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

  • Louisa Wickham
  • Wen Xing
  • Catey Bunce
  • Paul Sullivan
Clinical Investigation



To determine the outcome of surgery in patients who presented with posterior segment intraocular foreign bodies (IOFBs) and to identify factors associated with poor visual outcome. To assess whether improvement in vitreo-retinal surgical techniques over the past 17 years has resulted in an improvement in the outcome of these patients.


A retrospective cohort study carried out at Moorfields Eye Hospital, London. Patients who underwent a primary surgical repair and removal of a posterior segment IOFB were identified using a hospital database. Of the 140 patients identified, 114 (81%) were included in the study. Data on age, activity at time of injury, presenting clinical features, surgical techniques, complications and final visual outcome were recorded and analyzed.


The mean age at time of injury was 34.6±12.4 years. All patients were male. The majority of IOFBs were metal (83%). Hammering and chiselling were the most common activities at the time of injury (66%). Fifty-three percent of patients presented with a visual acuity of 6/36 or better. Primary closure was achieved in a median of 1 day (interquartile range 1–3 days) following injury. A final visual outcome of 6/60 or worse was documented in 31%. Presentation with a relative afferent pupillary defect (P<0.001), hyphaema (P=0.024), vitreous haemorrhage (P=0.003), uveal prolapse (P=0.038) or retinal detachment (P=0.031) was associated with a poor visual outcome (6/60 or worse). Postoperative complications of retinal detachment (P<0.001) and proliferative vitreoretinopathy (P<0.001) were prognostic of poor final visual acuity. Improvements in surgical techniques, e.g. panoramic viewing systems has resulted in a significant improvement in the final visual outcome of these patients (P=0.043).


This large series of posterior segment IOFBs shows that recent advances in surgical techniques are associated with a significant improvement in prognosis.


