Clinical treatment for perforating injuries with foreign bodies located at posterior global wall

Abstract

To describe the clinical features and surgical outcomes in a series of patients with perforating injuries and foreign bodies located at the exit wound in posterior global wall. Retrospective case series of 17 eyes of 17 patients were included in the study, each patient who received treatments between January 2006 and December 2010 had perforating injuries with foreign bodies located at posterior global wall. The exit wounds of perforating injuries were in the area of optic disc and macula in 8 eyes. Seventeen eyes had vitreous hemorrhage, 11 eyes had traumatic cataract, 8 eyes had retinal detachment and one eye had endophthalmitis. According to different therapeutic regimen, cases were divided into two groups. Group A (7 cases) underwent vitrectomy combined with extraction of foreign body as an emergency operation. Group B (10 cases) underwent extraction of foreign body as an emergency operation and secondary vitrectomy were performed 1 - 2 weeks later. The mean follow-up time was 18 months (ranged from 9 - 47 months). The functional and anatomical results were compared between Group A and B. Fisher's exact test were used to analyze the data. The foreign bodies were extracted in 17 cases. Poor final best corrected visual acuity (BCVA) (worse than or equal to 0.1) was presented in all 8 cases with the exit wound being in the area of optic disc and macula, but only in 4 of 9 cases with the exit wound located in other sites, the difference between these two groups was statistically significant (P = 0.029). At final follow-up, vision was improved in 5 cases from Group A and 7 cases from Group B (P = 1.000); BCVA were better than or equal to 0.1 in 4 cases from Group A and 3 cases from Group B (P = 0.350) the differences were statistically nonsignificant. Intraoperative leakage at the exit wound occurred in 4 cases from Group A and one from Group B, the difference was statistically significant (P = 0.015). Intraoperative retinal detachment and postoperative silicone oil leakage occurred in 2 cases from Group A and none from Group B (P = 0.154). Postoperative retinal detachment occurred in 1 case from Group A and 3 cases from Group B (P = 0.603). Silicone oil-dependent eye occurred in 1 case from Group A and 2 cases from Group B (P = 1.000); the differences were statistically nonsignificant. The visual prognosis is worse in cases with the exit wound being in the area of optic disc and macula. Both therapeutic regimens were effective, but each has their pros and cons. Appropriate therapeutic regimen should be selected in term of situations. To avoid leakage at the exit wound in vitrectomy, we recommend therapeutic regimen B be selected first.