Size Of Intraocular Foreign Bodies Research Articles

Traumatic intraocular foreign bodies

Background Ophthalmic trauma caused by intraocular foreign bodies (IOFBs) can impact visual prognosis by generating direct ocular structural damage. Factors bearing poor visual prognosis are related to size and velocity of IOFB, location in posterior segment with associated retinal detachment or endophthalmitis. Current study is aimed to evaluate size and location of IOFB and associated ocular structural damage. Methods In this retrospective study done at single tertiary center, patients injured by IOFBs were analyzed between January, 2010 to January, 2021 for ocular structural damage caused by size, velocity and location of impacted IOFB. All were assessed for corneal or scleral perforation and other structural damage due to IOFB. Location, route of retrieval and size of IOFB was measured. Results All 41 eyes were operated for removal of metallic IOFB. Corneal repair was done in 90.2% and scleral repair in 9.8% eyes. Hyphema cleared in 53.6% eyes. Traumatic cataract in 85.4% requiring phacoemulsification, preexisting aphakia (previous surgery) and siderosis was seen in 2.4% eyes. Retinal detachment was present in 14.6% and endophthalmitis in 4.9% eyes. Location of IOFB was on iris and lens in 2.4% each, with 19.5% impacted in retina and 75.6% were isolated in vitreous cavity. Small size IOFB was 58.3%, medium size was 29.3%, large size was 4.9% and very large size was 7.3%. No eye was deformed requiring evisceration of enucleation. Corneal or scleral repair, phacoemulsification, pars plana vitrectomy and intraocular foreign body removal as one stage procedure was done in each case. Intraocular lens implantation was done where sufficient anterior or posterior capsule was present. Conclusion Trauma caused by IOFB is commonly seen at workplace in young male laborers. It usually presents as corneal or scleral perforation, traumatic cataract, endophthalmitis and retinal detachment. Level of structural damage to ocular structures is dependent on the size, velocity and location of IOFB impaction. One stage surgical intervention for wound closure and IOFB should be considered for better surgical prognosis.

Exploring Minimum Secondary Injury for the Treatment of Ocular Trauma With Giant Intraocular Foreign Bodies.

PurposeTo investigate the clinical therapy for giant intraocular foreign bodies (IOFBs) and evaluate the best treatment method with minimum secondary injury.MethodsWe retrospectively analyzed the data of 73 eyes of 73 patients with ocular trauma caused by giant IOFBs between January 2016 and December 2018. The IOFB size, localization, shape, and magnetic properties were recorded. The best corrected visual acuity (BCVA), ocular tissue injuries, entrance wound, interval time from injury to second phase surgery, silicone oil removal, and globe recovery were also observed. The cases were divided into three groups based on the following IOFB extraction paths: limbus path, the pars plana path, and the entrance wound path. The BCVA, IOFB size and shape, the wound, endophthalmitis, and silicone oil removal were compared among the three groups.ResultsThe IOFBs were 46 cases of magnetic and 27 cases of nonmagnetic, with a shape of thin flat in 19 cases, thick flat in 12 cases, long in seven cases, and irregular in 35 cases. Multiple damages were caused by the giant IOFBs, mainly involving the severe cornea, lens, and retina injuries. The postoperative BCVA increased compared with the preoperative BCVA (z = −6.06, P < 0.01). The rate of recovery from blindness was 40.85% (29/71). The thin flat IOFB and long IOFB resulted in a better postoperative BCVA than the other two IOFB shapes (all P < 0.05). The irregular IOFB had a poorer silicone oil removal rate than the other three IOFB shapes (all P < 0.05). The IOFB extraction followed the limbus path in 18 cases, pars plana path in 27 cases, and entrance wound path in 28 cases. The IOFB length and width in the pars plana path group were significantly lower than that in the limbus path group (all P < 0.05), the preoperative BCVA of the pars plana path group was superior to that of the limbus path group (P < 0.05), and the IOFB length, width, and entrance wound length in the pars plana path group were significantly lower than in the entrance wound path group (all P < 0.05). But the postoperative BCVA in the pars plana path group was not better than that in the other two groups (all P > 0.05). The postoperative BCVA of the entrance wound path group was significantly superior to that of the limbus path group (z = −2.01, P = 0.04), while there was no difference between the two groups in IOFB length, width, entrance wound length, or preoperative BCVA (all P > 0.05).ConclusionThe entrance wound path would benefit to minimize secondary injury in giant IOFB extraction procedure, compared with the limbus and pars plana path.

