Vitrectomy For Intraocular Foreign Bodies And The Treatment Strategy Of Ocular Wound In Modern War

Background and AimsIntraocular foreign bodies (IOFB) are major causes of ocular trauma and severe visual loss in young males. Vitrectomy is effective and main treatment for IOFB. The prognostic factors for final vision are mixed. There are different conclusions about the significant prognostic factors. However, the zone of retinal injury was not investigated and the timing of vitrectomy intervention remains highly controversial. Although vitrectomy is effective for most IOFB, the prognoses of some patients are still not good even on the base of retinal reattachment. The reason for that is not revealed. The objectives of this study were to identify the significant prognostic factors for visual outcome after IOFB injuries managed by vitrectomy, and to investigate the reason of poor visual outcome through macular architecture by OCT.The characteristics of ocular wound in modern war are more frequent and serious than in normal time. The timing of treatment is the significant factor influencing the outcome, but our ophthalmic military medicine should be improved in this aspect. So the primary exploration on the treatment strategy of eye injuries is also our aim.Methods1. 36 consecutive patients with posterior segment IOFB injuries by vitrectomy were prospectively investigated. Factors analyzed included initial visual acuity (VA), time between injury and vitrectomy, site and length of entrance wound, size of IOFB, Cataract, Vitreous hemorrhage, and zone of retinal injury and development of retinal detachment. Data were analyzed using univariate and multivariate logistic regression analysis.2. Part of these patients had clinical examinations, optometry and OCT on the 3rd month postoperatively. We measured the macular neurosensory retinal thickness (MNT) and observed foveal architecture through OCT. This study analyzed the relationship between MNT,foveal architecture and visual outcome, also macular epiretinal membrane and the zone of retinal injury.3. We have investigated the data of ocular trauma in recent wars, and compared the health service and management of ocular injuries between the war of laoshan-zheyinshan and the Persian Gulf War.Results1.There are 25 eyes(69.4%) achieved VA of 0.1 or better. Multivariate logistic regression analysis identified good initial VA and absence of retinal detachment was the factors significantly associated with good visual outcome (0.5 or better).In contrast, poor initial VA and development of retinal detachment as the factors significantly associated with poor visual outcome (less than 0.1). There are not statistical correlation between zone of retinal injury, timing of vitrectomy intervention and visual outcome.2. At the 3rd mouth postoperatively, 50% OCT showed macular epiretinal membranes and 20% showed normal foveal architecture. There is statistical correlation between VA and MNT.3. The zone of retinal injury significantly associated with macular epiretinal membranes.4. The characteristics of ocular wound in modern war are frequent, serious and various. The early defined management of hospitals offering are requested to be mobile, active and forward protrusion in high-tech war.Conclusions1. Initial VA and retinal detachment are the significant factors associated with visual outcome.2. The abnormal foveal architectures influence visual outcome, especially the macular epiretinal membranes. The MNT is thicker; the visual outcome is poorer. The macular epiretinal membranes usually occur in the case of retinal injured of macular zone nearby.3. The time-effect strategy should be implemented and the key point is forward protrusion of military ophthalmic care in the condition of the quick transportation shortage.