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

Advances in the management of intraocular foreign bodies

Intraocular foreign bodies (IOFBs) remain a severe complication of ocular trauma commonly encountered worldwide. This literature review aimed to discuss current practice patterns, areas of controversy, and advances in the management of IOFBs. Injuries involving IOFBs carry significant ocular morbidity and management can be extremely challenging. A systematic approach to preoperative evaluation and IOFB surgical management is detailed in this article and should be applied in each case. The location and composition of an IOFB have important implications on surgical approach and timing, especially in cases of toxic metals and vegetable matter. The advantages, disadvantages, and previous literature regarding immediate versus delayed foreign body removal are presented. Surgical approaches are described, with an emphasis on posterior chamber IOFB management and removal via pars plana vitrectomy. Final visual acuity is variable, but approaches have been used to prognosticate outcomes including the Ocular Trauma Score. By synthesizing current IOFB literature, the goal is to provide practitioners with guidance that will maximize the chances of surgical success and patient outcomes.

Early versus delayed timing of primary repair after open-globe injury: a systematic review and meta-analysis

TOPIC

The timing of primary repair of open-globe injury is variable in major trauma centres around the world and there is a lack of consensus on optimal timing.

CLINICAL RELEVANCE

Surgery is the mainstay of open-globe injury management, and appropriate timing of surgical repair may minimise the risk of potentially blinding complications such as endophthalmitis, thereby optimising visual outcomes.

METHODS

A systematic literature review was performed following PRISMA guidelines (PROSPERO registration number: CRD42023442972). CENTRAL, MEDLINE, Embase, ISRCTN registry and ClinicalTrials.gov were searched from inception to 29 October 2023. Prospective and retrospective non-randomised studies of patients with open-globe injury with a minimum of one month follow up after primary repair were included. Primary outcomes included visual acuity at last follow-up, and the proportion of patients who developed endophthalmitis. Certainty of the evidence was assessed using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) approach.

RESULTS

A total of 16 studies met inclusion criteria, reporting a total of 8497 eyes. The most common injury types were penetrating and intraocular foreign body (IOFB). Meta-analysis found that primary repair less than 24 hours after open-globe injury was associated with an odds of endophthalmitis of 0.30 compared to primary repair conducted more than 24 hours after trauma (OR 0.39; 95% CI 0.19-0.79; I2 95%; p = 0.01). There was no significant difference in reported visual outcomes between patients whose open-globe injuries were repaired more than, compared to less than, 24 hours after trauma (OR 0.89; 95% CI 0.61-1.29; I2 70%; p = 0.52). All included studies were retrospective and non-randomised, demonstrating an overall low certainty of evidence on GRADE assessment.

CONCLUSION

Only retrospective data exist around the effect of timing of open-globe repair, causing low certainty of the available evidence. However, this review of the current body of evidence, predominantly including penetrating and IOFB injuries, suggests that primary repair performed less than 24 hours after open-globe injury was associated with a reduced endophthalmitis rate, compared to longer delays, consistent with delay to primary repair increasing endophthalmitis risk.

Removal of an anterior chamber foreign body using hydropulsion and ophthalmic viscoelastic device capture in a dog

OBJECTIVE

To describe the removal of an adherent, presumed plant-based, anterior chamber foreign body (ACFB) from the inferior iridocorneal angle in a dog using hydropulsion and ophthalmic viscoelastic device (OVD) capture.

ANIMAL STUDIED

A 6-year-old female spayed pit bull terrier who was referred for further evaluation of a corneal opacity after being observed running into a thorned succulent plant 1 month earlier. On ophthalmic examination, no corneal foreign body was noted, though mild uveitis was present. Gonioscopy revealed a suspected plant foreign body (thorn tip) in the inferior iridocorneal angle.

PROCEDURE

Under general anesthesia, the ACFB was dislodged from the inferior iridocorneal angle using hydropulsion with balanced salt solution. The superior half of the anterior chamber had been filled with 2% hydroxypropyl methylcellulose OVD to trap the foreign object. One month later, the uveitis had resolved and repeat gonioscopy confirmed the absence of any ACFB in the iridocorneal angle.

