Long-Term Outcome of Pars Plana Vitrectomy for Retained Posterior Segment Intraocular Foreign Body Secondary to Gunshot Injury

Abstract

Purpose

To report the long-term outcome of pars plana vitrectomy (PPV) for management of retained posterior segment intraocular foreign body (IOFB) secondary to gunshot injury.

Methods

This is a retrospective interventional case series including consecutive patients who had PPV for retained posterior segment IOFB secondary to gunshot injury. Main outcome measures were final best-corrected visual acuity (BCVA), long-term globe survival and detection of complications. Spearman correlation analyzed relationships between numerical data. Kruskal–Wallis test compared differences in initial BCVA and final BCVA across variables. Categorical variables were tested using Chi square or Fisher’s exact test. P value is significant at 0.05.

Results

The study included 103 eyes of 103 patients. Mean baseline BCVA was 0.01 decimal unit (2 logMAR). Mean duration from primary repair to PPV was 3 weeks. Mean duration of post-operative follow-up was 60 months. Mean final BCVA was 0.04 decimal unit (1.3 logMAR), p 0.001. Post-operatively, BCVA improved in 58.2% of patients. Nineteen patients (18%) gained ≥2 lines of vision, and 15 patients (14.5%) achieved final BCVA of 0.4 decimal unit (logMAR 0.4). All complications were related to the original injury. These included macular scar (19%), macular pucker (6%), recurrent retinal detachment (4%), subretinal fibrosis (3%), consecutive optic atrophy (3%), and PVR (3%). Phthisis bulbi or sympathetic ophthalmia did not develop in any case.

Conclusion

PPV for removal of IOFB caused by gunshot injury yielded long-term favorable functional outcome with excellent globe survival. Poor initial BCVA, location of IOFB in the posterior pole, associated lens injury and retinal detachment are significant adverse prognostic factors for final BCVA but not for globe survival.

Keywords:

• Intraocular foreign body; IOFB
• ocular gunshot injury
• penetrating ocular trauma
• IOFB-associated endophthalmitis
• pars plana vitrectomy for intraocular foreign body
• PPV for IOFB

Institution

The study was conducted in a retina tertiary care center (Magrabi Eye Hospital), Tanta, Egypt.

Data Sharing Statement

The data collected from history taking and clinical examination of patients recruited in the current study are confidential. Access to these data is restricted by Magrabi Eye Hospital in accordance with patients’ data protection policy. Data are available for researchers who meet the criteria for access to confidential data through contacting the medical director Professor Hammouda Ghoraba [email protected].

Statement of Ethics

The study was approved by the institution review board of Magrabi Eye Hospital, Tanta, Egypt.

The study adhered strictly to the tenets of the Declaration of Helsinki of 1975 and the revision of 2013.

The study required that all participants received a thorough explanation of the surgical maneuvers entailed, possible outcome, and expected complications and signed an informed consent prior to enrollment either in person or via the legal custodian.

Disclosure

The authors report no conflicts of interest in this work.