A rare intraocular foreign body resulting from a workplace accident

A 54-year-old man presented to the ophthalmic emergency department of our center with eye pain and blurred vision in his right eye following a workplace accident. Examination revealed a penetrating corneal injury with the presence of an intraocular foreign body (IOFB) involving the corneoscleral limbus, perforating the cornea, iris, anterior lens capsule, and lens. Immediate surgical intervention was carried out with the extraction of the IOFB, identified as an 8mm mussel shell fragment, and the removal of the resulting traumatic cataract. Both preoperative and postoperative examinations showed an attached retina with no signs of retinal tears or vitreous hemorrhage. Appropriate management in this case, along with the timely identification of the agent, led to favorable outcomes despite the size of the intraocular foreign body.

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.

Utility of a nitinol stone extractor for intraocular foreign body removal

Purpose

To describe the novel application of a urological instrument, the nitinol stone basket, in the removal of a retained intraocular foreign body (IOFB).

Observations

This is a retrospective case series describing two eyes of two patients presenting with metallic IOFBs after hammering metal-on-metal. Both patients underwent 23-gauge pars plana vitrectomy (PPV) and successful IOFB extraction using the NCircle® Nitinol Tipless Stone Extractor. There were no intraoperative or post-surgical complications. Both patients demonstrated improvement in vision, with most recent postoperative visual acuities of 20/40 and 20/60.

Conclusions and importance

The nitinol stone basket may be considered for removal of IOFBs, particularly larger IOFBs that are difficult to grasp with forceps. Our cases add to the literature showing favorable visual outcomes and few complications in the post-operative period using this technique.

Diagnosis, management, and outcome of an intralenticular foreign body in a dog: A case report

Background

Intra-lenticular foreign bodies are rare in veterinary medicine and uncommon in human medicine. Approximately 50% of perforating ocular injuries in canines have lenticular involvement. Treatment choices include conservative management and surgical options. Retained intra-lenticular foreign body with delayed removal has not been reported in animals.

Case Description

A 3-year-old male neutered Lurcher presented with right-sided ocular discomfort and a sealed full-thickness corneal perforation. The full ophthalmic examination could not be performed at the initial presentation due to miosis. Recrudescence of anterior uveitis was seen post-drug cessation. Re-evaluation of the eye with a mydriatic pupil revealed an intra-lenticular foreign body. Surgical removal via phacoemulsification was performed 8 weeks after the initial perforating injury. The eye remains visual, comfortable, and normotensive 50 months post-operatively.

Conclusion

This is the first report of an encapsulated, retained intra-lenticular foreign body with delayed removal in a dog. Mydriasis and repeat examinations are of crucial importance when evaluating eyes post-perforation.

Intraocular foreign body: Characteristics, visual outcomes, and predictive values of ocular trauma score

Introduction

Retained intraocular foreign body (IOFB) remains an important cause of acquired visual impairment. The visual prognosis following treatments for eyes with retained IOFB was observed to be distinct from other mechanisms of open globe injury due to the specific nature and associated circumstances. This study evaluated the risk behaviors, visual results, and predictive values of Ocular Trauma Score (OTS) in determining visual outcomes in patients with IOFB that were not related to terrorism.

Methods

Medical records of patients who underwent surgical interventions between January 2015 and December 2020 were retrospectively reviewed.

Results

A total of one hundred and sixty-one patients (162 eyes) were recruited. The patients had a mean (standard deviation) age of 47.6 (14.0) years with working male predominance (93.2%). The majority of patients were injured by activities related to grass trimming (63.4%) and metallic objects were the main materials causing injuries (75.7%). Following treatments, the proportion of eyes having vision worse than 20/400 decreased from 126 eyes (77.8%) to 55 eyes (33.9%) at final visit. Ocular trauma score (OTS) had a high potential prediction for final vision in eyes in OTS categories 4 and 5. However, the discordance of final visual acuity distribution was observed in some subgroups of eyes in OTS categories 1 to 3.

Conclusion

This study highlights the significance of IOFB related eye injuries in a tertiary care setting. Decision making on treatments should be carefully considered, particularly in eyes in lower OTS categories, in light of a rise in the proportion of patients who experience improved vision after IOFB removal.

