Late complications from posterior segment intraocular foreign bodies with particular reference to retinal detachment.

Abstract

During the first half of the 20th century there was a strong controversy over the route for removal of an intraocular foreign body (IOFB) lying in the posterior segment of the eye. In the early years the anterior route was substantially the method of choice (Barkan and Barkan, 1927;Verhoeff, 1932 I961-1970, further details of which are published in the accompanying paper (Percival, I972). Double perforations have been excluded, and when five cases in which the site of the foreign body was either in the optic nerve or never known and two cases of transfixion are also excluded, there remain I 14 vitreous or preretinal foreign bodies and 39 foreign bodies clinically impacted in the retina or choroid. This group of I53 IOFBs, fifteen of which were non-magnetic, form the basis for the following study.Route of extraction The majority of foreign bodies were removed by the posterior route, and Table I compares the incidence of complications related to three different methods. As large foreign bodies are naturally associated with a high complication rate, all IOFBs known to be over 5 cu. mm. in size are excluded from this Table. In order that the methods should be comparable, all foreign bodies removed through the wound of entry, whether corneal or scleral, are also excluded. This tends to eliminate complications arising at the time of injury when the perforating wound was large and the ocular damage that much greater.The anterior route method involved drawing the foreign body into the anterior chamber with a magnet and extraction through a keratome incision. The high incidence of complications and poor prognosis is striking: even retinal detachment occurred twice as frequently as after posterior route extractions.

A Clinical Study of Penetrating Injuries of the Eye

“…Out of 100 cases 92 cases (92%) were found to be males, and 8 cases (8%) were found to be females. This is comparable to other studies, 5,6 like. S.P.Perceival Scarborough (1972) and P.Desai, Mac Ewen C, Baines P (1996) The age of the patients in our study ranged from 2 to 71 yrs.…”

Outcomes of surgery for posterior segment intraocular foreign bodies—a retrospective review of 17 years of clinical experience

“…The association between retinal detachment and poor visual outcome in this study was unsurprising, since the development of retinal detachment and proliferative vitreoretinopathy (PVR) is recognised as one of the major complications associated with poor visual outcome [5,17,25]. In a study by Cardillo, the relative risk of poor visual outcome was 11.7 times greater if PVR developed with the strongest stimulus for PVR being vitreous haemorrhage [3].…”

Results of Vitreoretinal Surgery in Posterior Segment Foreign Bodies

“…Percival manyetik olmayan ve küçük boyuttaki yabancı cisimlerin yıllarca gözde hasar yaratmadan kalabileceğini ifade etmiştir. [5] Yabancı cismin çıkarılması gerekiyorsa büyüklüğüne, özelliğine, şekline, yerine ve göze ait bulgulara göre nasıl çıkarılacağına karar verilmelidir. Eğer yabancı cisim muayene ile görülemiyorsa, manyetik değilse veya manyetik ama büyükse, ekvator gerisinde, kapsüllü, arka kutba yerleşmiş, retinaya gömülü ise, intraoküler hemoraji veya retina dekolmanı varsa PPV yapılarak çı-karılmalıdır.…”