Author: Catarina Xavier (Portugal)
Co-authors: Rita Serras Pereira, Afonso Murta, Catarina Mota, João Branco
Purpose
Intraocular foreign bodies (IOFBs) are a serious form of ocular injury that can cause direct mechanical damage to the eye but can also have a significant risk of associated post-traumatic endophthalmitis. Pars plana vitrectomy (PPV) is the most commonly used technique to remove IOFBs from the posterior segment. The purpose of this study was to evaluate the management of posterior segment IOFB in our service, as well as the clinical characteristics, complications, visual outcomes, and globe survival after IOFB extraction via PPV.
Setting/Venue
Tertiary ophthalmology center and surgical retina reference center, in Portugal.
Methods
Patients that suffered a penetrating eye injury with IOFB retained in posterior segment who underwent PPV for IOFB extraction between 2010 and 2020 were included. All patients were operated by the same surgeon. Patients with IOFB in the anterior segment or lens were excluded. We collected data from patients’ archives, namely patient’s demographic data, diagnostic tools, pre-surgical complications, and management. Timing of the first ophthalmologic examination and timing of PPV, surgical procedures, post-surgical complications, visual outcome, and globe survival were also collected. All statistical analyses were performed using SPSS statistical software (SPSS, Inc., Chicago, IL, USA). Non-parametric Mann-Whitney test was used to evaluate differences between groups. A p value of 0,01 or less was considered statistically significant.
Results
38 eyes were included, 86,8% males and 13,2% females with mean age of 48,68 years old. 59,5% came to the ophthalmology emergency at the same day of the accident, but 16,2% took 3 days or more. The diagnosis of IOFB was confirmed by CT-scan (83,3% of the cases), radiography (8,3%), ultrasound (5,6%), or MRI (2,6%). The most common complications on initial examination included traumatic cataract (52,6%), retinal lesions (34,2%) and hyphema (23,7%). Also, 42,1 % of patients developed endophthalmitis before IOFB extraction. Most patients (84,2%) had systemic antibiotics before IOFB extraction and 71,1% received intravitreal antibiotics. Primary closure of the wound was done on 45,9% of eyes. All had a PPV to extract the IOFB, performed on a median of 6 days after first ophthalmological contact. 84,2% also had a combined cataract surgery. Comparing the 15,8% of eyes that ended developing phthisis bulbi with those who didn’t, the only statistically significant difference (p<0,01) was the time between first ophthalmological contact and VPP, that was superior on the phthisis bulbi group, with a median of 13 days. The development of endophthalmitis was not significantly related to a superior time before surgery, nor to the use of intravitreal or systemic antibiotics.
Conlusions
Ocular traumas with IOFBs can have serious ocular complications, such as RD and endophthalmitis that can greatly affect the visual outcome. Most of our patients had traumas that occurred in an agricultural setting which usually gives rise to dirty wounds and probably contaminated IOFBs. This fact could possibly justify our rather high rate of 42% of endophthalmitis (which is, nonetheless, within what is described in the literature). We had a significant number of eyes that ended up developing phthisis bulbi which was related to a superior time delay to PPV. We conclude that our service could benefit from a protocol for IOFB suspicion cases, and it would be beneficial to find a solution to diminish the delay of PPV.
Financial Disclosure
The authors have no financial interests
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