Creatively tiding over the crisis

Background

A patient with a retained intraocular metallic foreign body post-trauma was taken up for vitrectomy and intraocular foreign body removal. Unfortunately, the intraocular magnet was not available at the moment on the table! How a little bit of creativity and innovative thought helped us tide over this crisis is the content of this video.

Purpose

To demonstrate magnetization of a metallic surgical instrument for temporary use in the event of unavailability of the intraocular magnet for intraocular foreign body removal.

Synopsis

A ferromagnetic substance can be magnetized temporarily using an existing magnet. We obtained a general-purpose magnet and wrapped it in sterile plastic, using which we magnetized normal intraocular forceps and a Micro Vitreo Retinal (MVR) blade by giving about 20-30 strokes over the magnet in a single direction. This aligned the magnetic domains in the metal in a parallel fashion. These Do It Yourself (DIY)- magnetic instruments were then effectively utilized to remove the metallic intraocular foreign body.

Highlights

The video showcases effectively harnessing the available resources and tiding over the dearth of a necessary instrument, with the right use of an innovative idea and some creativity!.

Video link

https://youtu.be/QtRC-AK5FLU.

High risk and low prevalence diseases: Open globe injury

INTRODUCTION

Open globe injury (OGI) is a rare but serious condition that carries with it a high rate of morbidity.

OBJECTIVE

This review highlights the pearls and pitfalls of OGI, including presentation, diagnosis, and management in the emergency department (ED) based on current evidence.

DISCUSSION

OGI refers to full-thickness injury to the layers of the eye. OGI can be caused by blunt or sharp trauma, and subtypes include penetration, perforation, intraocular foreign body (IOFB), globe rupture, or mixed types. OGI is more common in males and usually secondary to work-related injury, but in women it is most commonly associated with falls. Emergency clinicians should first assess for and manage other critical, life-threatening injuries. Following this assessment, a thorough eye examination is necessary. Computed tomography (CT) may suggest the disease, but it cannot definitively exclude the diagnosis. While point-of-care ultrasound (POCUS) is highly sensitive and specific for some findings in OGI, its use is controversial due to potential globe content extrusion. Management includes protecting the affected eye from further injury, preventing Valsalva maneuvers that could extrude ocular contents, updating tetanus vaccination status, administering broad-spectrum antibiotics, and ophthalmology consultation for surgical intervention to prevent the sequelae of blindness and endophthalmitis.

CONCLUSION

An understanding of OGI can assist emergency clinicians in diagnosing and managing this sight-threatening traumatic process.

Intraocular lens-blocking technique for intraocular foreign body removal

The aim of this study was to describe a novel technique for intraocular foreign body (IOFB) removal. Phacoemulsification was performed in all patients, followed by a complete microincision vitrectomy to free all tissues surrounding the IOFB. A three-piece intraocular lens (IOL) was placed in the capsular bag, and an opening was made in the upper center of the capsule. The IOFB was removed and lifted to the anterior chamber through the capsular opening and IOL edge. The IOFB was confined to the anterior chamber by the IOL, and then easily extracted through the main corneal incision. The technique was adopted in six eyes of six patients. All IOFBs were removed successfully in all patients without intraoperative or postoperative complications. The IOL-blocking technique is a useful approach for IOFB removal.

Analysis of ocular injury 1-year outcome in survivors of Beirut Port ammonium nitrate blast

Purpose

Ascertain the 1-year outcome of patients who sustained open eye injuries from the Beirut Port ammonium nitrate (AN) explosion, one of the most powerful non-nuclear explosions in history.

Methods

Retrospective chart review of the operated eyes in 2 major eye hospitals.

