Visual Outcomes after Intraocular Foreign Body Injuries at Parkland & UT Southwestern Hospitals and Clinics

BACKGROUND: Intraocular foreign bodies (IOFBs) make up a large portion of open globe injuries and can cause severe vision loss. IOFBs entrapped in the posterior segment are a particularly significant cause of greatly diminished visual acuity and legal blindness (VA<20/200), prompting analysis of the factors that may influence visual outcomes. OBJECTIVES: The purpose of our study is to determine how surgical approach (single vs. staged surgical repair) may affect visual outcomes for patients with traumatic posterior segment IOFB injuries. We also examine whether patients presenting with specific vision-threatening sequelae are more or less likely to undergo a specific surgical approach. Additionally, we record incidence data on different IOFB material types, mechanisms of injury, and the use of safety glasses. METHODS: This is a retrospective chart review with a target population of patients 18-85 years old who were surgically treated for traumatic posterior segment IOFB injuries at Parkland and UT Southwestern from 6/1/2011 to 5/23/2023. 53 patient records accessed through Epic Systems met inclusion criteria. 12 patients underwent single surgical repair and 41 underwent staged repair, suggesting a hospital/ systemwide preference in surgical approach. RESULTS: Our results did not find a significant difference between initial visual acuity (t-stat=-0.953, p=0.288), final visual acuity (t stat=-1.075, p=0.297), or change in visual acuity (t-stat=0.056, p=0.954) between single and staged repair groups. Among 19 different vision-threatening sequelae examined, patients presenting with scleral laceration (p=0.0378) and vitreous hemorrhage (p=0.0245), were significantly more likely to undergo staged surgical repair, while those presenting with endophthalmitis (p=0.0073) were more likely to undergo single surgical repair by Fisher's exact test. The IOFB material types were metallic (89%), glass (7%), and stone (4%). Hammering was the most common mechanism of injury, accounting for 30.2% of cases. Data on safety glasses use was available for 20 patients, amongst whom 25% affirmed and 75% denied use. CONCLUSIONS: Our data suggest a predominance of IOFBs of metallic origin and a skew towards staged surgical repair for patients at Parkland & UTSW hospitals and clinics. The poor use of safety glasses within the data collected underscores the necessity of emphasizing eye protection in metal work and other high-risk occupations. Given the small sample size of our study, more data may help better elucidate visual outcome differences based on repair type and provide further insight into specific sequelae that increase the likelihood of a particular surgical approach.