Preop factors key to predicting outcomes after intraocular foreign body injury

The majority of factors that may help predict visual outcomes and globe survival for patients with metallic intraocular foreign body injuries can be identified at presentation before intervention, a retrospective study suggests.

In order to determine prognostic factors for visual outcomes and globe survival, Justis P. Ehlers, MD, and colleagues reviewed clinical records for 96 eyes of 96 predominantly male patients who presented with metallic intraocular foreign body injuries at Wills Eye Institute between January 1991 and June 2002.

Patients averaged 33 years of age, and follow-up averaged 180 days.

At presentation, 38 patients (40%) had a visual acuity of 20/50 or better in the affected eye, the authors noted.

After foreign body removal, 38 eyes (40%) required additional surgery.

A final visual acuity of 20/50 or better was achieved in 25 eyes (26%); however, 48 eyes (50%) had a visual acuity of worse than 20/200. Final visual acuity was unavailable for five eyes (5%).

Surgeons performed enucleation or evisceration in eight eyes (8%).

The investigators identified significant associations between excellent visual outcomes, defined as a final visual acuity of 20/50 or better, the presence of a normal lens at presentation and an anterior segment metallic intraocular foreign body (P < .003).

Uveal prolapse and posterior segment intraocular foreign bodies were associated with poor visual outcomes, defined as a final visual acuity of worse than 20/200 (P < .0003).

Globe loss was associated with younger age, light perception or no light perception vision at presentation, BB or pellet injury, and afferent pupillary defect (P < .01), according to the study, published in the September issue of American Journal of Ophthalmology.