Facteurs de risque de décollement de rétine après extraction de corps étrangere intraoculaires

Abstract

Background: Better identification of patients at risk for retinal detachment after intraocular foreign body removal would guide management as well as help prevent this complication. We performed a study to identify risk factors for secondary retinal detachment in eyes with retained intraocular foreign bodies.Methods: We reviewed the records of 102 consecutive patients (95 males and 7 females with a mean age of 31.6 years) seen between 1990 and 1995 at one ophthalmology service for intraocular foreign body after penetrating ocular injury. All eyes underwent primary surgical repair and foreign body removal (via electromagnet or vitrectomy). The mean length of follow-up was 2 years (range 6 months to 6 years). Survival analysis (Kaplan-Meier, Cox regression) was performed to determine predictors of retinal detachment.Results: The foreign body was metallic in 95% of cases and magnetic in 60%. The largest diameter was 3 mm or more in 35% of cases (range I mm to 25 mm, mean 3.6 mm). The foreign body was preretinal or intraretinal in 24 patients (24%), intravitreal in 47 (46%), located in the sclera in 16 (16%) and located in the anterior segment in 15 (15%). A secondary retinal detachment developed in 25 patients (24%) after foreign body removal, with a mean delay of 4.6 (standard deviation 7.6) months (range 7 days to 31 months). The posterior pole was detached in 15 patients (60%). The retinal detachment was total in 13 patients (52%). Proliferative vitreoretinopathy was noted in 13 cases (grade B in 3, grade C I in 3, grade C I in I, grade C3 in I, and grade C4 in 5). Univariate analysis using Kaplan-Meier survival showed that firearm injuries, visual acuity less than 201200, presence of hyphema, presence of tissue prolapse and presence of vitreous hemorrhage at the initial examination were significantly associated with the occurrence of secondary retinal detachment. On multivariate analysis (Cox regression), two independent and combined factors were predictive of retinal detachment: initial visual acuity less than 201200 (odds ratio 5.5, p = 0.02) and presence of vitreous hemorrhage (odds ratio 2.2,p=0.05).Interpretation: Patients at risk for secondary retinal detachment after penetrating ocular injury with retained intraocular foreign body can be identified at the initial examination.