Retained intraocular foreign bodies and endophthalmitis.

Retained intraocular foreign bodies (IOFBs) are associated with endophthalmitis in approximately 7 to 13% of cases. The role of prompt surgical removal of the foreign body along with the use of intravitreal antibiotics in reducing this figure is uncertain. Retained IOFBs presenting to The Medical College of Wisconsin between July 1986 and June 1989 were reviewed. A total of 27 cases were evaluated and surgically treated. None of the 27 cases presented with or developed clinical signs of endophthalmitis, yet bacterial cultures of the removed intraocular material were positive in seven cases (foreign body in 5 cases, the aqueous fluid and the vitreous fluid in 1 case each). All eyes presenting within 24 hours of injury underwent immediate surgery (average, 4.5 hours after presentation). Of the seven eyes with positive intraocular cultures, all had pars plana vitrectomy removal of the IOFB and three of these eyes received intravitreal antibiotics at the time of surgery over concern of a high risk of infection. Two of these eyes eventually grew out the Bacillus sp. All eyes received subconjunctival antibiotics and postoperative topical and systemic antibiotics. Even after the positive cultures, no signs of clinical infection developed in any of the eyes. All seven eyes retained excellent visual acuity of 20/70 or better at an average of 10 months' follow-up. Follow-up ranged from 1 to 31 months. Prompt surgical intervention, the use of intravitreal antibiotics in high-risk-type injuries, and the possible use of vitrectomy surgery may reduce the incidence and severity of endophthalmitis.