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Naharwal A, Samanta R, Jayaraj S, Agrawal A. Gonioscopy aided detection and scleral indentation assisted extraction of an occult intraocular foreign body from the ciliary sulcus. BMJ Case Rep 2023; 16:e256954. [PMID: 37907314 PMCID: PMC10619009 DOI: 10.1136/bcr-2023-256954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2023] Open
Affiliation(s)
- Aarshi Naharwal
- Ophthalmology, All India Institute of Medical Sciences - Rishikesh, Rishikesh, Uttarakhand, India
| | - Ramanuj Samanta
- Ophthalmology, All India Institute of Medical Sciences - Rishikesh, Rishikesh, Uttarakhand, India
| | - Sreeram Jayaraj
- Ophthalmology, All India Institute of Medical Sciences - Rishikesh, Rishikesh, Uttarakhand, India
| | - Ajai Agrawal
- Ophthalmology, All India Institute of Medical Sciences - Rishikesh, Rishikesh, Uttarakhand, India
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Peters KS, Meeker A, Williams L. Endoscopic-assisted removal of intraocular foreign body embedded in ciliary sulcus. Am J Ophthalmol Case Rep 2022; 27:101665. [PMID: 35865658 PMCID: PMC9294040 DOI: 10.1016/j.ajoc.2022.101665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 07/11/2022] [Accepted: 07/11/2022] [Indexed: 11/16/2022] Open
Abstract
Purpose To report a novel approach for removal of intraocular foreign body in the ciliary sulcus. Observations A 72-year-old male presented with an intraocular foreign body embedded in the ciliary body, localized with ultrasound biomicroscopy. An intraoperative endoscopic camera was then used to directly visualize the foreign body in the ciliary body and the object was successfully removed with intraocular forceps. Conclusions and Importance Removal of foreign bodies in the ciliary sulcus often require either a transscleral approach or a pars plana approach with vitrectomy. In this case, direct visualization with endoscopy allowed for a much safer and less invasive technique for intraocular foreign body removal, preventing the need for sclerotomy or vitrectomy.
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El-Baha SM, Abou Shousha MA, Hafez TA, Ahmed ISH. Evaluation of the use of NGage® Nitinol stone extractor for intraocular foreign body removal. Int Ophthalmol 2021; 41:2083-2089. [PMID: 33661444 DOI: 10.1007/s10792-021-01765-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE To describe a novel technique to use the NGage® Nitinol Stone Extractor for large IOFB extraction. METHODS We conducted a retrospective case series study by reviewing the data of 4 eyes with retained large IOFB extracted with the use of the NGage® Nitinol Stone Extractor. The study was conducted in a single tertiary referral center on four eyes of four patients with large retained IOFB. Studied eyes were treated by pars plana vitrectomy (PPV) and IOFB extraction by using the NGage® Nitinol Stone Extractor through a limbal incision. RESULTS Four eyes of four male patients with large Retained IOFB were included in the study. The nature of the IOFB was metallic in 2 eyes, glass in 1 eye or ceramic 1 eye. All the IOFB were removed from a limbal wound. Silicone oil tamponade was required in 3 eyes. Two eyes required reoperation. At 6 months postoperative, the final visual acuity using Snellen chart ranged between PL and 0.1. CONCLUSION The NGage® Nitinol Stone Extractor can be a useful tool for the extraction of the large retained IOFB.
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Affiliation(s)
- Samir Mohammed El-Baha
- Faculty of Medicine, Ophthalmology Department, Alexandria University, Khartoum Square, Azarita, Alexandria, Egypt
| | - Mohsen Ahmed Abou Shousha
- Faculty of Medicine, Ophthalmology Department, Alexandria University, Khartoum Square, Azarita, Alexandria, Egypt
| | - Tarek Abdelrazek Hafez
- Faculty of Medicine, Ophthalmology Department, Alexandria University, Khartoum Square, Azarita, Alexandria, Egypt
| | - Islam S H Ahmed
- Faculty of Medicine, Ophthalmology Department, Alexandria University, Khartoum Square, Azarita, Alexandria, Egypt.
