Vitrectomy combined with silicone oil tamponade in the treatment of severely traumatized eyes with the visual acuity of no light perception

AIM: To evaluate the efficacy of surgical treatment of vitrectomy combined with silicone oil tamponade in the treatment of severely traumatized eyes with the visual acuity of no light perception (NLP).METHODS: This was a retrospective uncontrolled interventional case-series of 19 patients of severely traumatized eyes with NLP who underwent vitrectomy surgery at the Affiliated Hospital of Medical College, Qingdao University (Qingdao, China) during a 3-year period. We recorded perioperative factors with the potential to influence functional outcome including duration from the injury to intervention; causes for ocular trauma; open globe or closed globe injury; grade of vitreous hemorrhage; grade of endophthalmitis; grade of retinal detachment; size and location of intraocular foreign body (IOFB); extent and position of retinal defect; grade of proliferative vitreoretinopathy (PVR); type of surgery; perioperative complications and tamponade agent. The follow-up time was from 3 to 18 months, and the mean time was 12 months.RESULTS: After a mean follow-up period of 12 months (3-18 months) 10.53% (2/19) of eyes had visual acuity of between 20/60 and 20/400, 52.63% (10/19) had visual acuity less than 20/400 but more than NLP, and 36.84% (7/19) remained NLP. Visual acuity was improved from NLP to light perception (LP) or better in 63.16% (12/19) of eyes and the rate of complete retinal reattachment was 73.68% (14/19). Good visual acuity all resulted from those patients of blunt trauma with intact eyewall (closed globe injury). The perioperative factors of poor visual acuity prognosis included delayed intervention; open globe injury; endophthalmitis; severe retinal detachment; large IOFB; macular defect; a wide range of retinal defects and severe PVR.CONCLUSION:The main reasons of NLP after ocular trauma are severe vitreous hemorrhage opacity; refractive media opacity; retinal detachment; retinal and uveal damages and defects, especially defects of the macula; PVR and endophthalmitis. NLP after ocular trauma in some cases does not mean permanent vision loss. Early intervention of vitrectomy combined with silicone oil tamponade and achieving retinal reattachment of the remaining retina, may make the severely traumatized eyes regain the VA of LP or better.     

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

PURPOSE: 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. METHODS: 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. 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 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. CONCLUSIONS: 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.     

Vitreoretinal surgery of the posterior segment for explosive trauma in terrorist warfare

Background To describe surgical management and establish anatomic and visual results of patients with explosive ocular trauma in terrorist attacks treated with extreme vitreoretinal surgery.Methods Retrospective study of clinical records (6-month follow-up) of patients with visual acuity (VA) of light perception or better with posterior segment injuries [vitreous hemorrhage, retinal detachment (RD), intra-ocular foreign bodies (IOFB), perforating trauma (PT)] from explosive weapons who underwent vitreoretinal surgery. We reviewed the demographic characteristics, type of weapon, time between injury and surgery, VA at arrival and 6 months after surgery, and type of trauma according to the International Trauma Classification.Results Fifty-seven out of 236 patients with ocular injuries from explosive weapons were included in the study; all of them were military men, average age 22 years (range 16–53 years). The average time between the blast and primary closing was 1 day, and 10 days between primary closing and vitreoretinal surgery. Open traumas by laceration accounted for 96% of cases and 4% were closed traumas; 76% of the eyes had IOFB, of which 18% involved PT; 5% had endophthalmitis. Contusion was the diagnosis for 100% of the closed traumas. Of the open traumas, 40% were localized at zone I, 44% at zone II, and 16% at zone III. Upon arrival, 98% of patients had VA 20/800–LP and 2% had >20/40. The patients with closed trauma had the injuries at zone III and presented VA 20/800–LP. All patients underwent posterior vitrectomy, scleral buckling, endotaponade and when required, lensectomy (82%), IOFB removal (72%), and/or retinectomy (25%). Postoperative VA improved in 43% of the patients, stabilized in 41% and evolved to NLP in 15% of the cases. Initial expressions of ocular trauma such as RD, PT and endophthalmitis suggest bad prognosis.Conclusions We presented a series of patients with severe ocular trauma of the posterior segment from explosive weapons. These patients were treated according to our surgical protocol with extreme vitreoretinal surgery within the first 2 weeks after the blast; with our procedure we obtained stabilization or improvement of the VA for 84% of the cases.XXIV Meeting of the Club Jules Gonin. Athens, Greece. September 2004.     

