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J.B. Sanders, R.L. Funderburk, J.L. Stone, A.J. Franklin; Prophylactic Peripheral Panretinal Photocoagulation During Intraocular Foreign Body Removal Decreases the Risk of Postoperative Retinal Detachment . Invest. Ophthalmol. Vis. Sci. 2003;44(13):1854.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose: To investigate the potential benefit of 360 degrees of peripheral panretinal photocoagulation (PRP) in the management of intraocular foreign bodies. Methods: The charts of 16 patients who had a diagnosis of either a magnetic or non-magnetic intraocular foreign body were reviewed. The incidence of rhegmatogenous retinal detachments and re-operation rates are reported as 2 significant outcome parameters. Results: All patients underwent primary repair of the penetrating ocular injury including trans pars plana vitrectomy and removal of the foreign body. 15 of the IOFBs were metallic. One IOFB was vegetative matter. Postoperative rhegmatogenous retinal detachment (RRD) occurred in 6 of 16 (37.5%). Scatter laser was placed to 360 degrees of the retinal periphery during the initial surgery in 11 of the 16 patients (61%). Postoperative RRD occurred in 2 of the 11 (18%) patients who underwent initial PRP. Postoperative RRD occurred in 4 of the 5 (80%) patients who did not have initial PRP applied. The average number of operations was 1.27 in the initial PRP group compared to 1.8 in the non-PRP group. Conclusions: Intraocular foreign bodies cause extensive damage to the globe with profound visual impairment. The development of a retinal detachment in the postoperative period is associated with a poorer visual and anatomic outcome. Prophylactic scleral buckling has been suggested as a means to decrease the risk of postoperative RRD during IOFB removal. However, this procedure requires significantly larger incisions and manipulation of an eye that usually has undergone a profound injury. In our series of patients, the application of PRP during the initial surgical intervention reduced the rate of postoperative retinal detachment from 80% to 20%. The average number of operations required was found to be less in the PRP group compared to the non-PRP group. Certainly, there are other risk factors that influence the incidence of postoperative RRD such as size and location of the IOFB, as well as the presence of initial infection or retinal detachment. In summary, in this relatively small number of patients, placement of 360 degrees of peripheral PRP during initial IOFB removal appeared to decrease the risk of postoperative RRD, without the added manipulation and morbidity of scleral buckling.
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