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J. Akesbi, R. Adam, T. Rodallec, P. Barale, S. Scheer, L. Laroche, J. Sahel, C. Baudouin, J.-P. Nordmann; Intra ocular Foreign Bodies (IOFBs): Retrospective Analysis and Management About 56 Cases. Invest. Ophthalmol. Vis. Sci. 2009;50(13):3175.
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to determine the influence of prognostic factors and kind of tamponade agent in surgical management of intraocular foreign bodies (IOFBs).
56 consecutive cases were retrospectively reviewed in XV XX hospital between 2004 and 2007. Univariate and multivariate analyses were performed to identify prognostic factors. Several parameters were measured: pre and post-operative best corrected visual acuity(BCVA), material and size and location of the foreign body, entry site, delay between trauma and surgical removal, initial retinal detachment, choice of vitreous tamponade agent (none(N), gas(G), silicone oil(S)), post-operative visual outcome, complications( siderosis, endophthalmitis, and vitreoproliferative retinal detachment).
80.7% (=46) were metal IOFBs. 47.4% (=27) were located in the inferior retinal segment. Pre-operative and post-operative mean BCVA was respectively 2(+/-0,99) and 0,7(+/- 0,96)(logMar). Mean follow up was 17 months (J15-M60). 24.56% (=14) had a pre-operative retinal detachment, with a statically worse prognosis (BCVA 1.49 versus 0.87, p=0.03). The BCVA was better in the G (=16) than in the S group (= 21) or in the N group (=20) with respectively a BCVA of 0,3(+/-0,86), 2(+/-0,95) and 0,4(+/-0,91). Time of surgery was a predictive factor of final visual outcome with a cut off in the first week (BCVA of 0.83 versus 1.45), mean difference (MD) of 0.61 (IC 95% 0.052 to 1.17, p=0.03). The scleral or corneoscleral entry site had a better prognosis than corneal: 0.4615 versus 1.212 with a MD of 0.75 (IC 95%: 0.2753 to 1.22, p=0,003). 5 cases of siderosis (8.7%) related with delayed management and 3 endophthalmitis (5,2%) were found (despite use of prophylactic systemic antibiotics). No statistical difference was found regarding the location of the IOFB on the retina, the size or material of the IOFB. The number of remaining retinal detachment was 9 (15, 8%) with 4 cases in S group, 2 cases in N group and 2 cases in the G group. In one case the IOFB could not be extracted. A final BCVA of 20/40 or more was obtained in 39.3 % and 17.5% had light perception or worse.
The prognosis of the IOFB is mainly uncertain due to a complex combination of parameters. Nevertheless good post-operative results can be achieved without a silicone tamponade agent. The main prognostic factors related to better visual outcome were initial BCVA, time of surgery (first week), initially attached retina, scleral entry site. The main complications were represented by siderosis, vitreoproliferative retinal detachment and endophthalmitis. Location, material and size of IOFBs were not predictive factors.
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