Management of endophthalmitis with retained intraocular foreign body

AIMS: To assess the impact of primary injection of intravitreal antibiotics and delayed pars plana vitrectomy with removal of intraocular foreign body (IOFB) in patients with clinical features of bacterial endophthalmitis and retained IOFB. METHODS: Retrospective review of all patients with clinical features of infective endophthalmitis and a retained IOFB who had immediate injection of intravitreal antibiotics and delayed pars plana vitrectomy with removal of IOFB in two vitreo-retinal centres during 1995-2001. Nine patients were identified and minimum follow-up was 3 months. RESULTS: Four of the nine patients had a final visual outcome of 6/18 or better. One patient developed total retinal detachment. CONCLUSIONS: The current series suggests that immediate injection of intravitreal antibiotics with delayed removal of IOFB in eyes with clinical features of infective endophthalmitis and a retained IOFB is a possible alternative to immediate removal of IOFB. This management may be associated with preservation of the eye and restoration of useful visual acuity.     

Bleb-associated endophthalmitis: clinical characteristics and visual outcomes

PURPOSE: To analyze the clinical characteristics and treatment outcomes of patients with bleb-associated endophthalmitis (BAE). DESIGN: Retrospective, noncomparative, interventional case series. PARTICIPANTS: Consecutive patients treated at one institution for BAE. INTERVENTIONS: Prompt pars plana vitrectomy (PPV) with intravitreal injection of antibiotics, or prompt vitreous biopsy and intravitreal injection of antibiotics (tap and inject). METHODS: Retrospective analysis of 68 consecutive cases of BAE between July 1, 1989 and June 30, 2001. Clinical presentation, treatment modality, microbiologic data, and clinical course were analyzed. Visual outcomes were compared between vitrectomy and tap-and-inject groups, culture-positive and culture-negative groups, and early and late times. MAIN OUTCOME MEASURES: Snellen visual acuities (VAs) at 3 months and 12 months after treatment and at most recent follow-up. RESULTS: The incidence of no light perception (NLP) at 12 months after treatment for BAE was 35%. Vitreous isolates included streptococcal species (32% of positive cultures), Staphylococcus epidermidis (26%), Enterococcus, and Serratia (12% each). Patients with a positive vitreous culture had significantly worse VA (median, hand movements [HM] at 3 and 12 months after treatment) and a higher rate of NLP vision. Patients treated with tap-and-inject had a significantly worse final VA (medians, HM at 3 months and LP at 12 months) and a significantly higher rate of NLP vision than patients treated with PPV. One third of patients who underwent PPV achieved a final VA of 20/100 or better 12 months after treatment (P = 0.09). CONCLUSIONS: Bleb-associated endophthalmitis causes significant visual morbidity. Patients with culture-negative BAE and patients treated with prompt PPV may achieve better visual outcome.     

Metallic intraocular foreign bodies: characteristics, interventions, and prognostic factors for visual outcome and globe survival

PURPOSE: To describe metallic intraocular foreign body (IOFB) injuries and identify prognostic factors for visual outcome and globe survival. DESIGN: Interventional, consecutive, retrospective case series. METHODS: setting: Wills Eye Hospital. study population: Ninety-six eyes of 96 patients with metallic intraocular foreign bodies. procedures: Metallic IOFB injuries between January 1991 to June 2002 were reviewed for clinical characteristics, surgical intervention, and outcome. Univariate and multivariate analyses were performed to identify prognostic variables. main outcome measures: Final visual acuity and globe survival. RESULTS: The average patient age was 33.0 years with a male predominance (94%). Forty percent of eyes had a presenting vision of 20/50 or better. Following IOFB removal, 40% of patients required additional interventions. Thirty-one percent of eyes had a final acuity of 20/50 or better. Eight percent of patients ultimately required enucleation or evisceration. Excellent visual outcome (defined as > or =20/50) was associated with multiple variables, including normal lens at presentation and anterior segment IOFB (P< .003). Factors associated with poor visual outcome (defined as <20/200) included uveal prolapse and posterior segment IOFB (P < .0003). Globe loss was associated with younger age, presenting light perception (LP) or no light perception (NLP) vision, BB/pellet injury, and the presence of an afferent pupillary defect (P < .01). CONCLUSIONS: Multiple prognostic factors were identified in this large analysis of metallic IOFB injuries, which may help predict visual outcome and globe survival. Most of these variables were independent of intervention and can be identified at the time of initial presentation.     