Results

Out of 42 patients with open globe injury that was originally sutured, 29 patients (34 eyes) were followed at the 1-year mark. The initial vision in logMAR (mean ± SD) was 2.93 ± 0.87 (hand motion equivalent) and the final vision was 1.80 ± 1.47 (counting finger 2 m equivalent). No light perception (NLP) vision was noted in 12 eyes on presentation and 10 eyes remained so, while 2 eyes reached light perception (LP) vision. Eight eyes had an intraoperative expulsive choroidal hemorrhage (7 NLP and 1 LP both pre- and postoperatively), and 6 of the 8 developed phthisis. All eyes that developed phthisis had NLP preoperatively and postoperatively. Ocular Trauma Score (OTS) correlated inversely with both initial and final vision (p < 0.001). Zone of injury inversely correlated with initial vision (p = 0.02) and positively with final vision (p < 0.001). Final vision was significantly worse in zone 3 vs. zones 1 and 2 (3.2 ± 0.5) vs. 0.9 ± 1.1) (p < 0.001) injuries, as was the initial vision (3.3 ± 0.5 vs. 2.7 ± 0.8; p = 0.002).

Conclusion

The OTS, which provides prognostic information for serious ocular trauma, also yields valuable prognostic information for AN-associated ocular injuries. Expulsive choroidal hemorrhage and NLP vision at presentation remain very poor prognostic signs.

Traumatic intrachoroidal nail implantation

Penetrating globe injury can lead to serious vision loss and even loss of the eye. Intraocular foreign bodies (IOFBs) are a major cause of traumatic globe injury commonly seen in work-related accidents. We present a unique case of a large IOFB that was fully embedded within the choroid, where enucleation was pursued due to inability to safely remove the IOFB.

Comparison of causative microorganisms of posttraumatic endophthalmitis with and without retained intraocular foreign bodies

Background

The goals of this work were to report the demographic characteristics of patients with clinically diagnosed endophthalmitis with or without intraocular foreign bodies (IOFBs) and to analyze the causative microorganisms.

Methods

A retrospective analysis was conducted on 1257 patients with clinically diagnosed posttraumatic endophthalmitis who were admitted to Zhongshan Ophthalmic Center between January 1, 2013, and August 31, 2020.

Results

Of the 1257 patients with clinically diagnosed posttraumatic endophthalmitis, 452 (36.0%) patients had IOFBs. Male dominance was more common among the patients with IOFBs than the patients without IOFBs. The average age of the patients with IOFBs was older than that of the patients without IOFBs. The most common microbial pathogens in these two groups were Gram-positive cocci and Gram-negative bacilli. Gram-positive bacilli were more common in the patients with IOFBs than in those without IOFBs (17.9 vs. 9.4%), and Bacillus spp. accounted for 12.6 and 5.5%, respectively. Fungi were less abundant in the patients with IOFBs than in those without IOFBs (8.0 vs. 15.6%).

Conclusions

Patients with IOFBs were mostly male and older than those without IOFBs. Gram-positive bacilli were more common and fungi were less common in patients with IOFBs than in those without IOFBs.

Clinical outcomes of posterior segment intraocular foreign bodies: The volume effect

PURPOSE

To assess the effect of foreign body volume on visual and anatomic outcomes in patients with a posterior segment intraocular foreign body (IOFB).

METHODS

Patients were divided into three groups according to the volume of the IOFB; group 1 (n=18 eyes) with IOFBs<2mm³, group 2 (n=15 eyes) with 2mm³≤IOFBs<6mm³, group 3 (n=18 eyes) with IOFBs≥6mm³. All eyes underwent pars plana vitrectomy (PPV) for removal of the IOFB. Demographic characteristics, features of the injury and IOFB, findings of the initial and final ophthalmological examinations, and timing of IOFB removal were studied.

RESULTS

The mean age was 38.8±12.0years, and the median follow-up period was 12.0 (range: 6-98) months. Initial visual acuity (VA) was significantly lower in group 3 (P=0.005), while final VA was similar between the three subgroups. Frequencies of primary globe repair, initial vitreous hemorrhage (VH), corneoscleral entry, and IOFB removal through the cornea were significantly higher in eyes with large volume IOFBs (P<0.05). Siderosis was only seen in 4 patients in group 1 (22.2%). No patients developed postoperative endophthalmitis.

