodies depends on the size and type of the foreign body, presence and location of retinal lacerations, additional involvement of other intraocular structures, preoperative visual acuity, and timing of surgery. These factors may be important in preoperative counseling of the patient and for planning surgery.

Section snippets

Patients and methods

The study included 130 patients who were referred from 1989 to 1997 because of open-globe injuries with lacerations by FBs (Table 1). All FBs were located posterior to the lens. All patients underwent pars plana vitrectomy for removal of the FB and for repair of additional structural damage if present. All patients included in the study were operated by one of two surgeons (HLJK and JBJ) who were alternatively on call every other night during the entire study period.

The characteristics of the

Results

Final visual outcome ranged between no light perception and 1.20, with a mean of 0.58 ± 0.42 (median, 0.60). Five patients reported no light perception, and nine patients had light perception with no projection. Final visual acuity was equal to or better than 0.10 in 105 (105/130 [80.8%]) patients, it was equal to or better than 0.50 in 81 (81/130 [62.3%]) patients, and it was 1.00 or better in 26 (26/130 [20.0%]) patients.

Posttraumatic endophthalmitis developed in seven (7/130 [5.4%]) patients

Discussion

The purpose of this study was to determine risk factors and prognostic indicators of posttraumatic infectious endophthalmitis, proliferative vitreoretinopathy, and final visual outcome in patients with open-globe injuries caused by intraocular or retrobulbar foreign bodies. The results suggest that, for the development of posttraumatic infectious endophthalmitis, the timing of surgery is one of the factors that have an impact on the result and that can partially be influenced by the surgeon.

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