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. 2022 May 3:16:1401-1411.
doi: 10.2147/OPTH.S358064. eCollection 2022.

Endophthalmitis, Visual Outcomes, and Management Strategies in Eyes with Intraocular Foreign Bodies

Jason M Keil  1 , Peter Y Zhao  1 , Asad F Durrani  1 , Lyna Azzouz  1 , Michael J Huvard  1 , Vaidehi S Dedania  2 , David N Zacks  1
Affiliations

Endophthalmitis, Visual Outcomes, and Management Strategies in Eyes with Intraocular Foreign Bodies

Jason M Keil et al. Clin Ophthalmol. .

Abstract

Purpose: Ocular trauma with intraocular foreign body (IOFB) can have devastating visual consequences. Management and antimicrobial strategies remain variable due to the infrequency and heterogeneity of presentation. Our goal was to identify risk factors for endophthalmitis and poor visual outcomes in cases of IOFB and investigate management strategies.

Patients and methods: A retrospective chart review was conducted in 88 eyes of 88 patients suffering traumatic injury with IOFB at the University of Michigan between January 2000 and December 2019. Medical records were reviewed to characterize the injuries and IOFBs as well as how clinical presentation and treatment modalities were associated with outcomes.

Results: Delayed presentation (P=0.016) and organic IOFB (P=0.044) were associated with development of endophthalmitis. Retinal detachment (P=0.012), wound length greater than 5 mm (P=0.041), and poor presenting visual acuity (P=0.003) correlated with poor final visual outcome. Antibiotic prophylaxis was given to all patients, though agents and routes of delivery varied. Endophthalmitis developed in 4.9% of the eyes after initial management, with primary and secondary removal of posterior segment IOFBs associated with similar rates of endophthalmitis (P=1.000).

Conclusion: Poor presenting visual acuity and severity of injury, as measured by large wound and retinal detachment, correlate with poor visual outcome. Prompt globe closure and antimicrobial prophylaxis are critical for infection prevention. In cases where IOFB removal and globe closure cannot be performed concurrently, primary globe closure with aggressive antibiotic prophylaxis offers a reasonable alternative to prevent endophthalmitis.

Keywords: IOFB; retina; trauma; vitreous.

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Conflict of interest statement

The authors have no relevant financial or non-financial interests to disclose. The abstract of this paper was presented at the 2021 ARVO meeting as a poster presentation with interim findings. The poster’s abstract was published in “Poster Abstracts” in Investigative Ophthalmology & Visual Science, June 2021, Vol.62, 3679: https://iovs.arvojournals.org/article.aspx?articleid=2775931

Figures

Figure 1
Figure 1
Regression analysis of factors associated with endophthalmitis and good or poor final visual acuity. (A) Factors associated with endophthalmitis development and final visual acuity. p < 0.05 significant. *Severe anterior segment damage defined as concurrent corneal laceration, uveal prolapse, and lens disruption. (B) Initial and final visual acuity of eyes presenting with IOFBs, with dashed line slope=1 and continuous trendline demonstrating Pearson’s correlation coefficient (R = 0.58). Points below the dashed line demonstrate eyes with improved visual acuity compared to presentation.
Figure 2
Figure 2
Days elapsed between initial globe closure and deferred IOFB removal by PPV.
Figure 3
Figure 3
Antimicrobial treatment by agent class and route of delivery in patients with IOFBs.
See this image and copyright information in PMC

References

    1. Loporchio D, Mukkamala L, Gorukanti K, Zarbin M, Langer P, Bhagat N. Intraocular foreign bodies: a review. Surv Ophthalmol. 2016;61(5):582–596. doi:10.1016/j.survophthal.2016.03.005 - DOI - PubMed
    1. Colyer MH, Weber ED, Weichel ED, et al. Delayed intraocular foreign body removal without endophthalmitis during Operations Iraqi Freedom and Enduring Freedom. Ophthalmology. 2007;114(8):1439–1447. doi:10.1016/j.ophtha.2006.10.052 - DOI - PubMed
    1. Kazokoğlu H, Saatçi O. Intraocular foreign bodies: results of 27 cases. Ann Ophthalmol. 1990;22(10):373–376. - PubMed
    1. Thompson JT, Parver LM, Enger CL, Mieler WF, Liggett PE. Infectious endophthalmitis after penetrating injuries with retained intraocular foreign bodies. National Eye Trauma System. Ophthalmology. 1993;100(10):1468–1474. doi:10.1016/s0161-6420(93)31454-5 - DOI - PubMed
    1. Zhang Y, Zhang M, Jiang C, Qiu HY. Intraocular foreign bodies in China: clinical characteristics, prognostic factors, and visual outcomes in 1421 eyes. Am J Ophthalmol. 2011;152(1):66–73.e1. doi:10.1016/j.ajo.2011.01.014 - DOI - PubMed