http://www.evrs.eu/medias/2006/congress/Intraocular-Foreign-Body-Removal-at-Walter-Reed-Army-Medical-Center-during-Operations-Iraqi-and-Enduring-Freedom.swf

Marcus H Colyer, MD (Washington, DC), Eric Weichel, MD (Washington, DC), Eric Weber, MD (Washington, DC), John S.B. Dick, MD (San Diego, CA), Julia A. Haller, MD (Baltimore, MD)*

PURPOSE:

What are the risk factors for poor final visual acuity in soldiers sustaining intraocular foreign bodies during Operation Enduring Freedom and Iraqi Freedom?

METHODS:

Retrospective, noncomparative, interventional case series of clinical records (6-month followup) for soldiers deployed in support of Operation Iraqi and Enduring Freedom sustaining penetrating ocular trauma with retained IOFB. Variables include 1) Preoperative and final visual acuity 2) type and size of intraocular foreign body 3) type and size of globe injury 4) postoperative complications 4) Time from initial injury to primary closure 6) time from injury to foreign body removal 7) method of injury 8) type and frequency of antibiotics 9) associated ocular injuries 10) rate of proliferative vitreoretinopathy.

RESULTS:

68 eyes of 62 United States military soldiers (59 men and 3 women) are included. Average age was 27 years (range 18-52 years) with an average of 288 days postoperative followup. Average IOFB size was 4 mm. Time to primary closure was within hours of injury, while median time to IOFB removal was 21 days (mean 38 days). Mean preoperative visual acuity was 2.06 (HM) and and mean final visual acuity was 1.06 (20/200) logMAR units. There were no cases of endophthalmitis or siderosis bulbi. 8% of eyes evolved to NLP or enucleation at 6 month followup. 20% of patients developed proliferative vitreoretinopathy. Worse visual acuity correlated greatest with PVR (p<0.0001), posterior exit wound (p<0.001), and associated retinal detachment (p<0.013). Proliferative vitreoretinopathy correlated with presence of retinal detachment at surgery (p<0.00001), posterior exit (p<0.003), and presenting vision (p<0.032). Time to IOFB removal did not correlate with a worse visual outcome.

CONCLUSION:

Delayed traumatic IOFB removal with a combination of systemic and topical antibiotic coverage can result in favorable visual outcome without an increased risk of endophthalmitis or other deleterious side effects. However, presence of a retinal detachment at time of removal and/or posterior penetration injury do correlate with a poor final acuity.
* Financial interest disclosed