Endophthalmitis, Visual Outcomes, and Management Strategies in Eyes with Intraocular Foreign Bodies

Figures & data

Table 1 Summary of Demographics and Clinical Presentation of Eyes Suffering Trauma with IOFB

Total Number of Eyes with Retained IOFB	100
Excluded eyes	12
<30 days’ follow-up	6
Primary enucleation	1
Secondary enucleation within 30 days	5
Included eyes	88
Male	84/88 (95.5%)
Age (years)	34.4 ± 17.0 (range: 5–73; median: 31)
Presenting visual acuity (logMAR)	1.25 ± 1.04 9 CF, 15 HM, 10 LP, 1 NLP, 5 unable to test
Presentation >24 hours after injury	16/88 (18.2%)
Follow-up time from injury (days)	774 ± 1241 (range: 20–6467; median: 314)
Endophthalmitis	10/88 (11.4%)
Endophthalmitis on presentation	6/88 (6.8%)
Endophthalmitis after management	4/82 (4.9%)
Final visual acuity (logMAR)	0.74 ± 0.99 2 CF, 6 HM, 3 LP, 5 NLP, 1 missing VA

Abbreviations: IOFB, intraocular foreign body; logMAR, logarithm of minimum angle of resolution; CF, count fingers; HM, hand motion; LP, light perception; NLP, no light perception; VA, visual acuity.

Table 2 IOFB Characteristics and Patterns of Injury in 88 Studied Eyes

Zone of Entry
Zone 1	59/88 (67.0%)
Zone 2	19/88 (21.6%)
Zone 3	10/88 (11.4%)
Wound size >5 mm	20/88 (22.7%)
IOFB location
Anterior segment	28/88 (31.8%)
Posterior segment	60/88 (68.2%)
IOFB type^a
Metallic	71/88 (80.7%)
Glass or plastic	9/88 (10.2%)
Organic	6/88 (6.8%)
Other/unknown	4/88 (4.5%)
IOFB largest dimension (mm)	4.75 ± 4.24 (range: <1–25; median: 3; 6 missing records)
Injury mechanism
Hammering metal	37/88 (42.0%)
Projectile weapon	10/88 (11.4%)
Explosion	13/88 (14.8%)
Machine tool	8/88 (9.1%)
Other	20/88 (22.7%)
Ocular injuries
Uveal prolapse	24/88 (27.3%)
Lens disruption	50/88 (56.8%)
Vitreous hemorrhage	42/88 (47.7%)
Retinal tear	36/88 (40.9%)
Retinal detachment	25/88 (28.4%)

Note: ^aTwo patients had multiple IOFBs of varying composition.

Abbreviations: IOFB, intraocular foreign body; mm, millimeters.

Table 3 Timing and Type of Surgical Interventions in 88 Studied Eyes

Primary concurrent globe closure and IOFB removal
Anterior segment surgery	25/88 (28.4%)
Pars plana vitrectomy	28/88 (31.8%)
With C3F8 tamponade	7
With silicone oil	4
With scleral buckle	1
Primary globe closure with secondary IOFB removal
Anterior segment surgery	3/88 (3.4%)
Pars plana vitrectomy	31/88 (35.2%)
With C3F8 tamponade	15
With silicone oil	4
With scleral buckle	2
Primary globe closure, IOFB retained and not removed	1/88 (1.1%)

Abbreviation: IOFB, intraocular foreign body.

Figure 1 Regression analysis of factors associated with endophthalmitis and good or poor final visual acuity. (A) Factors associated with endophthalmitis development and final visual acuity. p < 0.05 significant. *Severe anterior segment damage defined as concurrent corneal laceration, uveal prolapse, and lens disruption. (B) Initial and final visual acuity of eyes presenting with IOFBs, with dashed line slope=1 and continuous trendline demonstrating Pearson’s correlation coefficient (R = 0.58). Points below the dashed line demonstrate eyes with improved visual acuity compared to presentation.

Table 4 Primary and Secondary Removal of Posterior Segment IOFBs Including Presenting Characteristics, Treatments, and Outcomes

	Globe Closure with Concurrent Primary IOFB Removal	Primary Globe Closure with Secondary IOFB Removal
Number of eyes	25	29
Presenting VA	logMAR average 0.86 ± 1.01 0 NLP, 3 LP, 1 HM, 3 CF	logMAR average 1.65 ± 0.91 0 NLP, 3 LP, 10 HM, 3 CF, 2 unable
Final VA	logMAR average 0.67 ± 0.98 0 NLP, 0 LP, 1 HM, 1 CF, 2 enucleated	logMAR average 1.22 ± 1.08 2 NLP, 2 LP, 3 HM, 1 CF, 1 enucleated
Presenting with RD	7/25 (28.0%)	15/29 (51.7%)
Presenting with RT	13/25 (52.0%)	21/29 (72.4%)
Endophthalmitis	1/25 (4.0%)	2/29 (6.9%)
IOFB removal after globe closure	0	4.5 ± 6.4 days (range 0–28, median 2)
Intraocular antibiotics at closure	9/25 (36.0%)	25/29 (86.2%)
Enucleations	2/25 (8.0%)	1/29 (3.4%)
Development of PVR	1/25 (4.0%)	6/29 (20.7%)
Development of SO	0/25 (0%)	1/29 (3.4%)

Abbreviations: IOFB, intraocular foreign body; VA, visual acuity; RD, retinal detachment; RT, retinal tear; PVR, proliferative vitreoretinopathy; SO, sympathetic ophthalmia; logMAR, logarithm of minimum angle of resolution; NLP, no light perception; LP, light perception; HM, hand motion; CF, count fingers.

Figure 2 Days elapsed between initial globe closure and deferred IOFB removal by PPV.

Figure 3 Antimicrobial treatment by agent class and route of delivery in patients with IOFBs.