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A. S. Shah, M. T. Andreoli, C. M. Andreoli, C. Kloek; Visual Recovery in Patients Suffering Open-Globe Injuries Caused by Intraocular Foreign Bodies. Invest. Ophthalmol. Vis. Sci. 2007;48(13):718.
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To better counsel patients on prognosis following an open-globe injury related to an intraocular foreign body (IOFB).
We reviewed 647 open-globe injuries presenting to the Massachusetts Eye and Ear Infirmary during the past 6 years, and we found 94 cases related to IOFBs. We examined these injuries for (i) type of IOFB, (ii) zone of injury, (iii) visual acuity (VA) on presentation, (iv) VA after repair, and (v) risk of increased IOP, endophthalmitis, and enucleation.
Of the 94 cases, 88 involved men, and 6 involved women. The average age was 33 years (range 9-78 years). Projectiles caused 56% of the ruptured globes, while other IOFBs included nails (11%), BBs (9%), wood (6%), and debris from motor-vehicle accidents (4%). Zone 1 injuries comprised 45% of IOFB-related ruptured globes, and zones 2 and 3 injuries represented 13% and 14%, respectively. The remaining injuries could not be classified into a zone. Median VA on presentation was count fingers. However, 67% of patients experienced improved VA post-repair such that the median best acuity post-repair was 20/30. Eight patients experienced a decline in VA. VA did not vary significantly based on zone of injury. With regards to complications, 22% experienced intraocular pressures greater than 23 mm Hg during their post-injury course. Endophthalmitis was suspected in 3.2% of patients with IOFB-related open globe injuries but in only 0.9% of open-globe injuries without IOFB. Enucleation was performed in 3 cases.
As with any illness, patients and family ask about the prognosis. These data suggest that 2 out of 3 patients with ruptured-globe injuries from IOFBs will have improvement in their initial VA. However, this optimistic prediction is balanced by a 3-fold increase in endophthalmitis when an IOFB causes a ruptured globe. Future studies should search for factors associated with endophthalmitis such that early intervention may reduce this adverse outcome.
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