Hashem Abbas A A, Khalil Ahmad S, Dabour Sherif A, El-Haig Wael M
Department of Ophthalmology, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
Int J Retina Vitreous. 2025 Jul 14;11(1):78. doi: 10.1186/s40942-025-00701-5.
Retained posterior segment intraocular foreign bodies (IOFBs) present a surgical challenge with potential for serious complications, including retinal detachment (RD) and vision loss. While pars plana vitrectomy (PPV) is the standard technique, there is no consensus regarding the optimal route for IOFB extraction, whether through a limbal incision or via the pars plana. This study aims to compare anatomical and visual outcomes between the two surgical approaches and to identify risk factors for postoperative RD and poor visual outcome.
This prospective comparative study included 51 eyes with retained posterior segment IOFBs and an attached retina at presentation. Patients were randomly assigned to IOFB extraction via either a limbal incision (n = 26) or a pars plana incision (n = 25), following 23-gauge PPV. All patients were followed for a median of 12 months. Primary outcomes included the incidence of postoperative RD recorded over the entire first postoperative year and best-corrected visual acuity (BCVA) at one year. Univariate and multivariate logistic regression analyses were performed to identify predictors of RD and poor visual outcome, defined as BCVA worse than 0.8 logMAR.
Postoperative RD developed in 8 eyes (15.7%): 2 eyes (7.7%) in the limbal group and 6 eyes (24%) in the pars plana group (P = 0.14). Impacted IOFB (P = 0.042) and longer foreign body diameter (P = 0.032) were independent predictors of RD. Both groups showed significant improvement in BCVA from baseline (P < 0.001), with no significant difference between groups at any follow-up point. Poor visual outcome was independently associated with longer wound length (P = 0.011) and preoperative VA ≤ 1.6 logMAR (P = 0.005). The route of extraction was not a significant predictor of anatomical or functional outcome.
IOFB extraction via the limbus or pars plana using 23-gauge PPV provides comparable anatomical and visual outcomes. Impacted IOFBs and larger foreign bodies increase the risk of postoperative RD, while wound length and poor baseline visual acuity are strong predictors of poor final visual outcome. Early recognition of these predictors is important for optimizing surgical planning and patient counseling.
眼后段眼内异物（IOFB）残留带来了手术挑战，存在包括视网膜脱离（RD）和视力丧失在内的严重并发症风险。虽然玻璃体切割术（PPV）是标准技术，但关于IOFB取出的最佳途径，无论是通过角膜缘切口还是经睫状体扁平部，尚无共识。本研究旨在比较两种手术方法的解剖学和视觉效果，并确定术后RD和不良视觉预后的危险因素。
这项前瞻性比较研究纳入了51例就诊时眼后段IOFB残留且视网膜附着的患者。患者在接受23G PPV后，被随机分配通过角膜缘切口（n = 26）或睫状体扁平部切口（n = 25）取出IOFB。所有患者的中位随访时间为12个月。主要结局包括术后第一年记录的术后RD发生率以及一年时的最佳矫正视力（BCVA）。进行单因素和多因素逻辑回归分析，以确定RD和不良视觉预后的预测因素，不良视觉预后定义为BCVA差于0.8 logMAR。
8只眼（15.7%）发生了术后RD：角膜缘组2只眼（7.7%），睫状体扁平部组6只眼（24%）（P = 0.14）。嵌顿性IOFB（P = 0.042）和更长的异物直径（P = 0.032）是RD的独立预测因素。两组的BCVA均较基线有显著改善（P < 0.001），在任何随访时间点两组之间均无显著差异。不良视觉预后与更长的伤口长度（P = 0.011）和术前视力≤1.6 logMAR（P = 0.005）独立相关。取出途径不是解剖学或功能结局的显著预测因素。
使用23G PPV通过角膜缘或睫状体扁平部取出IOFB可提供相当的解剖学和视觉效果。嵌顿性IOFB和较大的异物会增加术后RD的风险，而伤口长度和较差的基线视力是最终不良视觉预后的有力预测因素。早期识别这些预测因素对于优化手术规划和患者咨询很重要。