CONCLUSION

In the absence of an intraoperative goniolens or endoscopy, hydropulsion and OVD capture of adherent ACFBs may be a feasible option for removal.

A rare intraocular foreign body resulting from a workplace accident

A 54-year-old man presented to the ophthalmic emergency department of our center with eye pain and blurred vision in his right eye following a workplace accident. Examination revealed a penetrating corneal injury with the presence of an intraocular foreign body (IOFB) involving the corneoscleral limbus, perforating the cornea, iris, anterior lens capsule, and lens. Immediate surgical intervention was carried out with the extraction of the IOFB, identified as an 8mm mussel shell fragment, and the removal of the resulting traumatic cataract. Both preoperative and postoperative examinations showed an attached retina with no signs of retinal tears or vitreous hemorrhage. Appropriate management in this case, along with the timely identification of the agent, led to favorable outcomes despite the size of the intraocular foreign body.

Development, comparison, and internal validation of prediction models to determine the visual prognosis of patients with open globe injuries using machine learning approaches

INTRODUCTION

Open globe injuries (OGI) represent a main preventable reason for blindness and visual impairment, particularly in developing countries. The goal of this study is evaluating key variables affecting the prognosis of open globe injuries and validating internally and comparing different machine learning models to estimate final visual acuity.

MATERIALS AND METHODS

We reviewed three hundred patients with open globe injuries receiving treatment at Khatam-Al-Anbia Hospital in Iran from 2020 to 2022. Age, sex, type of trauma, initial VA grade, relative afferent pupillary defect (RAPD), zone of trauma, traumatic cataract, traumatic optic neuropathy (TON), intraocular foreign body (IOFB), retinal detachment (RD), endophthalmitis, and ocular trauma score (OTS) grade were the input features. We calculated univariate and multivariate regression models to assess the association of different features with visual acuity (VA) outcomes. We predicted visual acuity using ten supervised machine learning algorithms including multinomial logistic regression (MLR), support vector machines (SVM), K-nearest neighbors (KNN), naïve bayes (NB), decision tree (DT), random forest (RF), bagging (BG), adaptive boosting (ADA), artificial neural networks (ANN), and extreme gradient boosting (XGB). Accuracy, positive predictive value (PPV), recall, F-score, brier score (BS), Matthew correlation coefficient (MCC), receiver operating characteristic (AUC-ROC), and calibration plot were used to assess how well machine learning algorithms performed in predicting the final VA.

RESULTS

The artificial neural network (ANN) model had the best accuracy to predict the final VA. The sensitivity, F1 score, PPV, accuracy, and MCC of the ANN model were 0.81, 0.85, 0.89, 0.93, and 0.81, respectively. In addition, the estimated AUC-ROC and AUR-PRC of the ANN model for OGI patients were 0.96 and 0.91, respectively. The brier score and calibration log-loss for the ANN model was 0.201 and 0.232, respectively.

CONCLUSION

As classic and ensemble ML models were compared, results shows that the ANN model was the best. As a result, the framework that has been presented may be regarded as a good substitute for predicting the final VA in OGI patients. Excellent predictive accuracy was shown by the open globe injury model developed in this study, which should be helpful to provide clinical advice to patients and making clinical decisions concerning the management of open globe injuries.

Management of scleral tears with concurrent intraocular foreign bodies and factors affecting outcomes

AIM

To report the clinical settings and factors predicting outcomes in scleral tears with concurrent retained intraocular foreign bodies METHODS: All cases with scleral and corneoscleral wounds with retained intraocular foreign bodies (RIOFB) from January 2014 to January 2021 were retrospectively analysed. Favourable anatomic outcome was defined as presence of globe integrity, attached retina, absence of hypotony and active inflammation at last visit. Favourable functional outcome was defined as final visual acuity (VA) > 20/200.