Clinical characteristics and prognostic factors for visual outcome in 669 patients with intraocular foreign bodies.

To describe the clinical characteristics and analyze prognostic factors that influence visual outcome in 669 patients with intraocular foreign bodies (IOFBs). Medical records of 669 patients with IOFBs from West China Hospital were reviewed. Best corrected visual acuity (BCVA) values were recorded using standard Snellen acuity chart and were converted to logarithm of the minimum angle of resolution (logMAR) scale for statistical analysis. The visual outcome was defined by the final BCVA (excellent visual outcome: final BCVA of 20/40 or better; poor visual outcome: final BCVA less than 20/200). Statistical analysis of collected data was performed using IBM SPSS Statistics version 23. A 2-tailed P value of less than 0.05 was considered statistically significant throughout the study. The average age ranged from 1 to 79 years old (mean age, 34.8±12.7 SD) and the majority of patients were men (626, 93.6%). The major cause of ocular injury was hammering (383, 57.2%). Almost all the patients (97.8%) underwent surgeries (97.8%) and the average time interval between injury and surgery was 26.4±322.3d (0-7300), while 327 patients received surgeries within 24h (48.9%) and 590 patients received surgeries within seven days (88.2%) after IOFBs injury. The poor BCVA was associated with older age (P=0.013), larger IOFBs size (P<0.001), presence of complications (P<0.001) and worse presenting BCVA (P<0.001). On the contrary, younger age (P=0.005), smaller IOFBs size (P<0.001), absence of complications (P<0.001) and better presenting BCVA (P<0.001) were considered to relate to excellent BCVA. Multiple prognostic factors may influence the final visual outcome, including age, size of IOFBs, complications and presenting BCVA. Meanwhile, further education and promotion on eye protection should be taken for the improvement on self-protection and self-health awareness.

Clinical characteristics of posterior segment penetrating eye injuries treated in tertiary referral hospital in Serbia

Background/Aim. Ocular trauma is a significant cause of visual impairment worldwide. The aim of the study was to analyze clinical characteristics of patients with penetrating eye injuries with retained intraocular foreign body (IOFB) in posterior segment of the eye. Methods. The retrospective study enrolled medical records of consecutive patients hospitalized in a five year period (2012?2016) in a tertiary referral center in Serbia. Surgical repair included pars plana vitrectomy and IOFB removal. Postoperative results were evaluated using the best corrected visual acuity (BCVA). Results. Out of 130 patients who suffered penetrating eye injury with retained IOFB, 72 had IOFB in posterior segment of the eye (43 in retina, 25 in vitreous, 3 in ciliary body, 1 on the optic nerve). Patients were predominantly young adults (aged 44.3 ? 14.9 years, 97.2% men). Average BCVA at admission was poor (0.27 ? 0.38, measured by Snellen chart), and 52.8% of patients had BCVA of counting fingers at 1 meter or less. The majority of patients had corneal wound (70.8%), medium sized IOFB (48.6%), iris injury (61.1%) and traumatic cataract (69.4%). Complications included retinal detachment (16.7%) and endophthalmitis (15.3%). Two patients had the eye enucleated due to severe endophthalmitis, which could not be otherwise controlled. Significant risk factors for postoperative outcome were: initial BCVA (p &lt; 0.001), ocular hypotony (p = 0.013), medium size of IOFB (p = 0.037), presence of traumatic cataract (p = 0.036), retinal detachment (p = 0.032) and endophthalmitis (p = 0.045). Conclusion. Treatment of posterior segment penetrating eye injuries remains a challenge due to high frequency of low initial visual acuity, retinal detachment and endophthalmitis, all of which are risk factors for poor visual outcome. Patients with better initial BCVA, normal intraocular pressure and small IOFB have better postoperative results.

Intraoperative Macula Protection by Perfluorocarbon Liquid for the Metallic Intraocular Foreign Body Removal during 23-Gauge Vitrectomy.