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Agarwal R, Tripathi M, Bansal B, Patil A. Unusually located metallic foreign body in posterior chamber of eyeball: role of multimodal ocular imaging in its diagnosis and management. BMJ Case Rep 2020; 13:13/10/e239345. [PMID: 33109699 DOI: 10.1136/bcr-2020-239345] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Rinky Agarwal
- Ophthalmology, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Manasi Tripathi
- Ophthalmology, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Bhavika Bansal
- All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Anuja Patil
- Ophthalmology, All India Institute of Medical Sciences, New Delhi, Delhi, India
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Yang X, Liu C, Liu L, Zhang L. A missed diagnosis of multiple intraocular foreign bodies for 21 years. Cont Lens Anterior Eye 2017; 40:432-435. [PMID: 28844655 DOI: 10.1016/j.clae.2017.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 06/17/2017] [Accepted: 08/15/2017] [Indexed: 02/05/2023]
Abstract
A 30-year-old patient went to the emergency department because of a chemical burn to the left eye more than 10 days ago by toilet cleanser. Surprisingly, a small piece of glass was found in the inferior anterior chamber in the same eye. The visual acuity was counting fingers. There was conjunctival congestion, corneal oedema and Descemet's membrane striae. And there was also a corneal leukoma around 4 to 5 o'clock. Through repeated questioning he recalled that he was injured by an exploded light bulb around 21 years ago. He was asymptomatic until he saw "something moving" in front of the left eye one month ago. Computed tomography (CT) scanning, ultrasonography, ultrasound biomicroscopy (UBM), anterior segment optical coherence tomography (AS-OCT) verified the presence of multiple intraocular foreign bodies (IOFBs) in the anterior chamber and vitreous cavity. B-scan verified the IOFB in the vitreous cavity. Thus, he was diagnosed with corneal chemical burn, IOFBs and corneal leukoma of the left eye. The IOFB in the anterior chamber was removed through surgery. An attempt was made to remove the IOFB in the vitreous cavity with electromagnet, but it was not successful. Vitrectomy could not be performed as it was hindered by the opacity of cornea. After surgery, the visual acuity remained counting fingers and the corneal oedema still existed. This case is a reminder that a detailed history taking, a thorough physical examination and modern imaging techniques are beneficial for establishing the diagnosis and treatment of IOFBs.
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Affiliation(s)
- Xubo Yang
- Department of Ophthalmology, West China Hospital of Sichuan University, 37 Guoxue Xiang, Chengdu, Sichuan, 610041, PR China; Department of Optometry and Visual Science, West China Hospital of Sichuan University, 37 Guoxue Xiang, Chengdu, Sichuan, 610041, PR China
| | - Chunling Liu
- Department of Ophthalmology, West China Hospital of Sichuan University, 37 Guoxue Xiang, Chengdu, Sichuan, 610041, PR China.
| | - Longqian Liu
- Department of Ophthalmology, West China Hospital of Sichuan University, 37 Guoxue Xiang, Chengdu, Sichuan, 610041, PR China; Department of Optometry and Visual Science, West China Hospital of Sichuan University, 37 Guoxue Xiang, Chengdu, Sichuan, 610041, PR China.
| | - Lanlan Zhang
- Department of Ophthalmology, West China Hospital of Sichuan University, 37 Guoxue Xiang, Chengdu, Sichuan, 610041, PR China
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Loporchio D, Mukkamala L, Gorukanti K, Zarbin M, Langer P, Bhagat N. Intraocular foreign bodies: A review. Surv Ophthalmol 2016; 61:582-96. [PMID: 26994871 DOI: 10.1016/j.survophthal.2016.03.005] [Citation(s) in RCA: 97] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 03/06/2016] [Accepted: 03/10/2016] [Indexed: 01/15/2023]
Abstract
Intraocular foreign body injuries may result in a wide range of intraocular pathology and visual outcomes based on the mechanism of injury, type of foreign body, and subsequent complications. We have reviewed the literature to describe the epidemiology and mechanisms of such injuries; types of foreign bodies; imaging tools for diagnosis; current trends in management, presurgical, and surgical interventions; as well as visual prognosis and potential complications. The purpose of this review is to familiarize clinicians with the recent advances in diagnosis and management of such injuries.