CONCLUSION

Large volume posterior segment IOFBs are associated with poor initial VA, initial VH and corneoscleral injury. Nevertheless, PPV and IOFB extraction under favorable conditions may provide significant visual improvement in eyes with large volume IOFBs.

Evaluation of the use of NGage® Nitinol stone extractor for intraocular foreign body removal

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.

Open Globe Injury with Intraocular Foreign Body

Purpose

To investigate characteristics of Open Globe Injuries (OGI) that presented with Intra-Ocular Foreign Body (IOFB), along with their long-term visual outcomes, complications and need for subsequent surgeries.

Methods

Retrospective interventional consecutive case series of OGIs with IOFBs that presented to the Eye Trauma service at the Massachusetts Eye and Ear from 2010 to 2015. Data collected included time from injury to OGI repair, location of injury and IOFB, retinal detachment (RD) rate, presenting and final visual acuity (VA) and subsequent surgeries.

Results

Fifty-seven consecutive cases of OGIs with IOFBs were included. The majority of patients were male (93%), mean age was 37 years and mean follow-up was 28 +/- 22 months. The median time from injury to OGI repair was 0 days (range: 0-16 days). Overall, 38/57 (66.7%) eyes achieved final vision of 20/40 or better and 43/57 (75.4%) vision of 20/150 or better. Zone I injuries were the most common (86%), followed by Zone II (16%), and Zone III (10%). 33 cases had IOFBs in the anterior segment only and 24 cases had posterior segment involvement. In total, 30% of cases (17/57) were complicated by an RD, 58.3% (14/24) in the posterior versus 9.1% (3/33) in the anterior IOFB group.( p<0.01). There were no cases of endophthalmitis. Posterior IOFB and higher zone of injury were found to be risk factors for RD both at presentation (all p<0.05) and post-primary repair.(all p<0.05) Posterior IOFB was associated with higher vitrectomy rates both at presentation (p<0.0001) and post-primary repair (p=0.002) and worse long-term visual outcome (p = 0.014).

Conclusion

OGIs with IOFB involving the posterior segment are associated with higher complication and re-operation rates and worse visual prognosis compared to those involving the anterior segment only.

Siderotic glaucoma without detectable intraocular foreign body in a pseudophakic eye: a case report

Background

Ocular siderosis is induced by a retained intraocular foreign body (IOFB) containing iron and can present as siderotic glaucoma. We report a rare case of histopathologically proven siderotic glaucoma in a middle-aged blacksmith with a preceding history of ocular trauma but no radiologically detectable IOFB.

Case presentation

A 42-year-old blacksmith presented with an elevation of intraocular pressure (IOP) in left eye showing iris heterochromia and brownish deposits throughout the trabecular meshwork (TM). Preoperative ophthalmic examination did not reveal any retained IOFBs. Electroretinography showed the classic changes of retinal degeneration in ocular siderosis. Histopathologic staining of the TM verified the presence of iron deposits.

Conclusion

This case underlines the importance of the close monitoring of patients with a history of ocular trauma and highlights the necessity of electroretinography, histopathologic study, and detailed ophthalmic examination in the diagnosis of siderotic glaucoma, even if there is no definite radiologically detectable IOFB.

Use of medical sodium hyaluronate gel in surgical removal of a glass intraocular foreign body

A 38-year-old healthy man presented to our department of ophthalmology after sustaining an ocular injury in a glass explosion more than 10 days prior. A glass intraocular foreign body (IOFB) was found in the left eye. During surgical removal of the IOFB, medical sodium hyaluronate gel was used to detach the IOFB from the retina; this avoided damage to the retina and made it easier for the surgeons to grasp the glass fragment. Multiple surgical instruments have been developed to help remove IOFBs; however, many optic hospitals have limited surgical instruments, thus increasing the difficulty of the operation. The application of sodium hyaluronate gel, a widely used agent, may be a new technique in IOFB surgery.

Ocular siderosis: a misdiagnosed cause of visual loss due to ferrous intraocular foreign bodies-epidemiology, pathogenesis, clinical signs, imaging and available treatment options

Purpose

The purpose of this paper is to provide a meaningful literature review about the epidemiology, pathogenesis, clinical signs, imaging and treatment of ocular siderosis (OS).