A 10-year review of assault-related open-globe injuries at an urban hospital

Background

To describe the demographics and outcomes of assault-related open-globe injuries (OGI) at University Hospital (UH), Newark, New Jersey over a ten-year period.

Methods

The medical records of all subjects presenting to a single university referral center with an OGI were retrospectively analyzed to identify prognostic factors for enucleation and final visual acuity (VA) of no light perception (NLP).

Results

One hundred and forty-eight eyes of 147 patients presented to UH with assault-related OGI. Eighty-two percent of patients were male, and the mean age was 35.9 years. The anatomic site of the wound was zone 3 in the majority (54.1 %) of eyes. Most common type of injury noted was rupture (57.4 %), followed by penetrating injury (35.1 %). Mean initial presenting and final VA in LogMAR were 2.38?±?0.12 and 2.18?±?0.16 respectively. Initial Snellen VA was no light perception (NLP) in 57 eyes (38.5 %); four eyes had an initial VA of ≥20/40 (2.7 %). Final VA was NLP in 68 eyes (45.9 %) of which 46 were enucleated (31.1 %); 18 eyes (12.2 %) had a final VA of ≥20/40. Fifty eyes (33.8 %) underwent pars plana vitrectomy (PPV). Significant risk factors of final VA of NLP or enucleation included initial VA of NLP, perforating or rupture type of OGI, and zone 3 injury. Eyes that sustained penetrating injuries were less likely to have final VA of NLP or require enucleation.

Conclusions

Assault-related OGIs carry an extremely poor visual prognosis and a high rate of enucleations. Only eighteen eyes (12.2 %) recovered VA ≥20/40. We found initial VA of NLP and zone 3 injury to be significant predictors of final VA of NLP or undergoing enucleation. Penetrating injuries were less likely to have a final VA of NLP or an enucleation.     

Pediatric ocular trauma with pars plana vitrectomy in Southwest of China: clinical characteristics and outcomes

AIM: To investigate the clinical characteristics and predictive factors of pediatric ocular trauma patients with vitrectomy. METHODS: Pediatric ocular trauma patients (aged 14y or younger) who received vitrectomy in Southwest Hospital between January 2007 and December 2017 were reviewed retrospectively. Age, gender, mechanism of injury, final visual acuity (VA), and prognostic factors were analyzed. RESULTS: A total of 139 eyes in 139 pediatric patients were included in the study. The mean age was 7.4±3.7 years old and the male-to-female ratio was 5:1. There were 104 (74.8%) open globe injuries and 35 (25.2%) closed globe injuries. The top one traumatic eye injuries were penetrating injuries occur through sharp metal objects (43.9%). After vitrectomy, 116 patients had favorable anatomic outcome at the last follow-up, and 30 eyes (21.6%) achieved VA of 20/200 or better. Following univariate analysis, we found zone III injuries (P=0.021), poor initial VA (P=0.005), endophthalmitis (P=0.024), and recurrent retinal detachment (P<0.001) were poor prognostic factors for pediatric ocular trauma. After Logistic regression analysis, the poor initial VA (odds ratio: 8.276, 95%CI: 1.597-42.897, P=0.012) and recurrent retinal detachment (odds ratio: 6.455, 95%CI: 2.372-17.562, P<0.001) were significantly correlated with unfavorable vision outcome in pediatric ocular trauma. CONCLUSION: The treatment of vitrectomy for severe ocular trauma results in favorable anatomic outcomes, but VA improvement is not as good as anatomic outcomes. Initial VA and recurrent retinal detachment are the independent prognostic indicators for unfavorable visual outcome of severe pediatric ocular trauma.     

