RESUMO
Iatrogenic intraocular foreign bodies (IOFBs) are rare findings to be associated with sterile intraocular procedures. They are usually observed in the anterior chamber, introduced during cataract surgery, while IOFBs in the posterior segment of the eye are very rare. We report a case of a patient with intravitreal cotton fiber foreign body associated with intravitreal anti-VEGF injection. An 86-year-old male patient presented with sudden, painless loss of vision in his right eye. Examination of the fundus revealed dense subretinal hemorrhage (SRH) involving the macula and causing deterioration of vision. Examination also revealed a fiber foreign body in the posterior vitreous of the same eye. The patient had known neovascular age-related macular degeneration and had been treated with regular anti-VEGF intravitreal injections for the past 6 years. Due to SRH in his right, the only functioning eye, we decided to perform a pars plana vitrectomy. During the surgery, we were able to touch the intraocular fiber foreign body with surgical instruments and it proved to be soft, flexible, and relatively compact. Given the white color and composition, our conclusion was that it was a cotton fiber thread. Identical material is an integral part of cotton tips used to disinfect the conjunctiva with povidone iodine just before administering an intravitreal injection. We hypothesize that such a cotton tip was the source of the foreign body. Careful preparation of the operative field and selection of high-quality surgical materials are mandatory in avoiding such a complication.
RESUMO
BACKGROUND We report the successful treatment of a macular hole (MH) secondary to a retinal macroaneurysm (RAMA) rupture by pars plana vitrectomy (PPV) and autologous transplantation of an internal limiting membrane (ILM) during primary surgery. CASE REPORT A 60-year-old woman presented with a sudden loss of central vision in her right eye. Fundus examination revealed a large sub-ILM hemorrhage involving the macula in her right eye. We performed 25-gauge PPV and ILM peel overlaying the hemorrhage. A ruptured RAMA next to the inferotemporal branch of the central retinal artery, MH, and subretinal hemorrhage were discovered. Part of the subretinal blood clot was removed through the MH. ILM was then further peeled off outside vascular arcades and transplanted as a free flap into the MH. At the end of surgery, 10% C3F8 gas was instilled as tamponade. Postoperatively, we observed anatomical closure of the MH, restoration of outer retinal layers, and improvement of visual acuity. During the follow-up period, the patient also had cataract surgery. Two years after the vitrectomy, the MH remained closed, with visual acuity improved to 10/20. CONCLUSIONS Autologous ILM transplantation during primary PPV can be an effective surgical approach for treatment of MH related to ruptured RAMA in selected cases.
