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Tanuj Banker, Andrew Mcclellan, Fabiana Juan, Eric Weichel, Thomas Arno Albini, Harry W Flynn, Ajay E. Kuriyan; Management of Open Globe Injuries with and without Intraocular Foreign Bodies. Invest. Ophthalmol. Vis. Sci. 2016;57(12):1055.
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© ARVO (1962-2015); The Authors (2016-present)
To report visual acuities (VA) and anatomical outcomes of open globe injuries with and without intraocular foreign bodies ( IOFBs).
An interventional case series from 2004 to 2015 (n=722) of open globe injuries with or without IOFBs that underwent repair at a tertiary referral center. 52 eyes underwent PPV at the time of globe closure using either 20 or 23 gauge PPV instrumentation. Exclusion criteria included patients under 18 years of age and eyes undergoing primary enucleation.. Presence of an IOFB was confirmed preoperatively with either a CT scan and/or a B-scan. Primary outcome measures included VA, zone of injury, length of laceration, and use of PPV.
The study included 722 eyes that were followed for a mean time of 12 months. Open globe injuries without IOFBs were present in 93% of eyes (n=670) while 7% (n=52) had IOFBs. The mean age of patient without IOFBs was 52 years vs. 42 years in patients with IOFBs (p < 0.01). 33% (n=241) of eyes had zone 1 injuries, 19% (n=135) had zone 2 injuries, 10% (n=72) had zone 3 injuries. The mean length of scleral laceration was 8.24 mm in eyes without IOFBs vs. 4.01 mm in eyes with IOFBs (p < 0.038).40% (n=21) of eyes with IOFBs required 20 or 23 gauge PPV at the time of globe closure; 40% (n=21) eyes required lensectomies and 25% (n=13) had retinal detachment or retinal tears on presentation. 70% (n=36) of IOFBs were metallic and 23% (n=12) were glass.In eyes with IOFBs, 9.6% of eyes (n=5) had clinical evidence of endophthalmitis on exam; 7.7% of eyes (n=4) had culture positive endophthalmits. Presenting VA in eyes that developed endophthalmitis was 20/800 (logMAR 1.6). The final postoperative VA in eyes that developed endophthalmitis was CF (logMAR 1.9). In eyes without IOFBs, the mean presenting VA was 20/800 (logMAR 1.57), compared to 20/1000 (logMAR 1.67) in eyes with IOFBs (p < 0.63). Postoperatively, in eyes without IOFBs the mean final VA was 20/800 (logMAR 1.56), compared to 20/400 (logMAR 1.26) in eyes with IOFBs (p < 0.14). Overall, 29.6% (n=214) of patients had a final VA >20/100.
In this large series of non-combat related open globe injuries, with eyes with IOFBs are were often younger and had smaller scleral lacerations compared to eyes without IOFBs. IOFB removal using PPV at the time of globe closure was the most common approach. VA outcomes were variable depending on the extend and nature of injury.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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