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Affiliation(s)
- Dean Loporchio
- Institute of Ophthalmology and Visual Science, Department of Ophthalmology, Rutgers New Jersey Medical School, Newark, New Jersey 07103, USA
| | - Lekha Mukkamala
- Institute of Ophthalmology and Visual Science, Department of Ophthalmology, Rutgers New Jersey Medical School, Newark, New Jersey 07103, USA
| | - Kavya Gorukanti
- Institute of Ophthalmology and Visual Science, Department of Ophthalmology, Rutgers New Jersey Medical School, Newark, New Jersey 07103, USA
| | - Marco Zarbin
- Institute of Ophthalmology and Visual Science, Department of Ophthalmology, Rutgers New Jersey Medical School, Newark, New Jersey 07103, USA
| | - Paul Langer
- Institute of Ophthalmology and Visual Science, Department of Ophthalmology, Rutgers New Jersey Medical School, Newark, New Jersey 07103, USA
| | - Neelakshi Bhagat
- Institute of Ophthalmology and Visual Science, Department of Ophthalmology, Rutgers New Jersey Medical School, Newark, New Jersey 07103, USA.
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Wang K, Liu J, Chen M. Role of B-scan ultrasonography in the localization of intraocular foreign bodies in the anterior segment: a report of three cases. BMC Ophthalmol 2015; 15:102. [PMID: 26268356 PMCID: PMC4535674 DOI: 10.1186/s12886-015-0076-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 07/15/2015] [Indexed: 01/20/2023] Open
Abstract
Background The accurate localization of intraocular foreign bodies (IOFBs) is very important for the management of ocular trauma patients. B-scan ultrasonography is usually used to detect IOFBs in the posterior segment. Here, we report three cases with IOFBs in the anterior segment near the posterior lens capsule, which were accurately localized by B-scan ultrasonography under dynamic transversal scanning. Case presentation All three patients had a history of ocular trauma, and their clinical symptoms were compatible with the persistence of IOFBs. It was difficult to get a direct visualization of IOFBs with slit-lamp biomicroscopy because of opacities of the cornea and traumatic cataract. A computed tomography scan detected IOFBs in the anterior segment, but could not determine the exact location. Ultrasound biomicroscopy was performed but failed to show any IOFBs owing to the limited depth of penetration. B-scan ultrasonography was further applied but also failed to show any intraocular foreign bodies using axial scanning, a routine procedure of B-scan ultrasonography examination. However, using dynamic transversal scanning of B-scan ultrasonography, the accurate location of IOFBs was eventually shown to be embedded in the posterior lens cortex in case 1, adjacent to the posterior lens capsule in case 2, and located in the anterior vitreous close to the posterior lens capsule in case 3. Different surgical procedures were designed according to localization by B-scan ultrasonography, and all IOFBs were successfully removed. Conclusion B-scan ultrasonography is a simple and effective imaging modality in the localization of IOFBs in traumatic cataract. Transversal scanning is more suitable than axial scanning to detect IOFBs in the anterior segment near the posterior lens capsule.
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Affiliation(s)
- Kaijun Wang
- Eye Center, The 2nd Affiliated Hospital, Medical College of Zhejiang University, No. 88 Jiefang Road, Hangzhou, 310009, China. .,Zhejiang Provincial Key Laboratory of Ophthalmology, Hangzhou, China.
| | - Jun Liu
- Eye Center, The 2nd Affiliated Hospital, Medical College of Zhejiang University, No. 88 Jiefang Road, Hangzhou, 310009, China.
| | - Min Chen
- Eye Center, The 2nd Affiliated Hospital, Medical College of Zhejiang University, No. 88 Jiefang Road, Hangzhou, 310009, China. .,Zhejiang Provincial Key Laboratory of Ophthalmology, Hangzhou, China.
