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L. Wickham, W. Xing, C. Bunce, P. Sullivan; Outcomes Following Posterior Segment Intraocular Foreign Bodies – A Retrospective Review of 17 Years of Clinical Experience at Moorfields Eye Hospital . Invest. Ophthalmol. Vis. Sci. 2005;46(13):5522.
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Purpose: To determine the outcome of surgery in patients who presented with posterior segment intraocular foreign bodies (IOFB’s) and to identify factors associated with poor visual outcome. To assess whether improvement in vitreo–retinal surgical techniques over the past 17 years has resulted in an improvement in the outcome of these patients. Methods: A retrospective cohort study. Patients who underwent a primary surgical repair and removal of a posterior segment IOFB were identified using a hospital database. Of the 140 patients identified, 114 (81%) were included in the study. Data on age, activity at time of injury, presenting clinical features, surgical techniques, complications and final visual outcome were recorded and analyzed. Results: The mean age at time of injury was 34.6 +/– 12.4 years. All patients were male. The majority of IOFB’s were metal (83%). Hammering and chiselling were the most common activities at the time of injury (66%). 48% of patients presented with a visual acuity of 20/80 or better. Removal of IOFB was carried out a median of 1 day (interquartile range 1–5 days) following injury. A poor final visual outcome (20/125 or worse) was documented in 31% and was associated with the presence of a relative afferent papillary defect (p<0.001), hyphaema (p=0.024), vitreous haemorrhage (p=0.003), uveal prolapse (p=0.038) or retinal detachment (p=0.031) at the time of presentation. Endophthalmitis was a presenting feature in 9% of cases but was not found to be significantly associated with a poor visual outcome (p=0.16). Post–operative complications of retinal detachment (p<0.001) and proliferative vitreoretinopathy (p<0.001) were prognostic of poor final visual acuity. Following the introduction of a panoramic viewing system (oculus BIOM) in 1999 there has been a significant improvement in the final visual outcome of these patients (p=0.043). Conclusions: This is the largest series of posterior segment IOFB’s reported in Great Britain. Factors associated with a poor prognosis are similar to those reported in the USA. It shows that recent advances in surgical techniques are associated with a significant improvement in prognosis.
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