Retinal detachment after posterior segment intraocular foreign body injuries.

Abstract

To identify the risk factors for retinal detachment after posterior segment intraocular foreign body (IOFB) injuries and to study the association between the development of retinal detachment and visual outcome. Ninety-six consecutive patients with posterior segment IOFB injuries were retrospectively reviewed. Vitrectomy techniques were used in primary and secondary treatment. Two eyes were eviscerated after primary repair because of Clostridium perfringens endophthalmitis. Factors analyzed included (1) entrance wound location, (2) presence of uveal prolapse, (3) presence of vitreous prolapse, (4) presence of traumatized iris, (5) presence of endophthalmitis, (6) location of IOFB, (7) size of IOFB, (8) use of scleral buckling and/or an encircling band, (9) use of gas tamponade, (10) use of lensectomy. Data were analyzed using univariate and multivariate logistic regression analysis. Retinal detachment was present in 6 eyes at presentation and occurred in another 19 eyes after vitrectomy. After a mean follow-up of 8.6 months, 63 (65.6%) eyes achieved visual acuities of 20/200 or better, and total retinal detachment complicated by inoperable proliferative vitreoretinopathy was present in 9 (9.4%) eyes. Multivariate analysis identified retinal detachment as a factor significantly associated with a poor visual outcome (odds ratio = 4.54, 95% confidence interval [CI] = 1.05-19.6). Foreign body size of more than 4 mm (odds ratio = 5.8, 95% CI = 1.66-2.03) and presence of endophthalmitis (odds ratio = 11.7, 95% CI = 2.57-52.9) were identified as the only predictive factors for the development of retinal detachment after vitrectomy. Use of prophylactic scleral buckling and/or an encircling band reduced the risk of developing postoperative retinal detachment. Retinal detachment after posterior segment IOFB injuries is associated with a poor visual outcome. Large IOFB and presence of endophthalmitis are the strongest predictive factors for the development of retinal detachment.