RESULTS

Total 139 eyes were included. Mean age was 30.66 ± 13.32 years (median 29 years, IQR 17). Penetrating trauma accounted for 87.1%, rupture for 5.8%, perforation for 7.2%. In 5.8% of the eyes the injury involved zone I extending till Zone II while in 66.9% it involved Zone II and in 27.3% in Zone III. Snellen visual acuity at presentation was logMAR 2.97 ± 1.01 and at last visit was logMAR 2.38 ± 1.45 (p < 0.0001). Time between presentation and repair was 13.93 ± 19.56 h (median 7.6 h, IQR 17.17). Favourable functional outcome was seen in 34.5% eyes and 2/3rd achieved favourable anatomic outcome. Absence of endophthalmitis (OR = 6.25, p = 0.003) and ability to remove the foreign body (OR = 7.05, p = 0.003) were associated with a favourable anatomic outcome. Better presenting Snellen visual acuity (OR = 2.77, p = 0.003), manifest scleral tear (OR = 3.36, p = 0.04), and absence of endophthalmitis (OR = 50, p = 0.0009) were associated with a favourable functional outcome.

CONCLUSION

A third of the cases achieved favourable visual outcome while 2/3rd achieved favourable anatomic outcome. Absence of endophthalmitis is an important factor predicting both.

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.

Intraocular foreign body in the anterior chamber angle misdiagnosed as herpetic stromal keratitis

We report a case of a metallic intraocular foreign body (IOFB) retained in the anterior chamber (AC) angle that was masquerading as herpetic stromal keratitis. A 41-year-old male construction worker was referred to our ophthalmology clinic with the complaint of consistent blurred vision for 3 days in his left eye. He had no history of ocular trauma. The best-corrected visual acuity was found to be 10/10 in the right eye and 8/10 in the left eye. On slit-lamp examination of the anterior segment, the right eye was normal, while the left eye showed unilateral corneal edema and scarring, anterior lens capsule opacification, +2 cells in the AC, and the Seidel test was negative. Fundus examination was normal bilaterally. Despite there not being history of it, we still suspected ocular trauma considering the patient's occupational risk. Consequently, an orbital computed tomography imaging was performed which revealed a metallic-IOFB in the inferior iridocorneal angle. On the second follow-up day, the corneal edema regressed, and a gonioscopic examination of the affected eye was performed, showing a small foreign body embedded in the inferior iridocorneal angle of the AC. Subsequently, the IOFB was surgically removed using Barkan lens, and excellent visual results were achieved. This case emphasizes the importance of considering IOFB in the differential diagnosis of patients with unilateral corneal edema and anterior lens capsule opacification. Fur-thermore, the presence of IOFB should be definitely excluded in patients with occupational risk of ocular trauma even if there is no history of trauma. More awareness about the proper use of eye protection should be raised to circumvent penetrating ocular-trauma.

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.

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.

Endophthalmitis, Visual Outcomes, and Management Strategies in Eyes with Intraocular Foreign Bodies

Purpose

Patients and Methods

Results

Conclusion

Comparison of Two Cases of Foveal Laceration Caused by a Mower

We report and compare 2 cases of open globe injury with foveal damage incurred while mowing. Case 1 is a healthy 67-year-old man presenting with an intraocular metallic foreign body and eye pain in his right eye after using a mower. The foreign body perforated the cornea's inferior area and damaged the foveal centralis, leading to central scotoma and decreased visual acuity. 27G pars plana vitrectomy was performed, and the final corrected decimal visual acuity was 0.1, but the visual field was preserved, except for the central scotoma. Case 2 is a healthy 50-year-old man presenting open globe injury with an intraocular metallic foreign body while using a mower. The foreign body damaged the fovea and triggered extensive retinal detachment. One month after surgery, proliferative vitreoretinopathy occurred, requiring additional surgery. The final corrected decimal visual acuity dropped to 0.05, resulting in an extensive visual field defect. Both cases of eye trauma were caused by mower injury, but the visual function outcomes differed with the size of the foreign body and the injury severity at the time of onset. Mower eye trauma is preventable, and efforts to educate users on safety measures are needed.

"IRIS SHELF" TECHNIQUE FOR MANAGEMENT OF POSTERIOR SEGMENT INTRAOCULAR FOREIGN BODIES

PURPOSE

To describe "iris shelf" technique for removal of posterior segment intraocular foreign bodies (IOFBs) through a corneal incision combined with phacovitrectomy and to report its outcomes.

METHODS

Medical records of patients with posterior segment metallic IOFBs who had combined phacovitrectomy were collected and analyzed. In all patients, the IOFB was placed on the iris surface after forming the anterior chamber with viscoelastic to be extracted through a corneal phacoemulsification incision.