Methods

A computerized search from inception up to March 2020 of the online electronic database PubMed was performed using the following search strings: “ocular siderosis” and “siderosis bulbi”. The reference list in each article was analysed for additional relevant publications.

Results

OS is an uncommon cause of visual loss due to a retained ferrous intraocular foreign body (IOFB). It may develop from 18 days to years after a penetrating trauma that usually occurs during hammering. On average, patients are 22–25 years old, and the vast majority are male. The most common cause of OS development is delayed presentation by the patient or missed diagnosis of IOFB after trauma. The pathophysiology is not fully understood; nevertheless, iron deposition causes hydroxyl radical formation, which damages photoreceptors and retinal pigment epithelium. Moreover, iron damages retinal vessels with consequent inner retinal layers degeneration. The most frequent signs are iris heterochromia, pupillary mydriasis, cataract development and retinal arteriolar narrowing with pigmentary retinal degeneration. Electroretinogram signs, in particular, b-wave amplitude reduction, arise earlier than clinical signs. Orbital CT scans and ultrasonography play an essential role in detecting IOFBs. Treatment depends on the IOFB location and OS development. However, it is crucial to remove the IOFB after OS development because visual acuity and clinical signs may improve. Anterior segment IOFBs can be dislodged using an intraocular magnet (IOM) or forceps through limbal paracentesis. In contrast, posterior segment IOFBs require a pars plana vitrectomy and IOM or forceps to be removed through an enlarged sclerotomy or the limbus.

Conclusion

Recommending the usage of protective glasses and spreading knowledge about OS may further benefit patient care.

Clinical presentations and surgical outcomes of intraocular foreign body presenting to an ocular trauma unit

OBJECTIVES

To describe, evaluate, and identify the characteristics, prognostic factors, and visual outcomes in patients with intraocular foreign body (IOFB) in a Latin American population.

METHODS

A retrospective, observational case-series of patients with a diagnosis of IOFB. Variables analyzed included age, gender, initial and final best correct visual acuity (BCVA), ocular trauma score, intraocular pressure, mechanism of injury, material and number of IOFB, zone of injury, timing of primary repair and IOFB removal, complications, and follow up.

RESULTS

Sixty-one patients with IOFB were identified of which 97% were male with a mean age of 37.9 years (SD 2.16). The most common IOFB location was intravitreal (43%). IOFBs were metallic in 78%, vegetal in 3%, and other materials in 11%. Primary repair and secondary IOFB removal were performed at a mean timepoint of 3 days and 5 days, respectively. Systemic and topical antibiotics were administered to all patients. The initial BCVA was 1.62 logMAR and the final was 0.6 logMAR, which was statistically significant (Pearson's chi-squared test, p value 0.01). No cases of endophthalmitis were seen.

CONCLUSION

IOFB removal can be delayed when there are no signs of infection or evidence of retinal detachment, without an increased risk of endophthalmitis and a negative impact on visual outcomes. Use of topical and systemic antibiotics appear sufficient to prevent endophthalmitis in these cases.

Electroretinograms before and after extraction of large intraocular iron foreign body

Purpose

We present our findings in a case with an intraocular foreign body in which the electroretinographic (ERG) findings were useful.

Observations

A 37-year-old man was injured by an iron fragment that penetrated into his left eye through the cornea. His visual acuity was counting fingers, and a traumatic cataract prevented an examination of the fundus. B-mode ultrasonography showed a stick-like foreign body of approximately 14 mm in length in the eye. Preoperative ERGs with a contact lens electrode showed reduced responses with many blinking artifacts. Lensectomy and pars plana vitrectomy were performed and a fragment of a wire brush was seen embedded in the superior nasal retina which was removed. The decimal visual acuity improved to 1.2 two weeks later. The postoperative ERG performed with a skin electrode showed reduced responses in the injured eye.

Conclusions and importance

We recommend that the physiology of the retina be assessed by recording ERGs with a skin-type electrode as soon as possible after a traumatic injury to the eye.

