Chorioretinectomy for perforating or severe intraocular foreign body injuries

Background: To report the outcomes of chorioretinectomy versus non-chorioretinectomy in combat ocular injuries where a foreign body penetrated the choroid or perforated the globe. Methods: Retrospective, comparative, consecutive interventional case series of 32 perforating or severe intraocular foreign body combat ocular trauma injuries sustained by United States military soldiers and treated at a single institution from March 2003 to March 2009. Final best-corrected visual acuity (BCVA) in 19 non-chorioretinectomy-treated eyes was compared to 13 chorioretinectomy-treated eyes. The chorioretinectomy group was repaired with a 20 gauge three-port pars plana vitrectomy (PPV) by removing the choroid and/or retina at the impact or perforation site of the foreign body following evacuation from a combat zone. The main outcome measures were best-corrected visual acuity and rates of globe survival, retina reattachment and proliferative vitreoretinopathy. Results: Thirty-two eyes of 31 patients with a mean age of 29±9 years (range, 19-53 years) were followed for a median of 463±226 days (range, 59-1022 days). The mean time of injury to the operating room in the chorioretinectomy group was 12.6±9.8 days, compared to that of the non-chorioretinectomy group of 22.1±16.4 days (P=0.05) Final BCVA ≥20/200 occurred in seven of 13 (54%) of the chorioretinectomy group, compared to two of 19 (11%) in the non-chorioretinectomy group (P=0.04). Globe survival rates were higher in the chorioretinectomy group [11 of 13 (85%) vs 9 of 19 (45%); P=0.06], as well as the final retinal reattachment rate [8 of 13 (62%) vs 8 of 19 (42%); P=0.47]. The proliferative vitreoretinopathy rate was eight of 13 (62%) in the chorioretinectomy group, compared to 14 of 19 (74%) in the non-chorioretinectomy group (P=0.70). Graft failure occurred in five of six eyes (83%) of non-chorioretinectomy cases, requiring temporary keratoprosthesis and penetrating keratoplasty. Conclusion: Chorioretinectomy is a surgical option that may improve final BCVA and increase globe survival rates when a foreign body penetrates the choroid or perforates the globe.