Outcomes of surgery for posterior segment intraocular foreign bodies—a retrospective review of 17 years of clinical experience

Abstract

To determine the outcome of surgery in patients who presented with posterior segment intraocular foreign bodies (IOFBs) and to identify factors associated with poor visual outcome. To assess whether improvement in vitreo-retinal surgical techniques over the past 17 years has resulted in an improvement in the outcome of these patients. A retrospective cohort study carried out at Moorfields Eye Hospital, London. Patients who underwent a primary surgical repair and removal of a posterior segment IOFB were identified using a hospital database. Of the 140 patients identified, 114 (81%) were included in the study. Data on age, activity at time of injury, presenting clinical features, surgical techniques, complications and final visual outcome were recorded and analyzed. The mean age at time of injury was 34.6+/-12.4 years. All patients were male. The majority of IOFBs were metal (83%). Hammering and chiselling were the most common activities at the time of injury (66%). Fifty-three percent of patients presented with a visual acuity of 6/ 36 or better. Primary closure was achieved in a median of 1 day (interquartile range 1-3 days) following injury. A final visual outcome of 6/60 or worse was documented in 31%. Presentation with a relative afferent pupillary defect (P<0.001), hyphaema (P=0.024), vitreous haemorrhage (P=0.003), uveal prolapse (P=0.038) or retinal detachment (P=0.031) was associated with a poor visual outcome (6/60 or worse). Postoperative complications of retinal detachment (P<0.001) and proliferative vitreoretinopathy (P<0.001) were prognostic of poor final visual acuity. Improvements in surgical techniques, e.g. panoramic viewing systems has resulted in a significant improvement in the final visual outcome of these patients (P=0.043). This large series of posterior segment IOFBs shows that recent advances in surgical techniques are associated with a significant improvement in prognosis.