Visual outcome and prognostic factors after vitrectomy for posterior segment foreign bodies

PURPOSE. To identify the prognostic factors that predict final visual outco me in eyes with posterior segment intraocular foreign body (IOFB) injuries managed by primary pars plana vitrectomy. METHODS. Ninety-six consecutive patients with posterior segment IOFB injuri es 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, locat ion and size of IOFB, use of scleral buckling and/or an encircling band, ga s tamponade, lensectomy, number of surgical procedures, and development of retinal detachment. Data were analyzed using univariate and multivariate lo gistic regression analysis. RESULTS. 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 complic ated by inoperable proliferative vitreoretinopathy. On univariate analysis, predictors of poor Vision (hand movements or less) were poor initial VA, c orneoscleral entrance wound, uveal prolapse, vitreous prolapse, traumatized iris, and development of retinal detachment. In contrast, predictors of go od visual outcome (20/200 or better) were absence of uveal prolapse, no end ophthalmitis, and no retinal detachment. Multivariate analysis identified c orneoscleral entrance wound, uveal prolapse, and development of retinal det achment as the only factors significantly associated with poor visual outco me. Absence of uveal prolapse was the only factor significantly associated with good visual outcome. CONCLUSIONS. Final visual outcome is greatly determined by the severity of the primary injury. On multivariate analysis, significant predictive factor s of final VA were corneoscleral entrance wound, presence or absence of uve al prolapse, and development of retinal detachment.