The claw: A novel intraocular foreign body removal forceps

RETRACTABLE UROLOGY THREE-PRONGED GRASPING FORCEPS FOR REMOVAL OF LARGE, NONMAGNETIC INTRAOCULAR FOREIGN BODIES

PURPOSE

To demonstrate the use of urology retractable three-pronged grasping forceps in the removal of a large, round, and nonmagnetic intraocular foreign body (IOFB) that was difficult to remove with other surgical instruments.

METHODS

Extraction of a 3.0 mm lead shot pellet embedded in vitreous hemorrhage was attempted with multiple surgical instruments including an intraocular magnet, IOFB forceps, and two tools designed for urology stone removal: a three-pronged grasping forceps and a nitinol basket extractor.

RESULTS

Owing to the round and smooth surface, large size, and nonmagnetic nature of the IOFB, extraction was challenging and failed with multiple other surgical instruments. The wide and secure grasp of the grasping forceps allowed for swift IOFB extraction without iatrogenic injury to the retina.

CONCLUSION

The grasping forceps offer an effective and safe method for removal of large, round, and nonmagnetic IOFBs.

T-shaped pars plana scleral incision to remove large intraocular foreign body

Aim

To investigate the efficacy and safety profile of T-shaped pars plana scleral incision technique in removing large intraocular foreign bodies, during 23-gauge pars plana vitrectomy.

Methods

Retrospective interventional case series that included patients diagnosed with a large intraocular foreign body (IOFB). Possible postoperative complications were recorded 24 h, 1 month, 3 and 6 months postoperatively.

Results

Thirty eyes of 30 patients (48 ± 5 years old) were enrolled. All IOFBs were successfully removed: mean diameters of 7.8 ± 2.0 mm and 2.6 ± 0.3 mm. Silicone oil and sulfur hexafluoride were used in 27 and 3 eyes, respectively. Lensectomy was performed in 27 eyes. Intraocular lens was implanted at first attempt in 12 eyes; during a second operation in 12 eyes and 6 eyes remained aphakic. At any follow-up, no signs of postoperative complications were observed. Secondary retinal detachment occurred in 12 eyes. Mean preoperative corrected distance visual acuity was 0.04, on the Snellen scale; it increased to 0.07, at last follow-up. Mean intraocular pressure was 17.97 mmHg. All eyes were preserved.

Conclusion

T-shaped scleral incision could be an effective, safe and easy-to-perform standard procedure to remove large IOFBs during pars plana vitrectomy, without increasing the risk of surgical complications and additional damage to the ocular tissues.

Comparing forceps and self-assembled intraocular rare earth magnet in removing metallic intraocular foreign bodies in 25-guage vitrectomy

PURPOSE

To compare the efficacy and efficiency of self-assembled intraocular rare earth magnet and forceps in removing intraocular foreign bodies(IOFBs) undergoing 25-gauge(G) pars plana vitrectomy.

METHODS

A total of 30 patients with metallic IOFB underwent 25-G PPV were enrolled into this study. Self-assembled intraocular rare earth magnet were used in 15 patients(bar group), and forceps were used in 15 patients(forceps group). Success rate of removing IOFB, time taken to remove IOFB, incidence of IOFB slippage and fall, iatrogenic retinal damages were compared between the two groups.

RESULTS

There was no significant difference in success rate of removing IOFBs between the groups(93.3% and 100%, P > 0.99). The median time taken of removing FB was significantly shorter in bar group than in forceps group(112 and 295 s, P = 0.001). None of the patients in bar group had IOFB slippage and fall, or related iatrogenic retinal damage in the process of removal. In forceps group, IOFB slippage and fall during removal were observed in 7 of 15(47.6%) patients, related iatrogenic retinal injuries were recorded in 6 of 15(40.0%) patients, both were significantly higher than bar group(P = 0.003 and P = 0.017, respectively).

CONCLUSIONS

Compared with forceps, the assembled intraocular magnet can greatly reduce the possibility of IOFB slippage and fall, prevent related iatrogenic retinal damage, and shorten the time taken to remove IOFB. The assembled intraocular magnet can be an useful tool in removing metallic IOFBs in PPV.

Eckardt Forceps Tip Widening for the Removal of Posterior Intraocular Foreign Bodies Bigger Than 1 mm

PURPOSE

To propose a new technique with an "old" tool to allow for better intraocular foreign body (IOFB) grasping and manipulation during mininvasive vitreoretinal surgery.

