Delayed Intraocular Foreign Body Removal without Endophthalmitis during Operations Iraqi Freedom and Enduring Freedom

Objective: To report the long-term follow-up results of intraocular foreign body (IOFB) removal at Walter Reed Army Medical Center during Operation Iraqi Freedom and Operation Enduring Freedom from February 2003 through November 2005 and to determine the prognostic factors for visual outcome in this patient population. Design: Retrospective, noncomparative, interventional case series. Participants: Seventy-nine eyes of 70 United States military soldiers deployed in support of operations Iraqi Freedom and Enduring Freedom sustained IOFB injuries and subsequently were treated at the Walter Reed Army Medical Center with a minimum of 6 months of follow-up. Intervention: The principal procedure performed was 20-gauge 3-port vitrectomy with IOFB removal through limbal or pars plana incision. Main Outcome Measures: Final visual acuity, rate of proliferative vitreoretinopathy, rate of endophthalmitis. Results: Average patient age was 27 years, with an average of 331 days of postoperative follow-up. Average IOFB size was 3.7 mm (range, 0.1-20 mm). Median time to IOFB removal was 21 days (mean, 38 days; range, 2-661 days). Mean preoperative visual acuity was 20/400 (1.36 logarithm of mean angle of resolution [logMAR] units) and mean final visual acuity was 20/120 (0.75 logMAR). Of the patients, 53.4% achieved visual acuity of 20/40 or better, whereas 77.5% achieved visual acuity of better than 20/200. There were no cases of endophthalmitis (0/79 eyes; 95% confidence interval, 0%-3.1%), siderosis bulbi, or sympathetic ophthalmia. Among the eyes, 10.3% evolved to no light perception or had been enucleated by the 6-month follow-up visit. Poor visual outcome correlated with extensive intraocular injury (P<0.032). Seventeen of 79 eyes (21%) experienced proliferative vitreoretinopathy. Proliferative vitreoretinopathy correlated with poor initial vision (hand movements or worse; P = 0.035) and extensive intraocular injury (P<0.001). Timing of vitrectomy did not correlate with visual outcome. The most common systemic antibiotic administered was levofloxacin, whereas the most common topical antibiotic administered was moxifloxacin. Conclusions: Poor visual outcome and postoperative complication rates are related to extensive intraocular injury. Delayed IOFB removal with a combination of systemic and topical antibiotic coverage can result in good visual outcome without an apparent increased risk of endophthalmitis or other deleterious side effects.