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Background: Intraocular foreign body (IOFB) removal becomes tricky if its large and impacted in the ocular coats. When confronted with such a combination, the vitreoretinal surgeon will need to modify the surgical plan. This surgical video describes one of such situation encountered during removal of a long wooden IOFB impacted in the ocular coats. Purpose: The video describes a scenario when the surgeon becomes aware that injury to ocular structure is inevitable due to inherent length of the IOFB. However, a careful assessment of the situation helps the surgeon to identify how he could minimize the damage to the eye and not put vision at risk. Synopsis: A young boy presented with painful loss of vision in left eye since 15 days. Examination showed BCVA of 20/32 and limitation movement in up gaze. Fundus showed hazy media and an IOFB in superior quadrant. It was noted that IOFB was moving with eye movement. The impaction in sclera and extraocular extension was suspected. After pars plana vitrectomy, it was observed that IOFB was longer than what was measured by the scan and it was impacted in the coats. Removal using IOFB forceps further pulled the IOFB into vitreous cavity. A rectangular scleral window was created, IOFB was pushed towards opposite pars plana region to avoid injury to macula, optic nerve, lens and peripheral retina. The IOFB was then removed.The retinal tears were lasered. Three months following the surgery, he developed cataract, which needed surgery. His BCVA at the last follow up visit was 20/25 with attached retina. Highlights: 1. Limitation of movement in presence of linear IOFB shall raise a suspicion of IOFB being impacted in coats and possibility of its extraocular extension; 2.An oblique IOFB posterior to limbus, can have length more in transverse diameter of the eyeball. Though rarely used, an ab?externo approach can be a viable option in such a case to minimise injury to vital structure of the eye, particularly if the IOFB is severely impacted in sclera.
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A 36-year-old male presented with history of injury in the left eye 3 years back with a copper wire. Examination revealed the presence of typical sunflower cataract with golden yellow deposits over the anterior lens capsule with dull glow and old vitreous hemorrhage. Non-contrast computerized tomography revealed retained intraocular foreign body in the pars plana region. The patient underwent phacoemulsification with intraocular lens implantation followed by pars plana vitrectomy and foreign body removal. Intraoperatively, fleck-like deposits were noted on the retinal surface in a circinate manner around the fovea and also over mid-peripheral retina. Postoperative swept source optical coherence tomography (SS-OCT) was performed to document the location of deposits and their characteristics. Limited literature exists regarding SS-OCT characteristics of ocular chalcosis.
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Purpose: The objective of this study is to describe the removal of retained intraocular foreign body (RIOFB) by bimanual pars plana vitrectomy through midline sclerotomy in phakic patients. Technique: Four eyes with RIOFB and clear lens underwent microincision vitrectomy surgery. A chandelier illumination was placed through one of the existing ports. The foreign body (FB) was localized by direct visualization (intravitreal) or indentation (pars plana), stabilized using an intraocular magnet/FB forceps introduced through a midline sclerotomy and freed of vitreous from all sides using a vitrectomy cutter through the other port bimanually, reoriented along their long axis and extracted through the midline sclerotomy. Results: All four FBs were removed successfully without slippage or damage to the clear lens. Conclusion: Chandelier illumination-assisted removal of FB through midline sclerotomy helps in easier localization, stabilization and removal, avoiding lens touch even in anteriorly located FBs such as at pars plana.
RESUMEN
PURPOSE: This study was designed to compare the results and prognosis between the two groups; the removed (group A) and retained (group B). The factors which affect the final vision were also studied. METHODS: 57 eyes of 57 patients (56 male, mean age 36.3 years old) who had been managed for intraocular foreign bodies were divided in two; Group A 39 eyes, Group B 18 eyes. To determine prognostic factors for visual outcomes, variables including age of patient, visual acuity at first examination, kind and size of foreign body, site of penetration, intraocular location, timing and number of surgical session, and complications were compared with final visual acuity. RESULTS: The average follow up period was 26.8 months. During these period, the mean number of surgical treatment was 2.32 +/- 1.14 per one eye for primary closure or management of complications and sequelae. The risk factors which affect the final vision were initial visual acuity (p=0.000), size (p=0.012), number of surgical session (p=0.021) and retinal detachment (p=0.001), while others including age, kind, entry site, location, surgical timing and endophthalmitis showed no significance. There are no significant difference of anatomical and functional outcome between Group A and B, and there are no significant determinants among prognostic factors affecting final visual acuity between Group A and B. CONCLUSIONS: Traumatic intraocular foreign bodies require early surgical removal and adequate management. However, our study suggests the final visual acuity correlates best with the extent of damage at the time of the initial injury, and the presence of an intraocualr foreign body doesn't affect the visual prognosis when compared to cases without a foreign body.