Metallic intraocular foreign bodies: characteristics, interventions, and prognostic factors for visual outcome and globe survival.

PURPOSE: To describe metallic intraocular foreign body (IOFB) injuries and identify prognostic factors for visual outcome and globe survival.

DESIGN

Interventional, consecutive, retrospective case series.

METHODS

setting: Wills Eye Hospital. study population: Ninety-six eyes of 96 patients with metallic intraocular foreign bodies. procedures: Metallic IOFB injuries between January 1991 to June 2002 were reviewed for clinical characteristics, surgical intervention, and outcome. Univariate and multivariate analyses were performed to identify prognostic variables. main outcome measures: Final visual acuity and globe survival.

RESULTS

The average patient age was 33.0 years with a male predominance (94%). Forty percent of eyes had a presenting vision of 20/50 or better. Following IOFB removal, 40% of patients required additional interventions. Thirty-one percent of eyes had a final acuity of 20/50 or better. Eight percent of patients ultimately required enucleation or evisceration. Excellent visual outcome (defined as > or =20/50) was associated with multiple variables, including normal lens at presentation and anterior segment IOFB (P< .003). Factors associated with poor visual outcome (defined as <20/200) included uveal prolapse and posterior segment IOFB (P < .0003). Globe loss was associated with younger age, presenting light perception (LP) or no light perception (NLP) vision, BB/pellet injury, and the presence of an afferent pupillary defect (P < .01).

CONCLUSIONS

Multiple prognostic factors were identified in this large analysis of metallic IOFB injuries, which may help predict visual outcome and globe survival. Most of these variables were independent of intervention and can be identified at the time of initial presentation.