Intraocular foreign body Posterior segment Prognosis Visual acuity 


  1. 1.
    Ambler JS, Meyers SM (1991) Management of intraretinal metallic foreign bodies without retinopexy in the absence of retinal detachment. Ophthalmology 98:391–394PubMedGoogle Scholar
  2. 2.
    Bryden FM, Pyott AA, Bailey M, McGhee CN (1990) Real time ultrasound in the assessment of intraocular foreign bodies. Eye 4:727–731PubMedGoogle Scholar
  3. 3.
    Cardillo JA, Stout JT, LaBree L, Azen SP, Omphroy L, Cui JZ, Kimura H, Hinton DR, Ryan SJ (1997) Post-traumatic proliferative vitreoretinopathy. The epidemiologic profile, onset, risk factors and visual outcome. Ophthalmology 104:1166–1173PubMedGoogle Scholar
  4. 4.
    Chacko JG, Figueroa RE, Johnson MH, Marcus DM, Brooks SE (1997) Detection and localisation of steel intraocular foreign bodies using computed tomography. A comparison of helical and conventional axial scanning. Ophthalmology 104:319–323PubMedGoogle Scholar
  5. 5.
    Chiquet C, Zech JC, Gain P, Adeleine P, Trepsat C (1998) Visual outcome and prognostic factors after magnetic extraction of posterior segment foreign bodies in 40 cases. Br J Ophthalmol 82:801–806PubMedCrossRefGoogle Scholar
  6. 6.
    Chow DR, Garretson BR, Kuczynski B, Williams GA, Margherio R, Cox MS, Trese MT, Hassan T, Ferrone P (2000) External versus internal approach to the removal of metallic intraocular foreign bodies. Retina 20:364–369PubMedCrossRefGoogle Scholar
  7. 7.
    Cleary PE, Ryan SJ (1981) Vitrectomy in penetrating eye injury: results of a controlled trial of vitrectomy in an experimental posterior penetrating eye injury in the Rhesus monkey. Arch Ophthalmol 99:287–292PubMedGoogle Scholar
  8. 8.
    Coleman DJ (1982) Early vitrectomy in the management of severely traumatized eye. Am J Ophthalmol 93:543–551PubMedGoogle Scholar
  9. 9.
    Coleman DJ, Lucas BC, Rondeau MJ, Chang S (1987) Management of intraocular foreign bodies. Ophthalmology 94:1647–53PubMedGoogle Scholar
  10. 10.
    De Juan E, Sternberg P, Michels RG (1983) Penetrating ocular injuries. Types of injuries and visual results. Ophthalmology 90:1318–1322PubMedGoogle Scholar
  11. 11.
    De Souza DS, Howcroft MJ (1999) Management of posterior segment intraocular foreign bodies: 14 years experience. Can J Ophthalmol 34:23–29PubMedGoogle Scholar
  12. 12.
    El-Asrar AM, Al-Amro SA, Khan NM, Kangave D (2000) Visual outcome and prognostic factors after vitrectomy for posterior segment foreign bodies. Eur J Ophthalmol 10:304–311PubMedGoogle Scholar
  13. 13.
    Esmaeli B, Elner SG, Schork MA, Elner VM (1995) Visual outcome and ocular survival after penetrating trauma. A clinicopathologic study. Ophthalmology 102:393–400PubMedGoogle Scholar
  14. 14.
    Gregor Z, Ryan SJ (1982) Combined posterior contusion and penetrating injury in the pig eye. I. A natural history study. Br J Ophthalmol 66:793–798PubMedGoogle Scholar
  15. 15.
    Greven CM, Engelbrecht NE, Slusher MM, Nagy SS (2001) Intraocular foreign bodies, prognostic factors and visual outcomes. Ophthalmology 108:9–10CrossRefGoogle Scholar
  16. 16.
    Hadden OB, Wilson JL (1990) The management of intraocular foreign bodies. Aust N Z J Ophthalmol 18:343–351PubMedGoogle Scholar
  17. 17.
    Jonas JB, Knorr HL, Budde WM (2000) Prognostic factors in ocular injuries caused by intraocular or retrobulbar foreign bodies. Ophthalmology 107:823–828PubMedCrossRefGoogle Scholar
  18. 18.
    Lit ES, Young LH (2002) Anterior and posterior segment intraocular foreign bodies. Int Ophthalmol Clin 42:121–128Google Scholar
  19. 19.
    Kuhn F, Morris R (2000) Posterior segment intraocular foreign bodies—management in the vitrectomy era. Ophthalmology 107:821–822PubMedCrossRefGoogle Scholar
  20. 20.
    Maguire AM, Enger C, Eliott D, Zinreich SJ (1991) Computerized tomography in the evaluation of penetrating ocular injuries. Retina 11:404–411CrossRefGoogle Scholar
  21. 21.
    Mester V, Kuhn F (1998) Ferrous intraocular foreign bodies retained in the posterior segment: management options and results. Intl Ophthalmol 22:355–362CrossRefGoogle Scholar
  22. 22.
    Mieler WF, Ellis MK, Williams DF, Han DP (1990) Retained intraocular foreign bodies and endophthalmitis. Ophthalmology 97:1532–1538PubMedGoogle Scholar
  23. 23.
    Mieler WF, Mittra RA (1997) The role and timing of pars plana vitrectomy in penetrating ocular trauma. Arch Ophthalmol 115:1191–1192PubMedGoogle Scholar
  24. 24.
    Pavlovic S, Schmidt KG, Tomic Z, Dzinic M (1998) Management of intraocular foreign bodies impacting or embedded in the retina. Aust N Z J Ophthalmol 26:241–246PubMedGoogle Scholar
  25. 25.
    Percival SPB (1972) Late complications from posterior segment intraocular foreign bodies. Br J Ophthalmol 56:462–468PubMedGoogle Scholar
  26. 26.
    Ryan SJ, Allen AW (1979) Pars plana vitrectomy in ocular trauma. Am J Ophthalmol 88:483–491PubMedGoogle Scholar
  27. 27.
    Thompson JT, Parver LM, Enger CL, Mieler WF, Liggett PE (1993) Infectious endophthalmitis after penetrating injuries with retained foreign bodies. National eye trauma system. Ophthalmology 100:1468–1474PubMedGoogle Scholar
  28. 28.
    Wani VB, Al-Ajmi M, Thalib L, Azad RV, Abdul M, Al-Ghanim M, Sabti K (2003) Vitrectomy for posterior segment intraocular foreign bodies: visual results and prognostic factors. Retina 23:654–660PubMedCrossRefGoogle Scholar
  29. 29.
    Williams DF, Mieler WF, Abrams GW, Lewis H (1988) Results and prognostic factors in penetrating ocular injuries with retained intraocular foreign bodies. Ophthalmology 95:911–916PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • Louisa Wickham
    • 1
  • Wen Xing
    • 1
  • Catey Bunce
    • 1
  • Paul Sullivan
    • 1
  1. 1.Vitreoretinal DepartmentMoorfields Eye HospitalLondonUK

Personalised recommendations