The outcomes of bimanual posterior segment intraocular foreign body removal with vitrectomy and description of two different handshake techniques: A single surgeon case series

PURPOSE

To evaluate the outcomes of bimanual intraocular foreign body (IOFB) removal with vitrectomy and describe the techniques of "active aspiration to forceps" and "forceps to forceps handshake" for IOFB removal.

METHODS

Retrospective, interventional, single surgeon case series. The patients who had an IOFB and underwent vitrectomy with bimanual IOFB removal techniques and had a minimum follow-up period of 12 months were included. The main outcome measure was the functional and anatomical results of the bimanual surgical techniques.

RESULTS

Twenty eyes were included. The mean follow-up time after surgery was 16.5±3.6 months (range 12-24 months). The baseline best corrected visual acuity (BCVA) was light perception in 8 eyes (40%), hand motions in one eye (5%), and≥1.0LogMAR in 11 eyes (55%). BCVA improved in 14 eyes (70%); was stable in 3 eyes (15%), and decreased in 3 eyes (15%).

CONCLUSIONS

Both bimanual handshake techniques were safe and effective methods in the surgical treatment of IOFBs<5mm in size. The "active aspiration to forceps handshake" technique might be a gentle technique for the removal of IOFBs that are located on the surface of or trapped within the retina.

Clinical characteristics and prognostic factors of posterior segment intraocular foreign body in a tertiary hospital

Background

To identify the clinical characteristics, prognostic factors and visual outcomes in posterior segment IOFBs patients managed by PPV in a tertiary hospital.

Methods

A retrospective chart review was performed for 56 patients, who had PPV for IOFBs removal between November 2013 and November 2015. The mechanisms of injury, the nature of the IOFBs, the BCVA before and after the surgery, the penetrating site and the complications of the surgery were all collected. Univariate analyses were conducted to evaluate the prognostic factors.

Results

The mean age of the patients was 36.4 years. The nature of IOFBs was mainly metal. Most injuries were commonly caused by hammering the metal. The mean preoperative VA was 2.30 logMAR, and mean final VA was 0.92 logMAR. From univariate analysis, good visual outcome was correlated with the good visual acuity before surgery and poor visual outcome was correlated with the macular break and multiple surgeries.

Conclusions

In a tertiary hospital of eastern China, most cases of IOFBs were work-related. The prognosis of the patients was really well in the patients with good presenting visual acuity. Nevertheless the prognosis was not good for those patients who had macular injury or underwent several surgeries because of retinal detachment, epiretinal membrane or proliferative vitreous retinopathy. Good facilities for eye protection are urgently in demand for the workers indeed.

Secondary Sulcus-Fixed Foldable IOL Implantation with 25-G Infusion in Patients with Previous PPV after Open-Globe Injury

PURPOSE

To evaluate the safety and efficacy of secondary sulcus-fixed foldable intraocular lens (IOL) implantation through a clear corneal incision with 25-G infusion in patients with previous pars plana vitrectomy (PPV) after open-globe injury, and to analyze postoperative outcomes and prognostic factors of treatment.

METHODS

Clinical data of 89 eyes of 89 patients with open-globe injury who underwent secondary sulcus-fixed foldable IOL implantation through a clear corneal incision with 25-G infusion after vitrectomy in our hospital between January 2008 and June 2015 were retrospectively analyzed. The examinations before IOL implantation mainly included visual acuity, slit-lamp examination, direct and indirect ophthalmoscope, visual electrophysiology, corneal endothelium, B scan, ultrasound biomicroscope, and intraocular pressure. Five eyes underwent suturing of peripheral iris and 7 eyes underwent suturing of iris laceration simultaneously. The mean follow-up was 18 months with a range from 6 months to 8 years.

RESULTS

The mean interval between secondary sulcus-fixed foldable IOL implantation and vitrectomy was 2.8 months with a range from 2 to 6 months. The uncorrected visual acuity improved in all patients with a well-centered IOL ranging from 0.1 to 0.8 with the best-corrected visual acuity from 0.1 to 1.0 after secondary IOL implantation. The postoperative complications mainly included mild anterior chamber exudates in 10 eyes (11%), temporary IOP elevation in 12 eyes (13%), and recurrent retinal detachment in 5 eyes (6%), which were subsequently managed by surgery.

