Analysis of outcomes of secondary intraocular lens implantation in open-globe injury after vitrectomy

Abstract

To explore the time and method of secondary intraocular lens (IOL) implantation in open-globe injury after vitrectomy and to analyze the efficacies and relative factors of the treatment. This is a retrospective case series study. Clinical data of 78 eyes of 78 patients with open-globe injury who underwent secondary IOL implantation after vitrectomy in Tianjin Medical University General Hospital from 2007 to 2012 were analyzed. There were 27 eyes of 27 patients with penetrating injury, 36 eyes of 36 patients with intraocular foreign body (IFB), 4 eyes of 4 patients with ocular rupture, and 11 eyes of 11 patients with endophthalmitis. The IFB included magnetic foreign body in 23 eyes of 23 patients, glass foreign body in 6 eyes of 6 patients, and eyelash foreign body in 7 eyes of 7 patients. Thirty-one eyes of 31 patients were tamponadewith silicone oil, and 47 eyes of 47 patients were tamponadewith C3F8 during vitrectomy. The methods of IOL implantation included posterior chamber IOL implantation in 32 eyes of 32 patients and sulcus-fixed IOL implantation in 46 eyes of 46 patients. The examinations before IOL implantation mainly included visual acuity, slit lamp biomicroscope, direct and indirect ophthalmoscope, visual electrophysiology, corneal endothelium, B scan, ultrasound biomicroscope and intraocular pressure. Four eyes of 4 patients underwent suturing of peripheral iris, and 5 eyes of 5 patients underwent suturing of iris laceration. The visual acuity ranged from light perception to 0.1 before vitrectomy. The mean follow-up time was 15 ± 3 months with a range from 6 to 36 months. The mean interval between IOL implantation and vitrectomy was 2.5 ± 0.2 months with a range from 1.5 to 6 months. The best corrected visual acuity was from 0.1 to 1.0 after vitrectomy. The uncorrected visual acuity ranged from 0.1 to 0.8, and the best corrected visual acuity was from 0.1 to 1.0 after IOL implantation. The postoperative complications mainly included mild anterior chamber exudates in 4 eyes of 4 patients, temporary intraocular pressure elevation in 7 eyes of 7 patients, and recurrent retinal detachment in 2 eyes of 2 patients. The appropriate interval of secondary IOL implantation in open-globe injury after vitrectomy is important. Posterior chamber IOL implantation is performed in eyes with integrity of posterior capsule, and IOL sutured in the sulcus in eyes without posterior capsule support. It is safe and effective for secondary IOL implantation in open-globe injury after vitrectomy.