METHODS

The authors report herein their technique on seven eyes, diagnosed with posterior IOFBs, in which the surgery consisted of a 23-gauge vitrectomy, using, for IOFB grasping, a Grieshaber DSP 23-gauge Eckardt forceps, properly modified intraoperatively. Such result was achieved by enlarging the forceps opening bite, according to the IOFB size.

RESULTS

In all patients, IOFBs were removed using the modified 23-gauge Grieshaber Eckardt forceps. In 6 cases, a combined phacovitrectomy was performed, and the IOFB expressed through the corneal phacoincision; in one phakic patient, the removal was performed through the sclerotomy, extended just as needed.

CONCLUSION

The Grieshaber Eckardt forceps commonly used in MIVS can be used in IOFB surgery for a scleral or corneal removal. In case of IOFB bigger than 1 mm, enlarging the forceps bite according the IOFB size provides a firm and safe grip, allowing the surgeon to complete the surgery without switching to bigger and more traumatic instrumentation, reducing collateral damage and shortening the surgery time.

"IRIS SHELF" TECHNIQUE FOR MANAGEMENT OF POSTERIOR SEGMENT INTRAOCULAR FOREIGN BODIES

PURPOSE

To describe "iris shelf" technique for removal of posterior segment intraocular foreign bodies (IOFBs) through a corneal incision combined with phacovitrectomy and to report its outcomes.

METHODS

Medical records of patients with posterior segment metallic IOFBs who had combined phacovitrectomy were collected and analyzed. In all patients, the IOFB was placed on the iris surface after forming the anterior chamber with viscoelastic to be extracted through a corneal phacoemulsification incision.

RESULTS

Thirty-three eyes of 33 male patients with a mean age of 31.6 ± 8.3 years were included in the study. The mechanism of injury was hammering in 24 eyes (72.7%) and gunshot in 9 eyes (27.3%). The mean interval between injury and IOFB removal was 14.76 ± 6 days. The mean IOFB volume was 8.5 ± 5.5 mm3, and its longest dimension was 3.45 mm (range, 1-8 mm). The mean preoperative corrected distance visual acuity changed from 20/1,500 (1.79 logarithm of the minimum angle of resolution) to 20/94 (0.67 logarithm of the minimum angle of resolution), postoperatively (P < 0.001). Postoperative complications included retinal detachment (two eyes), proliferative vitreoretinopathy (one eye), epiretinal membrane (one eye), and posterior synechiae (three eyes).

CONCLUSION

The "iris shelf" technique with phacovitrectomy is a safe and reproducible approach for posterior segment IOFB extraction through a corneal incision with favorable visual and anatomical outcomes.

Low-cut, low-vacuum vitrectomy for releasing an embedded intraocular foreign body

Background

Removal of an embedded intraocular foreign body remains challenging due to the risks of bleeding and retinal damage. We present a novel technique to deal with this situation.

Case report

A 32-year man presented with two months of decreased vision in one eye (best corrected visual acuity of 20/200), a year after a workplace injury that necessitated surgery for an open globe injury. Examination revealed the sequalae of his previous surgery, a subtotal retinal detachment and an embedded intraocular foreign body close to inferior ora serrata at the 6 'o clock position confirmed by imaging. The other eye was normal. A pars plana vitrectomy was performed and the embedded intraocular foreign body was released from surrounding dense adhesions using the vitrectomy probe set at 1000 cuts/minute and 100 mm Hg vacuum, followed by fluid air exchange and endolaser with silicon oil injection. The retinal detachment settled well post-operatively, and at the end of one month, the patient had best corrected visual acuity of 20/60.

Conclusions

The low-cut, low-vacuum vitrectomy technique can be considered as a safe option for releasing the embedded intraocular foreign body in complex ocular trauma scenarios.

A Cross-Knotted Suture Basket Technique for Large Nonmagnetic Intraocular Foreign Body Removal

Purpose

To report a novel technique of cross-knotted suture basket and to test its effectiveness in large nonmagnetic intraocular foreign body (IOFB) removal.

Methods

A 7/0 Vicryl suture was cut in half and cross-knotted, and four ends were introduced into a 23G needle to form a basket. Pig eyes were used to set up the IOFB model, and the effectiveness of the suture basket in the removal of large nonmagnetic intraocular foreign bodies was tested.

Results

Several modifications can be made to adapt to different situations. For the materials (stone, metal, glass, and wood) and shapes (irregular, spherical, and rectangle) of large IOFB tested, the cross-knotted suture basket successfully removed all kinds of IOFBs.

Conclusion

The suture basket technique provides an accessible, safe, and effective alternative in large nonmagnetic IOFB removal. It can be adapted and interchangedand also worth's further clinical investigations.