Purpose. To evaluate visual and safety outcomes of 23-gauge (G) pars plana vitrectomy (PPV) with application of perfluorocarbon liquid (PFCL) for intraoperative protection of the macula during intraocular foreign body (IOFB) removal. Methods. Retrospective study of 42 patients who underwent 23 G PPV for IOFB removal from posterior segment with intraoperative PFCL application for the macula shielding. Collected data included corrected distance visual acuity (CDVA), size of IOFB, and complication rate. The mean follow-up period was 12 months. Results. The mean preoperative CDVA was 0.54 logMAR (SD 0.46), and the final mean CDVA was 0.68 logMAR (SD 0.66). All IOFBs were metallic with mean dimensions of 4.6 mm × 2.1 mm. Twenty-two IOFBs were removed through the corneal tunnel and 20 IOFBs through the sclerotomy. No intraoperative iatrogenic lesion of the macula was observed. As a tamponade, silicon oil was applied in 31 eyes, SF6 gas in 5 eyes, air in 4 eyes, and 2 eyes required no tamponade. Secondary retinal detachment was observed in 17% of cases, but at the end of the follow-up, all the retinas were attached. Conclusion. PFCL application during PPV is a safe method of protecting the macula from unexpected falling of the metallic IOFB during its removal.

An investigation into the accuracy of orbital X-rays, when using CR, in detecting ferromagnetic intraocular foreign bodies

PurposeThe aim of this study is to determine the accuracy of orbital X-rays, when using computed radiography (CR), in detecting ferromagnetic intra-ocular foreign bodies (IOFBs) prior to magnetic resonance imaging (MRI). MethodsA total of 64 orbital X-rays of an anthropomorphic head phantom were acquired using CR. For each image 1, 2, 3, or 4, large, medium, or small IOFBs were fixed to the anterior surface of the left or right orbit. Each of the acquired images with an IOFB was duplicated in order to increase the sample size. A further 16 normal images (no IOFB) were also included in the sample. Observers were invited to review the images and were permitted to manually magnify and window the images to detect any IOFBs present on each image. Results10 observers (4 radiographers; 4 reporting radiographers; 2 consultant radiologists) independently reviewed the images. The mean (SD) sensitivity and specificity were 72.1% (7.3%) and 99.2% (0.8%) for all observers, respectively. According to size the sensitivity in detecting small, medium and large IOFB were 46%, 76% and 93%, respectively. According to location, the lower lateral quadrants had the lowest sensitivity (53%) whereas the upper medial had the greatest (88%). ConclusionFindings from this study using CR support previous conclusions that conventional X-rays fail to detect metallic IOFBs in all cases. Diagnostic performance is governed by IOFB size and location.

Intraocular Foreign Bodies—A Review from Entry to Exit and Beyond

Ophthalmic trauma, the leading cause of irreversible blindness in young adults, may be associated with obvious or occult intraocular foreign bodies (IOFBs). Critical work-up includes careful history-taking as well as slit-lamp and dilated eye examination. These components are frequently supplemented by imaging tests. Currently, computed tomography is the mainstream modality, offering highly sensitive detection and localization of IOFBs as small as 0.5 mm. IOFBs impact visual prognosis by producing direct damage, causing secondary toxicity, and increasing infectious risk. Factors bearing a poor visual prognosis include large IOFB size, posterior segment location of IOFB, and retinal detachment or endophthalmitis on presentation. Timing of IOFB removal is controversial, but when possible, it is preferable to perform extraction within 24 to 48 hours of initial injury. Antibiotic coverage is also recommended with options of oral alone, intravenous followed by oral, or combination of intravitreal and oral. Even as technology and surgical techniques continue to improve IOFB management, we must still advocate accident prevention to our patients through education and emphasis of protective eyewear.

