Management of posterior segment intraocular foreign bodies: 14 years' experience

BACKGROUND: Penetrating ocular injuries with retained posterior segment foreign bodies are challenging cases requiring urgent attention by vitreoretinal surgeons. Posteriorly located injuries can result in serious immediate and delayed vitreoretinal sequelae, such as retinal detachment and endophthalmitis. We report our experience with posterior segment intraocular foreign bodies. METHODS: We reviewed the records of all patients with penetrating ocular injury with retained intraocular foreign bodies treated at a university-based referral practice in Toronto between April 1981 and December 1995. We noted the pre- and postoperative Snellen visual acuity, type and volume of foreign body, diagnostic technique, surgical management, and pre- and postoperative complications. RESULTS: Forty-one patients (all male with a mean age of 38 [range 8 to 78] years) were treated during the study period. The length of follow-up ranged from 1 to 118 (mean 20) months. Eighteen patients (44%) experienced a delay in diagnosis or management, or both, of 1 day to 3 years. The rates of retinal detachment and endophthalmitis were 41% (17/41) and 17% (7/41) respectively; culture gave positive results in 5 cases. Two of the eyes required enucleation. A final visual acuity of 6/60 or better was obtained in 33 eyes (80%) and of 6/12 or better in 21 eyes (51%). Multiple linear regression analysis showed that only immediate retinal detachment and the presence of a relative afferent pupillary defect had a significant independent effect on final visual acuity. In our previous series (1971-81) the retinal detachment rate was 14% (4/28), and there were no cases of culture-positive endophthalmitis; final visual acuities of 6/60 or better and of 6/12 or better were obtained in 46% and 32% of the eyes respectively. INTERPRETATION: Reasons for the better outcomes in our more recent series may include improved localization of posterior segment foreign bodies with computed tomography, more frequent intravitreal surgery with improved vitrectomy techniques and the use of the intraocular magnet.