Yuan Melissa, Kozek Lindsay K, Hoyek Sandra, Davila Jose, Kim Leo, Vingopoulos Filippos, Gong Dan, Young Lucy, Wu Frances, Armstrong Grayson, Eliott Dean, Breazzano Mark P, Seth Rajeev, Russell Jonathan F, Sengillo Jesse, Lin Benjamin, Fowler Benjamin, Sobrin Lucia, Miller John B, Patel Nimesh A
Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA.
Retina-Vitreous Surgeons of Central New York, Liverpool, NY, USA.
J Vitreoretin Dis. 2025 May 29:24741264251339090. doi: 10.1177/24741264251339090.
To describe the clinical characteristics, outcomes, and complications in cases of intraocular foreign bodies (IOFBs) when the diagnosis is missed or delayed. This nonconsecutive case series was a retrospective multicenter study of adult patients with a delayed diagnosis of IOFB, defined as initially presenting elsewhere with a missed diagnosis or a delay of more than 24 hours to seek care. Eighteen eyes were included. The mean (±SD) presenting logMAR visual acuity (VA) was 0.45 ± 0.70 (Snellen equivalent, 20/56). The most common presenting symptom was decreased vision (11 patients [61%]). The general emergency department setting accounted for most initial evaluations (11 patients [61%]); however, 6 patients (33%) were seen in an outpatient setting by an optometrist, ophthalmologist, or both. The most common anatomic locations of the IOFBs were in the iris/anterior chamber (4 [22%]) or lens (4 [22%]) followed by the pars plana/ciliary body (3 [17%]), vitreous (3 [17%]), or retina (3 [17%]). Complications at presentation included endophthalmitis (1 [6%]), retinal detachment (1 [6%]), and retinal tears (4 [22%]). Five patients (28%) had siderosis at presentation. The mean final logMAR VA was 0.13 ± 0.32 (Snellen equivalent, 20/26). At the last follow-up, 15 eyes (83%) had a VA of 20/30 or better. The median follow-up was 139 days (IQR, 86-557). Eyes with a delayed diagnosis of IOFBs often present with good vision and self-sealing wounds. Missed IOFBs can be associated with siderosis, RD, and endophthalmitis. Visual outcomes may be salvaged with prompt treatment.
描述眼内异物（IOFB）诊断延误或漏诊病例的临床特征、转归及并发症。本非连续性病例系列研究是一项针对IOFB诊断延误成年患者的回顾性多中心研究，IOFB诊断延误定义为最初在其他地方就诊时漏诊或延迟超过24小时才寻求治疗。纳入18只眼。就诊时平均（±标准差）对数最小分辨角视力（VA）为0.45±0.70（Snellen等效值，20/56）。最常见的就诊症状是视力下降（11例患者[61%]）。大多数初始评估在普通急诊科进行（11例患者[61%]）；然而，6例患者（33%）是由验光师、眼科医生或两者在门诊进行检查。IOFB最常见的解剖位置是虹膜/前房（4只眼[22%]）或晶状体（4只眼[22%]），其次是睫状体扁平部/睫状体（3只眼[17%]）、玻璃体（3只眼[17%]）或视网膜（3只眼[17%]）。就诊时的并发症包括眼内炎（1只眼[6%]）、视网膜脱离（1只眼[6%]）和视网膜裂孔（4只眼[22%]）。5例患者（28%）就诊时存在铁锈症。最终平均对数最小分辨角视力为0.13±0.32（Snellen等效值，20/26）。在最后一次随访时，15只眼（83%）的视力为20/30或更好。中位随访时间为139天（四分位间距，86 - 557天）。IOFB诊断延误的眼通常视力良好且伤口自行闭合。漏诊的IOFB可能与铁锈症、视网膜脱离和眼内炎相关。及时治疗可挽救视力转归。
