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T. Micelli, Sr., N. Recchimurzo, F. Boscia, L. Sborgia, N. Cardascia, C. Furino, G. Besozzi, M. Leozappa, E. Epifani, G. Ciccolo; 3–Port Pars Plana Vitrectomy for Intraocular Foreign Bodies: When and How . Invest. Ophthalmol. Vis. Sci. 2006;47(13):1450.
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intraocular foreign bodies (IOFB) in ocular penetrating trauma often results in poor visual acuity (VA).Our purpouse is to evaluate when and how 3–port Pars plana vitrectomy (PPV) and IOFB removal could result in better visual acuity.
a retrospective study of 84 eyes with penetrating trauma and IOFB located posterior to the lens from january 2001 to december 2004.All eyes underwent PPV, IOFB removal, additional surgical procedures, by three surgeons (TMF,NR,FB), within 72 hours from trauma.Mean follow–up was 15.19±4.89 months (range 6–24)
Of the 84 patients (mean age 42.9±17.37; range 15–70; median 43.5), 72 (85.8%) had a metallic foreign body, while in 12 eyes (14.2%) it was non–metallic (wood).In the 72 eyes with metallic IOFB, it was located in the vitreous cavity in 36 (50%), on the retinal surface at posterior pole or in middle periphery in 12 (16.7%) and intraretinal in 24 (33.3%); traumatic cataract was present in 36 (50%); we detected retinal breaks in 30 (41, 67%), located at the posterior pole inferior to the macula in 6 (20%), and in the middle periphery in 24 eyes (80%), mostly (60%) between 4 and 8 o’clock.All non–metallic IOFB were located in the vitreous cavity, traumatic cataract and retinal breaks were not present.Preoperative VA was worse than 20/200 in 24 of all patients (28.6%), including 18 (21.4%) from counting fingers to light perception, 20/200 to 20/50 in 12 (14.2%), better than 20/50 to 20/25 in 24 (28.6%), 20/20 in 24 (28.6%).Postoperative VA was worse than 20/200 in 6 of all patients (7.2%), 20/200 to 20/50 in 18 (21.4%), better than 20/50 to 20/25 in 12 (14.2%), 20/20 in 48 (57.2%).We practised PPV without posterior hyaloid removal and vitreous base shaving in the 36 eyes (42.8%) which shown metallic IOFB floating in the vitreous cavity.The foreign body was removed by intraocular forceps from an enlarged sclerotomy.We practised complete PPV in those eyes with metallic IOFB on the retinal surface or intraretinal and in all eyes with non–metallic IOFB.We sutured the cornea in 54 eyes (64.3%); cataract extraction was necessary in all patients with traumatic cataract.We tamponaded only 12 eyes (14.2%) with silicon oil. We did not observe complications as proliferative vitreoretinopathy, late retinal detachment and endophthalmitis
Our experience could suggest that the surgical approach in IOFB removal from posterior segment has to be as immediate as possible.The surgeon could choose not to remove all the vitreous, according to the clinical situation, however obtaining good visual recovery and no complications.
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