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Abstract
PURPOSE To report a case of an occult intraocular foreign body missed on initial presentation. To our knowledge, this is the first reported case of fiberglass as an intraocular foreign body. METHODS A case report in which the clinical presentation of the patient was documented by color anterior segment and fundus photographs, optical coherence tomography (OCT), and computed topography (CT) of the orbit. RESULTS A 34-year-old male was referred for the evaluation of an acute unilateral preretinal hemorrhage of undetermined origin. Three months before his presentation, he had a foreign body sensation while cutting fiberglass, which lasted for several hours. He denied having any visual complaints until his presentation 3 months later. On anterior examination, a small paracentral corneal scar was noticed. There was no cell or flare. A small iris defect inferior nasal with an adjacent area of broad based peripheral anterior synechia on gonioscopy was noted. On funduscopy, a large subretinal elevation with an underlying hemorrhage adjacent to the disk with a white foreign body partially imbedded in the retina was seen. A vitreous hemorrhage was overlying the macula. Because there were no signs of infection or inflammation, surgical intervention was avoided. Barrier laser was performed around the subretinal elevation. CONCLUSION Occurrence of intraocular foreign bodies, although not uncommon, has a varying presentation. Most often devastating and dramatic, clinical signs may not be obvious or appreciated on thorough examination, especially when the offending object is very small. Intraocular foreign bodies composed of inert material (i.e., glass/fiberglass) can leave the eye without inflammation, further making the diagnosis difficult.
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Yang Z, Yang XL, Xu LS, Dai L, Yi MC. Application of Prussian blue staining in the diagnosis of ocular siderosis. Int J Ophthalmol 2014; 7:790-4. [PMID: 25349794 DOI: 10.3980/j.issn.2222-3959.2014.05.09] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Accepted: 05/05/2014] [Indexed: 11/02/2022] Open
Abstract
AIM To explore the value of Prussian blue staining in the diagnosis of ocular siderosis. METHODS Between January 2012 and January 2013, the Prussian blue stain used in anterior lens capsule and vitreous liquid after centrifugation from patients with definitive diagnosis and suspicious diagnosed of ocular siderosis. At the same time, give a negative control. RESULTS Anterior lens capsule membrane and liquid of vitreous cavity from patients with definitive diagnosis and suspicious diagnosed of ocular siderosis revealed ferric ions that stained positively with Prussian blue. In the control group, there is no positive reaction. CONCLUSION Prussian blue staining in the diagnosis of ocular siderosis has a very significant worth, suspected cases can be definitive diagnosed.
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Affiliation(s)
- Zhen Yang
- Department of Ophthalmology, the Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
| | - Xiao-Li Yang
- Department of Ophthalmology, the Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
| | - Li-Shuai Xu
- Department of Ophthalmology, the Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
| | - Le Dai
- Department of Ophthalmology, the Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
| | - Mei-Chao Yi
- Department of Ophthalmology, the Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
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Abstract
Open globe injuries with intraocular foreign bodies are important cause of visual morbidity. Timely detection of foreign body is must to improve the visual outcome and to prevent eye from developing complications. It is important to understand the need of meticulous history taking and thorough examination besides other investigations to detect foreign body. Glass foreign bodies are little difficult to visualize because of its transparent nature. The best time to detect foreign body is at the time of primary repair. Until one suspects the presence of foreign body, it is missed most of the time. We chose to report this case as it is unusual to miss big IOFB in anterior chamber impacted in lens matter at the time of primary corneal repair. It is important to remember that an ounce of vigilant vision is worth a pound of care.
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Affiliation(s)
- Lakshmi Kuniyal
- Department of Vitreo-Retina, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Ekta Rishi
- Department of Vitreo-Retina, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Pukhraj Rishi
- Department of Vitreo-Retina, Sankara Nethralaya, Chennai, Tamil Nadu, India
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Gokmen O, Yesilirmak N, Kal A, Eroglu FC. Unusual presentation of an intraocular foreign body retained for sixty years. Cont Lens Anterior Eye 2013; 37:234-5. [PMID: 24332359 DOI: 10.1016/j.clae.2013.11.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2013] [Accepted: 11/20/2013] [Indexed: 11/17/2022]
Abstract
Intraocular foreign bodies may remain quiescent for many years particularly if they are not metallic. We report a case of a missed intraocular stone foreign body that had remained asymptomatic underneath the iris for 60 years and appeared during cataract surgery.
