Prognostic factors in ocular injuries caused by intraocular or retrobulbarforeign bodies

Objective: To evaluate prognostic factors associated with final visual outc ome, development of posttraumatic infectious endophthalmitis, and occurrenc e of proliferative vitreoretinopathy in patients with penetrating ocular in juries caused by intraocular or retrobulbar foreign bodies (FBs). Design: Clinic-based cross-sectional study. Participants: One hundred thirty patients presenting with penetrating ocula r injuries caused by lacerations from FBs were operated on by one of two su rgeons between 1989 and 1997. Follow-up time was an average of 20.84 +/- 20 .76 months (median: 17.0 months). All FBs were located posterior to the len s. Interventions: Pars plana vitrectomy; foreign body removal; additional surg ical procedures according to the clinical situation. Main Outcome Measures: Postoperative visual acuity; posttraumatic infectiou s endophthalmitis; proliferative vitreoretinopathy. Results: Occurrence of posttraumatic infectious endophthalmitis developing in seven patients (7/130 = 5.4%) was significantly (P = 0.026) associated w ith removal of the FB later than 24 hours after the accident and with the t ype of the FB (P < 0.01). Size (P = 0.37) of the FB, preoperative visual ac uity (P = 0.62), presence of traumatic cataract (P = 0.75) or a retinal les ion by the FB (P = 0.16), age (P = 0.39), and gender (P = 0.46) did not sho w a statistically significant influence on the occurrence of endophthalmiti s. Statistically significant risk factors for the development of proliferat ive vitreoretinopathy occurring in 27 patients (27 of 99 [27.6%] patients w ith a minimal follow-up of 3 months) were size of the FB (P < 0.001), preop erative visual acuity (P = 0.02), presence of a retinal lesion (P = 0.002), and traumatic cataract (P = 0.03). The time between FB removal and the acc ident was statistically marginally associated with the development of proli ferative vitreoretinopathy (P = 0.07). Postoperative visual acuity depended significantly on size of the FB (P = 0.002), preoperative visual acuity (P < 0.001), presence of a retinal lesion (P = 0.049), and location of the re tinal lesion (P < 0.001). Three eyes had to be enucleated because of endoph thalmitis or phthisis bulbi. Conclusions: Prognosis in open-globe injuries with intraocular or retrobulb ar foreign bodies depends on the size and type of the foreign body, presenc e and location of retinal lacerations, additional involvement of other intr aocular structures, preoperative visual acuity, and timing of surgery. Thes e factors may be important in preoperative counseling of the patient and fo r planning surgery. (C) 2000 by the American Academy of Ophthalmology.