Comparison of Approaches for the Removal of Metallic Intraocular Foreign Bodies

Jeong Ho Hwang; Eui Yong Kweon; Nam Chun Cho

doi:10.3341/jkos.2010.51.2.270

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Hwang, Kweon, and Cho: Comparison of Approaches for the Removal of Metallic Intraocular Foreign Bodies

Original Article

J Korean Ophthalmol Soc 2010;51(2):270-275.

Published online: 7 September 2010

DOI: https://doi.org/10.3341/jkos.2010.51.2.270

Comparison of Approaches for the Removal of Metallic Intraocular Foreign Bodies

Jeong Ho Hwang, MD, Eui Yong Kweon, MD, Nam Chun Cho, MD

Department of Ophthalmology, Chonbuk National University Medical School, Junju, Korea

Address reprint requests to Nam Chun Cho, MD Department of Ophthalmology, Chonbuk National University Hospital #San 2-20 Geumam-dong, Deokjin-gu, Jeonju 560-180, Korea Tel: 82-63-250-1969, Fax: 82-63-250-1960, E-mail: cnauo@moak.chonbuk.ac.kr

Received 20 February 2008 Accepted 17 August 2009

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To review the management of posterior segment metallic intraocular foreign bodies (IOFB) and to compare the use of an external approach using a large electromagnet and an internal approach using vitrectomy and its tools for their removal.

Methods

A retrospective review was performed on 49 eyes of 49 patients who underwent surgical removal of metallic IOFBs with either an internal or an external approach at a single institution between January 2003 and December 2006. We divided 49 eyes into two groups based on the type of approach: 26 external (n=26) and 23 internal (n=23). Visual acuity and the presence of any complications occurring with the two approaches were the main outcome measures studied.

Results

Thirty of 49 eyes (61%) showed improvements in visual acuity. When we compared patients treated with an external versus an internal approach, we found no statistically significant difference in regard to visual outcome. Preoperative vitreous hemorrhage and endophthalmitis were more common in the internal approach group. A trend toward a higher rate of reoperation was more common in the external approach group, but they were not statistically significant. Postoperative complications found to be significantly different between the two groups were the rate of postoperative endophthalmitis and retinal detachment, which were more common in the external approach group.

Conclusions

Surgical removal of metallic IOFBs results in significant visual improvement regardless of the approach method. The internal approach by vitrectomy is recommended as the first choice in preoperative conditions such as severe cataracts, vitreous hemorrhage and endophthalmitis, as well as in groups at high risk for postoperative endophalmitis and retinal detachment.

Keywords: Electromagnet, External approach, Internal approach, Intraocular foreign body, Vitrectomy

References

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Table 1.

Pre-and intraoperative characteristics of patients

Variable	External approach n=26 (%)	Internal approach n=23 (%)	p-value^†
Mean age(year)	31.4	33.6	0.439
Initial V/A			
<0.1	16 (62)	15 (65)	0.541
≥0.1	10 (38)	8 (35)	0.539
Type of injury			
Blunt	2 (7)	1 (4)	0.626
Sharp	24 (92)	22 (95)	0.467
Entrance location			
Corneal	13 (50)	11 (48)	0.879
Scleral	9 (34)	8 (35)	0.990
Corneoscleral	4 (16)	4 (17)	0.850
Entrance size			
<5mm	16 (62)	14 (61)	0.962
≥5mm	10 (38)	9 (39)	0.864
Hyphema	16 (62)	12 (52)	0.509
Cataract	17 (65)	14 (61)	0.744
Vitreous hemorrhage	10 (38)	14 (61)	0.046^‡
Iris prolapsed	14 (54)	8 (35)	0.181
Retinal detachment	1 (4)	2 (5)	0.480
Endophthalmitis	0	4 (17)	0.026^‡
IOFB^* size			
<3mm	15 (58)	14 (61)	0.821
≥3mm	11 (42)	9 (39)	0.791
IOFB^* location			
Intravitreal	19 (73)	15 (65)	0.551
Intra, sub-retinal	7 (27)	8 (35)	0.576

^* IOFB=Intraocular foreign body

^† p-value was calculated by unpaired t-test

^‡ p-value<0.05.