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Affiliation(s)
- Onur Gokmen
- Department of Ophthalmology, Baskent University, Faculty of Medicine, Ankara, Turkey
| | - Nilufer Yesilirmak
- Department of Ophthalmology, Baskent University, Faculty of Medicine, Ankara, Turkey.
| | - Ali Kal
- Department of Ophthalmology, Baskent University, Faculty of Medicine, Ankara, Turkey
| | - Fatma C Eroglu
- Department of Ophthalmology, Baskent University, Faculty of Medicine, Ankara, Turkey
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Yeh S, Ralle M, Phan IT, Francis PJ, Rosenbaum JT, Flaxel CJ. Occult intraocular foreign body masquerading as panuveitis: inductively coupled mass spectrometry and electrophysiologic analysis. J Ophthalmic Inflamm Infect 2011; 2:99-103. [PMID: 21805383 PMCID: PMC3345056 DOI: 10.1007/s12348-011-0035-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2011] [Accepted: 07/19/2011] [Indexed: 12/01/2022] Open
Affiliation(s)
- Steven Yeh
- Emory Eye Center, Emory University School of Medicine, Atlanta, GA, USA
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13
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Macsai MS. Surgical Management and Rehabilitation of Anterior Segment Trauma. Cornea 2011. [DOI: 10.1016/b978-0-323-06387-6.00154-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Mete G, Turgut Y, Osman A, Gülşen U, Hakan A. Anterior segment intraocular metallic foreign body causing chronic hypopyon uveitis. J Ophthalmic Inflamm Infect 2010; 1:85-7. [PMID: 21484173 PMCID: PMC3102852 DOI: 10.1007/s12348-010-0011-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2010] [Accepted: 10/22/2010] [Indexed: 11/24/2022] Open
Affiliation(s)
- Güler Mete
- Department of Ophthalmology, Harput State Hospital, 23119, Elazığ, Turkey,
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Güler M, Yilmaz T, Yigit M, Ulkü G, Arslan S. A case of a retained intralenticular foreign body for two years. Clin Ophthalmol 2010; 4:955-7. [PMID: 20856588 PMCID: PMC2938273 DOI: 10.2147/opth.s12635] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2010] [Indexed: 11/23/2022] Open
Abstract
We report a case of a missed metallic intraocular foreign body retained in the lens over a two-year period without causing inflammatory reaction, which presented with cataract later. A 24-year-old man presented with a progressive blurring of vision in the left eye for two years. He had had a history of metal-on-metal activity two years before. He had pain for one day in left eye and it was healed by the following day. Biomicroscopic examination revealed cataract, an intralenticular foreign body, and a corneal scar at seven o’clock meridian of the cornea in the left eye. Best-corrected visual acuity was 20/200 in the left eye. Intralenticular foreign body removal, phacoemulsification, and an intraocular lens implantation was performed under local anesthesia. The intralenticular foreign body was metallic and its size was about 2 × 2 mm. Two weeks after the operation best corrected visual acuity was 20/20 in left eye. A retained foreign body should be considered in each patient with a history of penetrating ocular trauma and all efforts must be made to exclude presumptive diagnosis of intraocular foreign body.
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Affiliation(s)
- Mete Güler
- Department of Ophthalmology, Elazıǧ Harput State Hospital, Turkey.
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Raina UK, Kumar V, Kumar V, Sud R, Goel N, Ghosh B. Metallic intraocular foreign body retained for four years--an unusual presentation. Cont Lens Anterior Eye 2010; 33:202-4. [PMID: 20223698 DOI: 10.1016/j.clae.2010.01.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2009] [Revised: 01/21/2010] [Accepted: 01/27/2010] [Indexed: 12/17/2022]
Abstract
Intraocular foreign bodies present a great threat to both sight and the globe of the patient especially if they are metallic and of long duration. We report a case of a metallic intraocular foreign body that presented four years after the initial trauma. The case was successfully managed by a simple technique and the role of ultrasound biomicroscopy (UBM) is highlighted.
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Affiliation(s)
- Usha K Raina
- Guru Nanak Eye Centre, Maulana Azad Medical College, New Delhi 110002, India
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