Management and clinical outcomes of intraocular foreign bodies with the aid of orbital computed tomography

BackgroundComputed tomography (CT) is known to be the first-line imaging method for patients with or suspect to have intraocular foreign bodies (IOFBs). The purpose of this study is to evaluate clinical outcomes in the management of IOFBs with the aid of CT. MethodsRetrospective chart review of patients who received orbital CT prior to the removal of an IOFB between January 2000 and December 2010 was carried out. Patients with an IOFB who did not receive an operation or those without a preoperation CT examination were excluded. Twenty patients with a mean age of 37 years were selected. The duration between injury and surgery ranged from hours to 4 months. Detailed information and ophthalmologic examination results including patient history, visual acuity (VA), slit-lamp examination, fundoscopic examination, operation notes and bacterial culture results were recorded for all patients. The orbital CT images were performed with multidetector CT scanners with a 2–3.75 mm slice thickness. ResultsThis study found 18 patients (90%) with only one IOFB on CT image, in which only nine IOFBs were discovered on clinical assessment. The CT image failed to discover the IOFB in two patients who had tiny iron dust fragments located in the cornea stroma or embedded in the lens. Preoperative determination of the IOFB size and location was helpful in the decision-making of the route of extraction.Further, there was a correlation between clinical presentation about vitreous hemorrhage and the development of postoperative retinal detachment (Fisher's exact test, p = 0.029). The presence of positive bacterial cultures was also found to be associated with decreased VA (Fisher's exact test, p = 0.047). The injured eyes were anatomically preserved in all patients. However, two patients had loss of light perception. Eleven patients (55%) had improved VA of more than two lines on Snellen's chart, seven patients worsened, and two patients retained the same initial VA. ConclusionMultidetector CT plays an important role in the detection, localization, size measurement, and surgical approach towards the extraction of the IOFB. The presence of vitreous hemorrhage is a predictive factor for postoperative retinal detachment, and positive bacterial cultures result in poorer visual outcomes.

Extraction of intraocular foreign body at or near the ciliary body under endoscopic vitrectomy

To study the feasibility and effectiveness of the extraction of intraocular foreign body (IOFB) at or near the ciliary body by using endoscopic vitrectomy. It was a retrospective case series study. Clinical materials and data of 15 patients (16 eyes) with IOFB at or near the ciliary body from July 2002 to December 2010 were analyzed retrospectively. Vitrectomy and IOFB extraction under endoscope were conducted in all cases. Thirty six IOFB (18 magnetic and 18 nonmagnetic IOFBs) were extracted successfully. The size of IOFB ranged from smaller than 1 mm×1 mm×1 mm to 9 mm×6 mm×4 mm. Among them, 31 IOFB were extracted from ciliary body or nearby and 5 IOFB were located at other places. The cornea was opaque before the operation in 11 eyes. Postoperative visual acuity was improved in 12 eyes. Vision was improved from finger-counting and below to 0.1-0.3 in 4 eyes. Intraocular pressure was normal in 14 eyes. The retina was reattached in 12 eyes. The cornea was clearer than before in 8 eyes. After the end of the fellow-up, vision was remained in finger-counting and below in only 7 eyes. There was almost no blind spot by using endoscope to observe the ciliary body, periphery retina tear or other pathological changes, the IOFB at or near ciliary body and the whole retina in the vitrectomy. This makes the extraction of IOFB at or near the ciliary body and the conduct of cyclophotocoagulation more accurate and simple.

Composition of intraocular foreign bodies: experimental study of ultrasonographic presentation

To investigate the reliability of ultrasound in determining the size and identify the sonographic features and artifacts generated by intraocular foreign bodies of different materials. Experimental study using 36 enucleated porcine eyes. Fragments of nine different compositions (wood, glass, plastic, cardboard, iron, aluminum, lead, powder and concrete) and similar dimensions (4 mm) were implanted via scleral incision into the vitreous cavity of 36 porcine eyes, four eyes were used for each material. Ultrasound examination was performed in all eyes using the contact technique, conductive gel and 10-MHz transducer (EZScan, Sonomed). Considering the material fragments of gunpowder, lead, concrete, aluminum, wood and glass, the size determined by ultrasound was considered statistically similar to the actual size. The material iron presented ultrasound-determined dimension statistically smaller than its actual size. Cardboard and plastic materials showed ultrasound-determined measurements far greater than the actual. All fragments of intraocular foreign bodies demonstrated hyper-reflective interfaces, irrespective of their composition. Whereas the artifacts generated by different materials, it was found that the materials iron, aluminum and lead showed reverberation of great extent. The material wood showed no reverberation. The length of the reverberation artifact for the materials iron, glass, aluminum and cardboard was lower when compared to other materials. All materials presented posterior shadowing artifact, with the exception of aluminum. Ultrasonography was considered a reliable technique to determine the size of intraocular foreign bodies in pigs, with little influence caused by its composition. Ultrasound artifacts generated were considered material-dependent and can assist the examiner to identify the nature of a foreign body of unknown etiology. Ultrasonography aided the surgeon to identify, locate and measure the intraocular foreign body, directing appropriate surgical planning.

