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Yvonne Wang, Seanna R Grob, Yewlin Chee, Christopher Andreoli, John B Miller; Retinal Detachment in Open Globe Injury with Intraocular Foreign Body. Invest. Ophthalmol. Vis. Sci. 2017;58(8):5511.
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© ARVO (1962-2015); The Authors (2016-present)
Intraocular foreign body (IOFB) represents a small subset of open globe injuries, yet can have significant visual outcome implications. We performed a retrospective clinical study to evaluate the characteristics, outcomes, and complications related to IOFBs. Particularly, we explored the relationship between IOFB location and development of retinal detachment.
661 open globe injuries were reviewed at Massachusetts Eye and Ear, a single large tertiary ophthalmology trauma hospital, between the years of 2010 and 2015. We reviewed 57 cases of open globe repair that underwent IOFB removal. Zone of injury, IOFB location, visual acuity, mechanism of injury, and operative reports from primary repair and secondary surgeries were reviewed.
661 open globe injuries, including 57 with IOFB, presented to Massachusetts Eye and Ear between 2010 and 2016. 86% of cases with IOFB had Zone I injury, 16% had Zone II injury, and 10% had Zone III injury. The IOFB was in the cornea in 46% of cases, 47% in the anterior chamber, 23% in the lens, and 42% in the posterior segment. 88% of the patients with anterior segment IOFB had a final BCVA better than 20/100, compared to only 54% of patients with a posterior segment IOFB. The most common mechanism of injury was construction or mechanical labor, with metal as the most common IOFB material. 93% of cases had IOFB removal during the time of primary open globe repair. 5% had secondary removal of the IOFB and 2% were observed.Pars-plana vitrectomy was used during primary open globe repair and IOFB removal in 30% of cases. Retinal detachment occurred in 28% patients with IOFBs. Of patients who had a posterior segment IOFB, 54% had a retinal detachment, and required an average of 2.4 total surgeries. Of the patients who had an anterior segment IOFB, 9% had a retinal detachment, and required an average of 1.7 total surgeries.
Intraocular foreign bodies pose unique challenges in the repair of open globe injuries. Retinal surgical intervention is often required. The location of IOFB is an important prognostic factor for development of a retinal detachment and worse visual outcomes. We found that a patient with a posterior segment IOFB is more likely to have a retinal detachment. Patients should be counseled regarding the additional risks and complications of intraocular foreign bodies, with a greater risk of needing subsequent retina surgical interventions.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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