眼内异物伤玻璃体切除术视力预后影响因素的研究

目的探讨眼内异物伤玻璃体切除术视力预后的主要影响因素。方法参与预后分析的影响因素包括：术前视力、手术时间、伤口位置、伤口长度、异物大小、是否伤及晶状体、玻璃体积血、视网膜损伤区域、视网膜脱离共9项。对各影响因素与较好术后视力（视力≥0.5）和较差术后视力（视力〈0.1）分别进行卡方检验,然后应用多变量逻辑回归分析寻找影响预后的主要因素。结果本组眼内异物伤玻璃体切除术后69.4%术后视力≥0.1;术前较好视力和无视网膜脱离是取得术后较好视力（视力≥0.5）的重要因素;而术前视力差和出现视网膜脱离是术后视力较差（视力〈0.1）的重要因素。结论术前视力和视网膜脱离是影响眼内异物伤玻璃体切除术后视力预后最重要的因素。     

Vitrectomy in the management of intraocular foreign bodies and their complications.

Twenty-six eyes with intraocular foreign bodies (IOFB) and/or their sequelae were treated by pars plana vitrectomy and associated surgery. One-step removal of the IOFB in combination with pars plana vitrectomy resulted in early visual rehabilitation and minimal complications. Of 11 eyes with IOFB treated by primary vitrectomy at the time of IOFB removal 20/50 or better visual acuity was obtained in 10 (91%). Four of these eyes had retinal injury, 3 of which were successfully repaired without subsequent complication and with retention of good visual function. In 3 eyes IOFBs were not removed owing to chronic retinal encapsulation. These eyes continue to retain good visual acuity, and ERG studies show no evidence of retinal toxicity. Of 12 eyes in which vitrectomy was performed for sequelae of IOFB only 5 (41%) showed visual improvement better than 20/50. Only in 2 of 7 eyes with tractional retinal detachment could the retina be reattached. In cases of retinal injury primary vitrectomy, cryocoagulation, and scleral buckling are suggested for prevention of late traction retinal detachment.     

Vitrectomy for endophthalmitis after intraocular lens implantation

PURPOSE: To report the results of vitrectomy and intraocular lens (IOL) removal for the treatment of endophthalmitis after IOL implantation. METHODS: We reviewed 14 eyes of 14 patients who underwent pars plana vitrectomy because of postoperative endophthalmitis. Culture results, surgical methods, and visual outcome are presented. RESULTS: The cultures grew Enterococcus faecalis (n = 3), Staphylococcus epidermidis (n = 2), Propionibacterium acnes (n = 1), and gram-negative bacillus (n = 3). The eyes infected with E. faecalis had poor visual outcome. Eleven eyes treated by the combination of pars plana vitrectomy and IOL removal did not have a recurrence. The remaining 3 eyes on which only vitrectomy was performed had a recurrence, and the additional procedures consisting of vitrectomy and IOL removal could result in eradicating endophthalmitis. CONCLUSIONS: A higher rate of E. faecalis was detected and these eyes had severe inflammation and poor visual outcome. Combined vitrectomy and IOL removal may be a more certain method to prevent recurrence.     

Bleb-associated endophthalmitis in a Chinese population (2003-2010): clinical characteristics and visual outcome

Purpose. To analyze the clinical characteristics and treatment outcomes of patients with bleb-associated endophthalmitis (BAE) in a Chinese population. Methods. A retrospective review of patients treated for BAE between January 2003 and December 2010 in a single institution was performed. Data on visual acuity (VA), clinical characteristics, causative organisms, and treatment outcomes were collected and analyzed. Results. Thirty-one eyes from 31 patients with BAE were identified during the study period. Primary open-angle glaucoma was the most common type of glaucoma in this series (18 eyes, 58.1%). The time between glaucoma filtering surgery and diagnosis of endophthalmitis ranged from 18 days to 32 years, with a mean of 6.95±8.22 years. Nine eyes (32.1%) were culture positive, and the most common organisms identified were Staphylococcus species (6/9, 66.7%). Best-corrected VA at 12 months after treatment ranged from 20/30 to no light perception (NLP). Twelve (38.7%) eyes achieved VA of 20/400 or better, and 7 (22.6%) eyes had NLP. In patients undergoing initial tap-and-inject treatment, the eyes with presenting VA of finger count or better were associated with a higher treatment success rate (87.5%) than those of hand movement (33.3%) or light perception or NLP (9.1%). Conclusions. Primary open-angle glaucoma was the most common type of glaucoma, and Staphylococcus species was the most common causative organism in this case series of BAE. Despite prompt treatment with appropriate intravitreal antibiotics, BAE still carries a poor visual prognosis.     