Spectrum of intra-ocular foreign bodies and the outcome of their management in Brunei Darussalam

To review the etiologies, prognostic factors and treatment outcomes of intraocular foreign bodies (IOFBs) occurring in the population of Brunei Darussalam, and provide guidelines to prevent and manage such injuries. A retrospective review was performed for all cases of traumatic IOFBs managed in our centre during a 3-year period between May 2008 and April 2011. The mechanism of injury, management, complications and visual outcomes were analyzed. Majority of the patients were males (93 %) and the mean age was 36 years. The main causes of trauma were metal hammering and grass cutting (43 % each). Other causes include road traffic accidents and firecracker explosion (7 % each). The visual outcome was ≥6/18 in 50 % and 'No perception of light' in 29 %. Causes of poor visual outcome were retinal detachment with proliferative vitreoretinopathy (21 %), endophthalmitis (21 %) and globe maceration (7 %). Prognostic factors associated with significantly worse final visual outcome included posterior location of the IOFB (p = 0.05) and larger IOFB size (p < 0.001). The time from injury to surgery did not correlate with a worse visual prognosis. In Brunei Darussalam, the commonest causes of IOFBs are hammering metal and cutting grass using power tools. The visual outcome varies between 6/6 and NPL. Poor visual outcome is related to the severity of the initial ocular injury, posterior segment IOFB and endophthalmitis.

Corps étrangers intraoculaires (CEIO) du segment postérieur : analyse rétrospective et prise en charge à propos de 57 cas

To determine the influence of prognostic factors and the type of tamponade agent in surgical management of intraocular foreign bodies (IOFBs) for better visual outcome. Fifty-seven consecutive cases were retrospectively reviewed at the XV-XX National Hospital (Paris) between 1 January 2004 and 31 December 2007. Univariate and multivariate analyses were performed to identify prognostic variables. Several parameters were measured: pre- and postoperatively: best corrected visual acuity (BCVA), material and size of the foreign body, entry site, time from trauma to surgical removal, IOFB location, initial retinal detachment, choice of vitreous tamponade agent (none, gas, silicone oil), postoperative visual outcome, and complications (siderosis, endophthalmitis, and vitreoproliferative retinal detachment). Metal IOFBs accounted for the majority with 80.7% (n=46). The inferior retinal segment was the most frequent location found: 47.4% (n=27). Initial and final mean BCVAs were, respectively, 1.47 (±0.99) and 1.03 (±0.96) (LogMar scale). The mean follow-up was 20.7 months (range, 12-60 months). Initial retinal detachment was found in 24.56% (n=14), with a statically worse prognosis. The BCVA was better in the group with gas tamponade (n=16) than in the group with silicone tamponade (n=21) and the group without a tamponade agent (n=20). Initial BCVA was the most important predictive factor for final BCVA. Time to surgery was a predictive factor of final visual outcome with a cut-off in the first week. The scleral or corneoscleral entry site had a better prognosis than the corneal site. Five cases of siderosis (8.7%) related to delayed management and two cases of endophthalmitis (3.5%) were found (despite use of prophylactic systemic antibiotics). No statistical difference was found regarding the IOFB location on the retina, its size, or the material. Finally, the retina remained detached in nine cases (15.78%). A final BCVA of 20/40 or more was obtained in 39.3 and 17.5% had light perception or worse. The prognosis of an IOFB injury is for the most part uncertain due to a complex combination of parameters. Nevertheless, good postoperative results can be achieved without a silicone tamponade agent. The main prognostic factors related to better visual outcome were initial BCVA, time to surgery (first week), initially attached retina, and the scleral entry site. The main complications were vitreoproliferative retinal detachment, endophthalmitis, and siderosis. The location, type, and size of IOFBs were not statistically significant predictive factors in this study.