Table 2.

Visual outcomes of external and internal approaches according to location of FB

	intravitreal FB^*			intra, sub-retinal FB^*
	External approach (x/n)	Internal approach (x/n)	p-value^†	External approach (x/n)	Internal approach (x/n)	p-value^†
Final V/A						
<0.02	9/19	6/15	0.468	4/7	3/8	0.500
≥0.2	6/19	5/15	0.678	1/7	3/8	0.426
Retinal detachment	4/19	0/15	0.160	3/7	1/8	0.185
Proliferative vitreoretinopathy	1/19	0/15	0.508	1/7	1/8	0.919
Endophthalmitis	2/19	0/15	0.340	3/7	1/8	0.185
Vitreous hemorrhage	1/19	1/15	0.512	2/7	1/8	0.438
Remained FB	0/19	0/15	−	2/7	0/8	0.104
Reoperation	5/19	0/15	0.108	5/7	2/8	0.072

^* FB=foreign body

^† p-value was calculated by chi-square test.

Table 3.

Variable factors associated with excellent visual outcome in both approaches

Variable	External approach			Internal approach
Variable	Number of patient	Final V/A ≥0.2 (n)	p-value^†	Number of patient	Final V/A ≥0.2 (n)	p-value^†
Initial V/A>0.1	10	6	0.012^†	8	7	0.014^†
Normal lens at presentation	9	2	0.571	9	3	0.638
Normal iris at presentation	12	2	0.348	15	5	0.606
Entrance size <5 mm	16	3	0.321	14	3	0.153
IOFB size <3 mm	15	6	0.048^†	14	7	0.042^†
Retinal sparing IOFB	19	4	0.352	15	5	0.606

^* p-value was calculated by chi-square test

^† p-value<0.05.

Table 4.

Postoperative complications of IOFB^* removal

Variable	External approach, n=26 (%)	Internal approach, n=23 (%)	p-value^†
Retinal detachment	7 (27)	1 (4)	0.033^‡
Proliferative vitreoretinopathy	2 (8)	1 (4)	0.626
Endophthalmitis	5 (19)	1 (4)	0.048^‡
Phthisis	1 (4)	1 (4)	0.929
Glaucoma	1 (4)	1 (4)	0.929
Optic neuropathy	1 (4)	0 (0)	0.342
Remained IOFB^*	2 (8)	0 (0)	0.174

^* IOFB=Intraocular foreign body

^† p-value was calculated by unpaired t-test

^‡ p-value<0.05.

Table 5.

Predictive factors for endophthalmitis and retinal detachment

Variable	Total (n=49)	Endophthalmitis (n=6)	p-value^†	Retinal detachment (n=8)	p-value^†
Initial visual acuity (Snellen)			0.199		0.049^‡
<0.1	29	5	0.083	7	
≥0.1	20	1	0.083	1	
Type of injury			0.250		0.411
Blunt	3	1	0.594	1	
Sharp	46	5	0.594	7	
Entrance location			0.396		
Corneal	24	3	0.064	3	
Scleral	17	1	0.064	4	0.372
Corneoscleral	8	2	0.064	1	
Entrance size			0.547		0.132
<5 mm	30	3	0.555	3	
≥5 mm	19	3	0.555	5	
Hyphema	28	2	0.208	4	0.655
Cataract	31	2	0.104	4	0.395
Vitreous hemorrhage	24	2	0.413	7	0.017^‡
Iris prolapsed	22	2	0.543	4	0.751
Retinal tear	3	0	0.504	1	0.411
IOFB^* size			0.024^‡		0.173
<3 mm	29	1	0.697	3	
≥3 mm	20	5	0.697	5	
IOFB^* location					0.235
Intravitreal	34	4	0.816	4	
Intra, sub-retinal	15	2		4	

^* IOFB=intraocular foreign body

^† p-value was calculated by unpaired t-test

^‡ p-value<0.05.

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