Vitrectomy for ocular perforating wounds caused by foreign bodies

Abstract

Objective To evaluate the effect of vitrectomy for ocular perforating wounds caused by foreign bodies;to investigate the surgical approach for removing foreign bodies and the timing of the vitrectomy.Methods This was a retrospective case-series study.Fifty-six cases (56 eyes) of ocular perforating wounds were analyzed.Patients were divided into an eye-wall foreign body group (24 cases) and an intraorbital foreign body group (32 cases) based on the results of computer tomography (CT) and ultrasonography positioning.Twenty-four cases with eye-wall foreign bodies underwent vitrectomy within 1 week after the injury.Twenty-two cases of intraorbital foreign bodies underwent orbital foreign body removal combined with scleral wound closure.The other 10 cases were not candidates for foreign body removal because the foreign bodies were located in the posterior pole or deep orbit.All eyes with intraorbital foreign bodies underwent vitreoretinal surgery about 2 weeks after injury.Patients were followed up for 3 to 12 months,visual acuity (VA) was evaluated and complications were noted.The factors affecting visual acuity were analyzed using Chi-square tests.Results Postoperative VA improved in 50 patients (89％).The VA of 34 patients (61％) was greater or equal to 0.05.The factors that influenced VA included the position of the anterior (x2=7.69,P=0.01) and posterior wound (x2=21.83,P＜0.01),retinal (x2=16.64,P＜0.01) and choroidal detachment (x2=7.73,P=0.01) and endophthalmitis (x2=6.89,P=0.01).After surgery,retinal detachment occured in 6 cases,hypotension in 2 cases and macular preretinal membrane or macular pucker in 12 cases.Conclusion The following factors are crucial in successfully dealing with ocular perforating wounds caused by foreign bodies:choose the right surgical approach and the timing of the vitrectomy based on the position of the foreign body and intraocular conditions,minimize the damage to the retina and prevent proliferative vitreoretinopathy. Key words: Eye injuries; Wound,penetrating; Vitrectomy; Eye foreign bodies