眼内异物摘出术手术径路的选择

目的 寻求摘出眼内异物的最佳手术径路。方法 对２２例眼内异物进行回顾性研究，１２眼用传统的巩膜切开法，１０眼用经睫状体平坦部玻璃体切除术摘出异物。结果 传统方法和玻璃体切除术法均成功地摘出异物。单纯伴玻璃体出血机化者，经玻璃体手术术后视力明显提高。同时伴视网膜脱离者，异物摘出联合视网膜复位术后视力恢复不理想。结论 眼内异物摘出以不进一步损伤眼组织为原则，必须综合分析异物位置及其并发症，以选择手术路     

球内异物伤玻璃体切割术后黄斑形态改变与视力的相关性研究

目的 从黄斑形态改变方面探讨球内异物伤玻璃体切割术后低视力的可能原因.方法 观察行玻璃体切割手术的20只眼球内异物伤病例,术后3月行验光和黄斑OCT检查,测量黄斑中央小凹神经上皮层厚度(MNT),分析MNT及黄斑形态改变与预后视力的相关性.结果 球内异物伤玻璃体切割术后3月,黄斑前膜的发生率为50%,黄斑前膜组和正常形态组之间视力存在显著性差异;MNT值与视力之间存在相关性:MNT值越大,视力越差.结论 球内异物伤玻璃体切割术后黄斑形态异常以黄斑前膜的发生率最高,对视力有严重影响;黄斑中央小凹神经上皮层厚度越大,视力越差.     

Retinal detachment after posterior segment intraocular foreign body injuries

Purpose: To identify the risk factors for retinal detachment after posterior segment intraocular foreign body (IOFB) injuries and to study the association between the development of retinal detachment and visual outcome. Methods: Ninety-six consecutive patients with posterior segment IOFB injuries were retrospectively reviewed. Vitrectomy techniques were used in primary and secondary treatment. Two eyes were eviscerated after primary repair because of Clostridium perfringens endophthalmitis. Factors analyzed included (1) entrance wound location, (2) presence of uveal prolapse, (3) presence of vitreous prolapse, (4) presence of traumatized iris, (5) presence of endophthalmitis, (6) location of IOFB, (7) size of IOFB, (8) use of scleral buckling and/or an encircling band, (9) use of gas tamponade, (10) use of lensectomy. Data were analyzed using univariate and multivariate logistic regression analysis. Results:Retinal detachment was present in 6 eyes at presentation and occurred in another 19 eyes after vitrectomy. After a mean follow-up of 8.6 months, 63 (65.6%) eyes achieved visual acuities of 20/200 or better, and total retinal detachment complicated by inoperable proliferative vitreoretinopathy was present in 9 (9.4%) eyes. Multivariate analysis identified retinal detachment as a factor significantly associated with a poor visual outcome (odds ratio = 4.54, 95% confidence interval [CI] = 1.05–19.6). Foreign body size of more than 4 mm (odds ratio = 5.8, 95% CI = 1.66–2.03) and presence of endophthalmitis (odds ratio = 11.7, 95% CI = 2.57–52.9) were identified as the only predictive factors for the development of retinal detachment after vitrectomy. Use of prophylactic scleral buckling and/or an encircling band reduced the risk of developing postoperative retinal detachment. Conclusions: Retinal detachment after posterior segment IOFB injuries is associated with a poor visual outcome. Large IOFB and presence of endophthalmitis are the strongest predictive factors for the development of retinal detachment. This revised version was published online in July 2006 with corrections to the Cover Date.     