Assessment of intraocular foreign bodies by helical-CT multiplanar imaging.

The aim of this study was to examine the effectiveness of helical CT in the assessment of intraocular foreign bodies, evaluating two protocols with different collimation. We performed helical-CT studies in 30 patients. Fifteen patients were examined with 1.5-mm collimation and the other 15 patients with 3.0-mm collimation. All other imaging parameters were identical in both protocols. Multiplanar images were reconstructed. The examinations were reviewed for presence, localization and size of intraocular foreign bodies. We compare our results with the surgical data. We estimate the required examination time. In the first group (collimation 1.5 mm) an intraorbital foreign body was detected in 8 of 15 patients. In 3 of 8 patients an intraocular foreign body (all were metallic) was detected. In the second group (collimation 3.0 mm) an intraorbital foreign body was detected in 9 of 15 patients. In 8 of 9 patients an intraocular foreign body (all were metallic) was detected. Our results were confirmed by surgery in all cases. Examination time was 36 s in the first group and 18 s in the second group. Computed tomography should be considered the imaging modality of choice in the assessment of metallic intraocular foreign bodies and 3.0-mm collimation is optional, because of reduced examination time and radiation exposure.

Visual Outcome and Prognostic Factors after Vitrectomy for Posterior Segment Foreign Bodies

To identify the prognostic factors that predict final visual outcome in eyes with posterior segment intraocular foreign body (IOFB) injuries managed by primary pars plana vitrectomy. Ninety-six consecutive patients with posterior segment IOFB injuries were retrospectively reviewed. Factors analyzed included initial visual acuity (VA), time between injury and presentation, site of entrance wound, uveal prolapse, vitreous prolapse, traumatized iris, endophthalmitis, location and size of IOFB, use of scleral buckling and/or an encircling band, gas tamponade, lensectomy, number of surgical procedures, and development of retinal detachment. Data were analyzed using univariate and multivariate logistic regression analysis. After a mean follow-up of 8.6 months, 63 eyes (65.6%) achieved VA of 20/200 or better, and 9 eyes (9.4%) had total retinal detachment complicated by inoperable proliferative vitreoretinopathy. On univariate analysis, predictors of poor vision (hand movements or less) were poor initial VA, corneoscleral entrance wound, uveal prolapse, vitreous prolapse, traumatized iris, and development of retinal detachment. In contrast, predictors of good visual outcome (20/200 or better) were absence of uveal prolapse, no endophthalmitis, and no retinal detachment. Multivariate analysis identified corneoscleral entrance wound, uveal prolapse, and development of retinal detachment as the only factors significantly associated with poor visual outcome. Absence of uveal prolapse was the only factor significantly associated with good visual outcome. Final visual outcome is greatly determined by the severity of the primary injury. On multivariate analysis, significant predictive factors of final VA were corneoscleral entrance wound, presence or absence of uveal prolapse, and development of retinal detachment.

EARLY VERSUS LATE REMOVAL OF RETAINED INTRAOCULAR FOREIGN BODIES

Purpose: To compare early versus late removal of retained intraocular foreign bodies (IOFBs). Methods: Sixty-two patients presenting with open-globe injuries due to lacerations by retained IOFBs were consecutively operated by the same surgeon between 1989 and 1997. Minimum follow-up was more than 3 months. In 43 patients, the IOFB was removed during the first 24 hours after the accident. In 19 patients, in whom the wound had been closed during a first operation, the IOFB was removed later than 24 hours after the accident. The study groups did not vary significantly in age, refractive error, type and size of IOFB, prevalence of traumatic cataract and peripheral or central corneal lacerations, or visual acuity on presentation. Results: Endophthalmitis developed significantly more often in the late intervention group than in the early intervention group (3/19 [15.7%] versus 1/43 [2.3%]; P = 0.0467; chi-square test). Considering patients with retinal lesions due to the IOFB (n = 47), proliferative vitreoretinopathy occurred significantly more often in the late intervention group than in the early intervention group (6/13 [46.2%] versus 6/34 [17.6%]; P = 0.0449). Conclusions: Confirming previous reports, the results of the current study suggest that removing retained IOFBs within the first 24 hours after the injury may in some clinical situations reduce the risks of infectious endophthalmitis and proliferative vitreoretinopathy.

