Intraocular Foreign Body Related Endophthalmitis: The Second-look Vitrectomy


ABSTRACT

The management of endophthalmitis associated with retained IOFB is always challenging. With the improvement in surgical techniques, even more eyes are being saved. Visual prognosis is affected by the complexity of confluent factors such as inflammation and features of the foreign body. Furthermore, it also depends on the surgery approach, often difficult because of the retinal necrosis and the ciliary body involvement. Even though there is a consensus that an early vitrectomy should be carried out in patients presenting endophthalmitis and retained IOFB, not everybody agrees on the issue of an early complete vitrectomy. According to the EVS, a complete removal of the posterior hyaloid should not be performed in eyes with an attached vitreous, for the risk of creating iatrogenic retinal injuries. Nevertheless, more recent papers (CEVE study, 2007), reports significantly better results with an early and complete vitrectomy. In 2015, a retrospective analysis study of endophthalmitis complications, evidences a better functional outcome after surgeries in which PVD induction was available, with 50% of cases that achieved more than 6/60, compared to 18.2%, in the other group. Certainly, in cases of associated endophthalmitis and intraocular foreign body, the removal the IOFB , a complete detachment of the posterior cortical vitreous and the removal of cyclitic membranes at the time of the first vitrectomy should be the goal of the surgery, to prevent complications in the long term course. However, when in the primary surgery some of this steps have high risk of iatrogenic intraoperative damage, a deferred surgery can be performed to complete the treatment. We discuss our experience in some cases of severe endophthalmitis associated with an intraocular foreign body, in which the careful primary care was followed by another surgery, carried out at up to 15 days. This way we were able to perform other surgical steps (complete removal of the posterior hyaloid, ILM peeling, endolasering) in less challenging conditions, in order to avoid complications that can threaten the final outcome. p.s. This abstract replaces the previous one.


CONTACT DETAILS

Paola Vastarella
Napoli, Italy
Email : paolavast@gmail.com
Cell Phone: +393388670585
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