MAGNETIC INTRAOCULAR FOREIGN BODY INJURIES: INTRAVITREAL ANTIBIOTIC PROPHYLAXIS, ENDOPHTHALMITIS RISK AND PROGNOSTIC FACTORS.

PURPOSE To investigate the preventive effect of intravitreal injection on posterior segment magnetic intraocular foreign body (IOFB)-related endophthalmitis, the risk factors for endophthalmitis, and the prognostic factors of posterior segment magnetic IOFBs.

METHODS Retrospective analysis of patients with posterior segment magnetic IOFBs admitted to Hebei Eye Hospital (2014-2022). Among them, 172 patients (2016-2022) received intravitreal antibiotics at the time of primary repair. Rates of endophthalmitis in this cohort were compared with those in a previous cohort admitted between 2014 and 2016(56 patients). In the previous cohort, patients received only primary repair.

RESULTS The cohort was predominantly male (94%), median age 39 years. the right eye was affected in 105 patients (45%). The incidence of endophthalmitis was 4.7% (8/172) and 13.6 % (8/59) in the recent and previous cohorts, respectively, with significant difference(P=0.043). Lens capsule rupture and IOFB > 2 mm were risk factors for magnetic IOFB-related endophthalmitis (P=0.024 and P=0.031, respectively). Lens capsule rupture (OR=2.872, 95% CI 1.487-5.548, P=0.002); vitreous hemorrhage(OR=2.010, 95%CI 1.064-3.796, P=0.031); retinal detachment (OR=3.745, 95%CI 1.758-7.979, P<0.001); choroidal detachment (OR=5.109, 95%CI 1.465-17.808, P=0.010) and IOFB>2mm(OR=1.914, 95%CI 1.025-3.574, P=0.042) were predictors of poor visual outcome.

CONCLUSIONS Prophylactic intravitreal antibiotics can reduce the incidence of endophthalmitis in posterior segment magnetic IOFB injuries. Lens capsular rupture and IOFB > 2 mm are risk factors for endophthalmitis. In addition, lens capsular rupture, vitreous hemorrhage, retinal detachment, choroidal detachment, and IOFB > 2 mm are associated with a poor prognosis. A good initial VA is associated with a good prognosis.