不同玻璃体腔填充物对玻璃体切除术治疗外源性眼内炎效果的影响

目的 分析应用玻璃体腔填充物硅油或全氟丙烷(C_3F_8),对玻璃体切除术治疗外源性眼内炎效果的影响.方法 回顾性分析2000年5月至2008年3月玻璃体切除术治疗的外源性眼内炎66例66只眼,术中应用硅油(52只眼)或全氟丙烷(C_3F_8)(14只眼)作为玻璃体腔填充物.结果 硅油填充组52只眼中,48只眼视力提高(92.3%),34只眼(65.4%)术后视力≥0.05.C_3F_8填充组14只眼中,10只眼视力提高(71.4%),5只眼(35.7%)术后视力≥0.05.硅油填充组术后视力优于C_3F_8组(X~2=4.017,P<0.05).结论 玻璃体切除联合硅油填充术是治疗外源性眼内炎的有效方法,硅油优于C_3F_8.     

玻璃体切割联合手术治疗严重眼外伤的临床观察

目的：探讨玻璃体切割联合手术治疗严重眼外伤的临床疗效。方法：回顾性分析我院自2011-01以来收治的经玻璃体切割联合手术治疗的严重眼外伤患者30例31眼。结果：患者31眼中术后视力提高24眼,术前无光感12眼中术后视力不变2眼,光感2眼,手动3眼,指数4眼,1眼恢复为0.1;6眼球内异物的异物取出率为100%,炎症控制好;18眼复杂视网膜脱离,15眼成功复位,视网膜复位率为83%;14眼外伤性白内障或晶状体脱位,玻璃体手术后12眼行人工晶状体植入术,晶状体植入率为86%。结论：严重眼外伤包括术前无光感眼,经过恰当的玻璃体手术联合相应的治疗措施,可以最大限度保留患者的眼球及挽救患者的视功能。     

Retinal tears and retinal detachment as factors affecting visual outcome after cataract extraction complicated by posteriorly dislocated lens material

PURPOSE: To evaluate the incidence and effect on visual acuity of complicating factors such as retinal tears (RTs) and rhegmatogenous retinal detachment (RRD) in eyes with posteriorly dislocated lens fragments after cataract extraction. METHODS: Retrospective consecutive series of patients presenting at a referral vitreoretinal practice with posteriorly dislocated lens material after cataract extraction over a period of 8 years. The presence of RT, RRD, endophthalmitis, and choroidal hemorrhage was noted, and their effect on visual outcome was studied. RESULTS: A total of 307 eyes with posteriorly dislocated lens material after cataract extraction were identified. Fifty-eight eyes (19%) were managed medically (Group I), whereas the other 249 eyes (81%) underwent pars plana vitrectomy for removal of the lens material (Group II). Indications for surgical management included uncontrolled inflammation, elevated intraocular pressure, and large lens fragments. No eyes in Group I developed RT or RRD. Of the 249 Group II eyes, 13 (5%) were found to have RT, and 25 (10%) developed RRD. In Group II, choroidal hemorrhage and endophthalmitis were noted in 12 (5%) and 4 (2%) eyes, respectively. Fifty-one (88%) of 58 eyes in Group I and 138 (55%) of 249 eyes in Group II achieved a final visual acuity of 20/40 or better. Seven (54%) of the 13 eyes with RT and 9 (36%) of the 25 eyes with RRD achieved a final visual acuity of 20/40 or better. In the RRD group, 9 (56%) of the 16 macula-on eyes achieved a final visual acuity of 20/40 or better, whereas none of the 9 macula-off eyes had a final visual acuity of 20/40 or better. None of the 4 eyes with endophthalmitis and only 1 (8%) of the 12 eyes with choroidal hemorrhage had a final visual acuity of 20/40 or better. Five (62%) of eight eyes with retinal detachment treated with pneumatic retinopexy needed further treatment with scleral buckle to achieve anatomical reattachment. CONCLUSION: A good visual outcome (20/40 or better) is possible in eyes with posteriorly dislocated lens fragments after cataract extraction, even when retinal tears or macula-on retinal detachment is present. The presence of a macula-off retinal detachment, however, has a significant adverse effect on the visual outcome. Pneumatic retinopexy is not associated with retinal reattachment in many cases and is not preferred.     

