Letters to the Editor

Abstract

After thoroughly reading Mr. Tripathi’s letter, it is obvious that he believes the time interval between injury and presentation is a critical prognostic factor in visual outcomes in patients with intraocular foreign bodies (IOFB). He states that we “completely ignored” this parameter in our article. We would like to point out that a more thorough reading of our article would show that this factor was mentioned three times. In the Patients and Methods section, we report that “the time from injury to initial surgical intervention was recorded.” In our Results section we state, “Our goal was to remove the foreign body in a timely manner. In some cases, delayed presentation by the patient or delayed referral by the referring physician prolonged the interval from the trauma to IOFB removal. However, the time between the trauma and the removal of the IOFB was less than 24 hours in 39 patients (66%), between 24 and 48 hours in 12 patients (20%), and more than 48 hours in 8 patients (14%).” Similarly, in the Discussion section we state, “Endophthalmitis has been estimated to occur in 0 to 10% of patients with retained IOFBs. We were fortunate to have no cases of endophthalmitis in our series. The precautions that we took included taking the patient to the operating room as expeditiously as possible.” We regret that Mr. Tripathi completely ignored these three paragraphs while reading our article. We obviously also advocate a prompt removal of an IOFB as expeditiously as possible. Surprisingly, his reference 1 looked at whether delay in vitreoretinal management affected final visual outcome and, indeed, there was no correlation with final visual acuity in this study (footnote 1). Despite the absence of a correlation as noted in this article, we still advocate prompt removal of the intraocular foreign body. As to Mr. Tripathi’s assertion that, “This article has nothing new to offer the reader,” we would like to reiterate the strengths of our series and summarize our article: 1.This was a relatively large series of 62 patients with IOFB with greater than a 6-month follow-up achieved on more than 95% of the patients.2.The final visual acuity achieved in these eyes was 20/40 or better in 71%, and 85% achieved ambulatory vision of greater than 05/200.3.No cases of endophthalmitis were recorded, and we attribute that to luck and prompt intervention.4.We hoped to point out that vitrectomy is not the only procedure for removing IOFBs in the vitreous cavity or embedded in the retina. In Mr. Tripathi’s references 2 and 3, 100% of 88 eyes had the foreign body removed with pars plana vitrectomy. We believe that other techniques—the external magnet and scratching down through sclera in foreign bodies embedded in the retina anterior to the equator—can be effective in managing these cases. Although these techniques may not be “new,” they are previously described methods of foreign body removal that may have been forgotten.1De Souza S. Howcroft M.J. Management of posterior segment intraocular foreign bodies 14 years’ experience.Can J Ophthalmol. 1999; 34: 23-29PubMed Google Scholar, 2Lam S.R. Devenyi R.G. Berger A.R. Dunn W. Visual outcome following penetrating globe injuries with retained intraocular foreign bodies.Can J Ophthalmol. 1999; 34: 389-393PubMed Google Scholar, 3Jonas J.B. Budde W.M. Early versus late removal of retained intraocular foreign bodies.Retina. 1999; 19: 193-197Crossref PubMed Google Scholar