RESULTS

Thirty-three eyes of 33 male patients with a mean age of 31.6 ± 8.3 years were included in the study. The mechanism of injury was hammering in 24 eyes (72.7%) and gunshot in 9 eyes (27.3%). The mean interval between injury and IOFB removal was 14.76 ± 6 days. The mean IOFB volume was 8.5 ± 5.5 mm3, and its longest dimension was 3.45 mm (range, 1-8 mm). The mean preoperative corrected distance visual acuity changed from 20/1,500 (1.79 logarithm of the minimum angle of resolution) to 20/94 (0.67 logarithm of the minimum angle of resolution), postoperatively (P < 0.001). Postoperative complications included retinal detachment (two eyes), proliferative vitreoretinopathy (one eye), epiretinal membrane (one eye), and posterior synechiae (three eyes).

CONCLUSION

The "iris shelf" technique with phacovitrectomy is a safe and reproducible approach for posterior segment IOFB extraction through a corneal incision with favorable visual and anatomical outcomes.

Intraocular foreign body in the anterior chamber angle of the eye-a 30-year-old 'emergency'

We report an unusual case of a missed intraocular foreign body, which was incidentally discovered in the anterior chamber drainage angle of the left eye of a retired masonry worker, some 30 years after the inciting injury. The ocular penetration and intraocular foreign body were missed during initial emergency management, despite the high-velocity mechanism of chiselling granite, which was reported. This case effectively highlights the need for a careful history and examination in high-velocity injuries to the eye (such as those caused by hammering and grinding), a high index of suspicion for intraocular foreign bodies, and considers best practice in managing such presentations.

Intraocular Foreign Bodies: Clinical Characteristics and Factors Affecting Visual Outcome

Objective

To investigate the clinical characteristics and factors affecting visual outcome in patients with intraocular foreign bodies (IOFBs) and determine the risk factors for the development of endophthalmitis. Study Design. A retrospective case-series study design was adopted.

Subjects

In total, 242 patients (242 eyes) who were hospitalized and underwent surgical treatment for IOFB at the Second Hospital of Hebei Medical University between January 1, 2008, and December 31, 2019, were included.

Methods

The demographic data, cause of injury, characteristics of IOFBs, postinjury ocular manifestations, and surgical details of the subjects were collected, and the factors affecting visual outcome and endophthalmitis development were analyzed.

Results

The most common cause of IOFBs was the propulsion of foreign bodies into the eye due to hammering (149 cases, 61.57%), followed by foreign body penetration (57 cases, 23.55%). Most of the subjects were young adult men who sustained injuries in the work environment. Poorer visual outcomes were found in subjects with initial presenting symptoms visual acuity (PVA) < 0.1, largest IOFB diameter ≥ 3 mm, IOFBs located in the posterior segment, wound length > 5 mm, entrance wound length larger than the largest IOFB diameter, concomitant retinal detachment, concomitant vitreous hemorrhage, concomitant endophthalmitis, and concomitant proliferative vitreoretinopathy (PVR). Factors related to the development of endophthalmitis included lens capsule rupture, time of stage 1 repair surgery ≥ 24 h after trauma, removal of IOFBs ≥ 24 h after trauma, and nonadministration of intravitreal antibiotic injection.

Conclusion

Among patients with IOFBs, initial PVA < 0.1, entrance wound length larger than the largest IOFB diameter, concomitant endophthalmitis, and concomitant PVR were risk factors for poor visual outcomes. Lens capsule rupture was a risk factor for endophthalmitis development, and the administration of intravitreal antibiotic injection was a protective factor against endophthalmitis development.

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.

Epidemiology, Clinical Characteristics, and Visual Outcomes of Patients with Intraocular Foreign Bodies in Southwest China: A 10-Year Review

INTRODUCTION

Intraocular foreign bodies (IOFBs) are a serious subset of open-globe injury that can result in visual loss. This study analyzed the epidemiology, clinical characteristics, and visual outcomes of patients with IOFBs in Southwest China.

METHODS

This retrospective study comprised 1,176 patients with the primary diagnosis of IOFBs who resided in Sichuan Province over a 10-year period. All data were collected from medical records and analyzed statistically.