Early versus late removal of retained intraocular foreign bodies.

To compare early versus late removal of retained intraocular foreign bodies (IOFBs). Sixty-two patients presenting with open-globe injuries due to lacerations by retained IOFBs were consecutively operated by the same surgeon between 1989 and 1997. Minimum follow-up was more than 3 months. In 43 patients, the IOFB was removed during the first 24 hours after the accident. In 19 patients, in whom the wound had been closed during a first operation, the IOFB was removed later than 24 hours after the accident. The study groups did not vary significantly in age, refractive error, type and size of IOFB, prevalence of traumatic cataract and peripheral or central corneal lacerations, or visual acuity on presentation. Endophthalmitis developed significantly more often in the late intervention group than in the early intervention group (3/19 [15.7%] versus 1/43 [2.3%]; P = 0.0467; chi-square test). Considering patients with retinal lesions due to the IOFB (n = 47), proliferative vitreoretinopathy occurred significantly more often in the late intervention group than in the early intervention group (6/13 [46.2%] versus 6/34 [17.6%]; P = 0.0449). Confirming previous reports, the results of the current study suggest that removing retained IOFBs within the first 24 hours after the injury may in some clinical situations reduce the risks of infectious endophthalmitis and proliferative vitreoretinopathy.

Management of glass intraocular foreign bodies.

To describe the results of management of glass intraocular foreign bodies (IOFBs). A total of 51 eyes of 43 patients that sustained penetrating injury with glass IOFB were studied retrospectively. A total of 23.5% had IOFB only in the anterior segment; the rest had IOFB in the posterior segment alone or in both the anterior and posterior segments. Six eyes were followed conservatively despite IOFB in a functional eye. Removal of IOFB was combined with repair of retinal detachment (where present) using internal tamponade with gas or silicone oil or buckle. After a mean follow-up of 16.8 months, 66.7% of eyes recovered better than 6/60 (20/200) vision and 75.6% had attached retina. On univariate analysis, scleral entry wound, posterior segment IOFB, larger size of IOFB, and retinal damage were found to be associated with poor anatomic outcome. Lower presenting visual acuity, hyphema, retinal damage, subretinal hemorrhage, detached retina, and larger IOFB were associated with a poor functional result. Multivariate analysis identified retinal damage caused by the foreign body as the only factor significantly associated with poor anatomic as well as functional outcome. Glass IOFBs are caused in a majority of cases by blast injury. Bilaterality is not uncommon. Presence of retinal damage is predictive of poor functional and anatomic results. Overall results are modest with modern vitreoretinal surgical techniques.

Management of posterior segment foreign bodies and long-term results.

The management of 158 posterior segment intraocular foreign bodies (IOFB) was retrospectively analyzed: transscleral magnet extraction via the pars plana was used for 40 magnetic IOFB, transscleral extraction via the IOFB bed for 35 magnetic and 4 non-magnetic IOFB, pars plana vitrectomy (PPV) for 44 magnetic and 32 non-magnetic IOFB, and open-sky vitrectomy for 3 non-magnetic IOFB. Final visual acuity of 0.02 and better was achieved in 104 out of 119 magnetic IOFB (87%) and 24 out of 39 non-magnetic IOFB (62%), and final visual acuity 0.05 and better in 79 magnetic IOFB (66%) and 17 non-magnetic IOFB (44%). Transscleral extraction via the IOFB bed under ophthalmoscopic control and IOFB removal by PPV proved to be the operations of choice for an increasing number of IOFB. For magnetic IOFB, these techniques yielded better final functional results than transscleral magnet extraction via the pars plana. Final visual acuity did not depend on the interval between injury and IOFB removal, and with regard to the risk of endophthalmitis, IOFB need not be considered an absolute indication for immediate intervention. IOFB size up to 5 mm2 and initial visual acuity of 0.5 and better were significant positive factors for both magnetic and non-magnetic IOFB.