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  • Prompt Open Globe Repair Is Crucial

    By Lynda Seminara
    Selected by Prem S. Subramanian, MD, PhD
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    Journal Highlights

    Clinical Ophthalmology
    2022;16:1401-1411

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    Open globe injury from an intraocular foreign body (IOFB) can severely affect vision and lead to endophthalmitis. Al­though there is consensus on common risk factors and stratification schemes for these wounds, there is controversy about the type and timing of treat­ment. Keil et al. reviewed IOFB cases in an effort to define predictors of poor outcomes and explore management strategies. They found that poor visual acuity (VA) and severe injury at presen­tation were associated with poor visual outcomes. Prompt globe closure and antimicrobial prophylaxis were crucial to avoid infection.

    For this study, the authors gathered details from medical records of 88 patients (88 eyes) who experienced IOFB-related injury and were seen at the University of Michigan Medical School from 2000 through 2019. Perti­nent data were documented, including VA, injury characteristics, treatment modalities, and clinical outcomes. Multivariate logistic regression was employed to determine correlations between presenting factors and visual outcomes, which were classified as good (corrected VA of 20/40 or better) or poor (corrected VA of 20/200 or worse). Unpaired t tests and Fisher’s exact tests were used to compare continuous and categorical variables, respectively.

    The analyses showed that delayed presentation (p = .016) and organic IOFB (p = .044) correlated strongly with endophthalmitis. Retinal detach­ment (p = .012), wound length >5 mm (p = .041), and reduced VA (p = .003) were linked to poor final visu­al outcomes. All patients were given antibiotic prophylaxis, but the choice of specific agent and route of delivery varied. More than 80% of patients received antibiotics systemically, and intravitreal administration was used in 50% of primary IOFB removals and in 86% of secondary removals. Endoph­thalmitis occurred in 4.9% of the eyes after initial management, and rates were similar for primary and secondary procedures.

    Findings of this 20-year experience indicate that outcomes are optimized by prompt treatment, including globe closure and antimicrobial prophy­laxis. The authors noted that if IOFB removal and globe closure cannot be done concurrently, aggressive antibiotic prophylaxis alone may be sufficient to prevent endophthalmitis.

    The original article can be found here.