RESULTS

The annual incidence for IOFBs was 0.14 per 100,000 (95% confidence interval 0.12-0.16 per 100,000) people in Southwest China. In that period, IOFBs accounted for 22.3% of all open-globe injuries. Working-age male patients accounted for 79.1% of all IOFBs patients and there had significant differences in age distributions between genders (p < 0.001). Metallic IOFBs were the most common (74.6%) IOFB, but there were significant differences in the materials of IOFBs between adults and children of different age-groups (p < 0.001). At discharge, 277 (23.6%) patients had increased visual acuity (VA) and 95 (8.0%) had no light perception. Initial VA <20/200 (odds ratio [OR], 5.5; p < 0.001), increasing wound size (OR, 1.3; p = 0.004), IOFBs in the posterior segment (OR, 2.6; p = 0.002) and existing complications (traumatic cataract, endophthalmitis, retinal detachment, or retinal break) were independent risk factors for final VA <20/200.

CONCLUSION

The incidence of IOFBs in Southwest China differed from global statistics. Adults and children had different clinical characteristics. Thus, their prevention strategies should be different.

Open-globe-injury: A single center Spanish retrospective 5-year cohort study

PURPOSE

To review and analyze the epidemiological profile, clinical characteristics and visual outcomes in patients attended for traumatic open globe injury (OGI) at our hospital over a 5-year period.

DESIGN

Retrospective chart review study.

METHODS

Retrospective analysis of all patients attended at Fundación Jiménez Díaz University Hospital for OGI between 2011 and 2015. Data from 104 patients including demographics, ocular examination, medical and surgical treatment, visual outcomes, and complications were analyzed.

RESULTS

Most patients were male (79.8%) and the median age at the time of injury was 41 years (interquartile range 31.5-58 years). Work-related accidents represent more than half of the cases and their main mechanism was penetrating trauma or foreign body. This type of accident had good prognosis (median final visual acuity in decimal scale 0.8; interquartile range 0.4-1). Falls were the second most common cause of OGI, predominantly affecting senior women (50%), with a high incidence of ocular rupture (50%) and associating a poor visual prognosis (median final visual acuity 0.01; interquartile range 0-0.5). There was a strong correlation (0.75; p < 0.001) between ocular trauma score (OTS) and final best corrected visual acuity.

CONCLUSIONS

Two different patterns of OGI were identified in our sample. Work-related trauma in young males was the most common form of OGI and was associated with good prognosis. However, falls in senior women were associated with poor prognosis.

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.

Timely Use of Conventional Vitrectomy and Endoscope-Assisted Vitrectomy for Endophthalmitis Following Open Ocular Trauma: A Retrospective Study of 18 Patients

Background

Endophthalmitis, or inflammation of the internal tissues of the eye, may follow trauma and results in loss of vision if not treated promptly. Vitrectomy is used to debride the inflamed vitreous. This retrospective study aimed to compare the outcome from conventional vitrectomy (CV) and endoscope-assisted vitrectomy (EAV) performed for endophthalmitis within five days and 10 days after open ocular trauma.

Material/Methods

The clinical data from 18 patients (18 eyes) with endophthalmitis caused by open ocular trauma were analyzed at a single center. CV or EAV was performed based on the degree of vision and the involvement of the vitreous cavity.

Results

Of the 18 patients with endophthalmitis, seven patients underwent EAV, and 11 patients underwent CV. The number of cases with preoperative corneal laceration, edema, bleeding, and formation of corneal nebular opacity was higher in the EAV group compared to the CV group. Four patients had retinal detachment, of which three patients were treated with EAV. Seventeen patients had their sight restored by a single vitrectomy procedure. In 10 cases, the culture of the vitreous fluid was positive for infection, and eight patients had Gram-positive Staphylococcus epidermidis infection. Follow-up showed that vitrectomy performed within five days (P=0.001) and 10 days (P=0.047) of open ocular trauma resulted in significant improvement of visual acuity.

Conclusions

Vitrectomy for endophthalmitis due to open ocular trauma performed within five days of injury restored visual acuity. EAV was shown to be an effective alternative to CV.