后入路玻璃体切割术治疗眼球贯通伤伴球内异物

目的:探索早期后入路玻璃体切割术治疗眼球贯通伤伴球内异物的有效性.方法:近2a来我院急诊收治的10例10眼眼球贯通伤伴球内异物患者,急诊行玻璃体切割+眼内异物取出+硅油填充术,术后给予积极预防感染、消炎处理,根据伤道周围视网膜生长情况补充视网膜光凝.结果:患者1眼因化脓性眼内炎、术中视网膜脉络膜损毁严重视网膜未能复位,最终眼球萎缩,患者9眼成功施行玻璃体切割手术,取出异物,随诊时间3~18mo,其中2例患者因复发性视网膜脱离行二次玻切硅油置换手术,其余患者视网膜复位良好,无再出血,眼压维持8~21mmHg;最后一次随访时患者3眼最佳矫正视力>0.1,2眼矫正视力0.01~0.1,患者4眼因后极部脉络膜视网膜损伤严重矫正视力光感~指数/50cm,眼球萎缩患者视力无光感.结论:早期后入路玻璃体切割、异物取出联合硅油填充术为一种有效地治疗眼球贯通伤伴球内异物的手术治疗方法.     

Relationship between clinical presentation and visual outcome in postoperative and posttraumatic endophthalmitis in south central India

PURPOSE: To determine risk factors for poor visual outcome in postoperative and posttraumatic endophthalmitis in a large referral center in south central India. METHODS: In this prospective observational series the authors examined 388 patients of postoperative (n= 206) and posttraumatic (n= 182) endophthalmitis at the L V Prasad Eye Institute in Hyderabad, India between 1991 and 1997.The analysis was confined to 236 patients-128 (62.1%) postoperative and 108 (59.3%) posttraumatic patients who were followed for a minimum period of 3 months. A detailed protocol was followed. Chi-square and logistic regression analysis were used to determine risk factors for visual outcome worse than 6/18 and worse than 6/120. RESULTS: Postoperative endophthalmitis: In univariate analysis the features associated with poor visual acuity (grouped as < 6/18 and < 6/120) included intracapsular cataract surgery, poor presenting visual acuity, presence of vitreous cells, inability to visualise the optic disc on indirect ophthalmoscopy, presence of vitreous membranes on ultrasonography, and a culture-positive vitreous biopsy. In the multivariate analysis, visual acuity of less or equal light perception (LP) at presentation was associated with a 3-month postoperative visual acuity of < 6/18, with an odds ratio of 5.85 [1.25 - 27.42, 95% CI], and vitreous membranes seen on ultrasonography was associated with a final visual acuity of < 6/120, with an odds ratio of 2.47 [1.05 - 5.83, 95% CI]. Posttraumatic endophthalmitis: In univariate analysis the features associated with poor visual acuity (grouped as < 6/18 and < 6/120) included a retained intraocular foreign body (IOFB), trauma by needle (hypodermic or sewing), poor presenting visual acuity, inability to visualise the optic disc on indirect ophthalmoscopy, presence of vitreous membranes on ultrasonography, and a culture-positive vitreous biopsy. In multivariate analysis, IOFB was associated with a 3-month follow-up visual acuity of < 6/18, with an odds ratio of 5.90 [1.85 - 18.78, 95% CI], and trauma by a needle (hypodermic or sewing) and retained IOFB was associated with a final visual acuity of < 6/120, with an odds ratio of 4.47 [1.22 - 16.38, 95%CI] and 3.76 [1.36 - 10.37, 95% CI] respectively. CONCLUSION: This is the largest, single-centre, prospective study on risk factors for poor visual outcome in postoperative and posttraumatic endophthalmitis. The independent risk factor for 3-month follow-up visual acuity of < 6/18 was the presenting visual acuity of < or =LP in postoperative endophthalmitis and a retained IOFB in posttraumatic endophthalmitis. The independent risk factor for 3-month visual acuity of < 6/120 was the presence of vitreous membranes on ultrasonography in postoperative endophthalmitis, and trauma by a needle (hypodermic/ sewing) and retained IOFB in posttraumatic endophthalmitis.