Prognostic factors in ocular injuries caused by intraocular or retrobulbar foreign bodies

Abstract

Objective To evaluate prognostic factors associated with final visual outcome, development of posttraumatic infectious endophthalmitis, and occurrence of proliferative vitreoretinopathy in patients with penetrating ocular injuries caused by intraocular or retrobulbar foreign bodies (FBs). Design Clinic-based cross-sectional study. Participants One hundred thirty patients presenting with penetrating ocular injuries caused by lacerations from FBs were operated on by one of two surgeons between 1989 and 1997. Follow-up time was an average of 20.84 ± 20.76 months (median: 17.0 months). All FBs were located posterior to the lens. Interventions Pars plana vitrectomy; foreign body removal; additional surgical procedures according to the clinical situation. Main outcome measures Postoperative visual acuity; posttraumatic infectious endophthalmitis; proliferative vitreoretinopathy. Results Occurrence of posttraumatic infectious endophthalmitis developing in seven patients (7/130 = 5.4%) was significantly ( P = 0.026) associated with removal of the FB later than 24 hours after the accident and with the type of the FB ( P < 0.01). Size ( P = 0.37) of the FB, preoperative visual acuity ( P = 0.62), presence of traumatic cataract ( P = 0.75) or a retinal lesion by the FB ( P = 0.16), age ( P = 0.39), and gender ( P = 0.46) did not show a statistically significant influence on the occurrence of endophthalmitis. Statistically significant risk factors for the development of proliferative vitreoretinopathy occurring in 27 patients (27 of 99 [27.6%] patients with a minimal follow-up of 3 months) were size of the FB ( P < 0.001), preoperative visual acuity ( P = 0.02), presence of a retinal lesion ( P = 0.002), and traumatic cataract ( P = 0.03). The time between FB removal and the accident was statistically marginally associated with the development of proliferative vitreoretinopathy ( P = 0.07). Postoperative visual acuity depended significantly on size of the FB ( P = 0.002), preoperative visual acuity ( P < 0.001), presence of a retinal lesion ( P = 0.049), and location of the retinal lesion ( P < 0.001). Three eyes had to be enucleated because of endophthalmitis or phthisis bulbi. Conclusions Prognosis in open-globe injuries with intraocular or retrobulbar foreign bodies depends on the size and type of the foreign body, presence and location of retinal lacerations, additional involvement of other intraocular structures, preoperative visual acuity, and timing of surgery. These factors may be important in preoperative counseling of the patient and for planning surgery.