CONCLUSIONS

The interval of 2.8 months between vitrectomy and secondary IOL implantation is an appropriate and safe option to correct aphakia in patients receiving vitrectomy for open-globe injury.

Characteristics of wooden intraocular foreign body by magnetic resonance imaging in rabbits

OBJECTIVE

Intraocular foreign body (IOFB), a frequent cause of ocular trauma, causes serious damage to the eyes. This study was designed to elaborate and compare the characteristics of different magnetic resonance imaging (MRI) sequences in detecting wooden IOFBs in rabbits.

METHODS

The right vitreous of 24 healthy rabbits was randomly implanted with diverse wooden foreign bodies (diameter φ = 0.2 mm). The T₁-weighted imaging (T₁WI), T₂-weighted imaging (T₂WI), proton density-weighted imaging (PDWI), and susceptibility-weighted imaging (SWI) sequences were applied individually 2 weeks after the implantation.

RESULTS

IOFBs were detected as linear low signals on T₁WI, T₂WI, PDWI, and SWI (SWI image). The detectable rates of poplar wood with a length of 0.5 mm were 0%, 50%, 0%, and 67% for T₁WI, T₂WI, PDWI, and SWI, respectively. SWI and T₂WI sequences exhibited higher sensitivity than T₁WI and PDWI. The detectable rates of the first three SWI sequences (magnitude, phase, and SWI) were all 67%, which was higher than that of the minimum intensity projection sequence (33%).

CONCLUSION

MRI is practicable in the diagnosis of wooden IOFBs. SWI and T₂WI are optimal for the integrated diagnosis of wooden IOFBs and could be used for diagnosis and immediate treatment.

Conservative management of penetrating ocular trauma caused by a nail gun

Purpose

To report the conservative management of a penetrating ocular trauma caused by a nail gun with a six-month follow up.

Observations

A 21 year-old healthy female suffered an ocular penetrating trauma with a nail gun. She presented with a metallic foreign body that partially entered her left eye through the nasal sclera via pars plana, 3 mm posterior to the limbus, but did not reach the retina. Surgical removal of the foreign body and closure of the scleral wound, without vitrectomy, was performed 16 h after the injury. Intravitreal prophylactic antibiotic was administered. Retinal atrophy developed in the areas that had commotio retinae at presentation, but no further complications were observed.

Conclusions and importance

Pars plana vitrectomy may not be necessary in all penetrating ocular traumas with intraocular foreign body, as long as the foreign body is accessible from the exterior of the eye and there are no other conditions (such as vitreous hemorrhage, retinal detachment, endophthalmitis, etc) that are an indication for vitrectomy.

Acute ocular pain during magnetic resonance imaging due to retained intraocular metallic foreign body: the role of ultrasonography and ultrasound biomicroscopy in diagnosis and management of this condition

PURPOSE

To report the case of a 65-year-old metalworker with no known history of ocular trauma, who suffered from intense ocular pain during magnetic resonance imaging (MRI) of the brain, due to a retained intraocular metallic foreign body (IOFB).

CASE REPORT

Meticulous ophthalmological examination was inconclusive. An IOFB was confirmed with X-ray scan, whereas its exact localization was enabled by means of ultrasonography and ultrasound biomicroscopy (UBM).

CONCLUSIONS

Despite appropriate screening protocols, MRI-related ocular complications might occur in the presence of a hidden metallic IOFB. Clinical detection of ocular foreign bodies can sometimes be challenging. Ultrasonography and UBM are valuable adjuncts for the accurate localization, especially of small or hidden particles.

A missed diagnosis of multiple intraocular foreign bodies for 21 years

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.

Metallic intraocular foreign body as detected by magnetic resonance imaging without complications- A case report

Purpose

To describe a case and present unique images of a metallic intraocular foreign body that was identified in a 12-year-old male patient who underwent routine magnetic resonance imaging (MRI) to assess neurodevelopmental delay.

Observations

We present MRI and diagnostic imaging of a metallic intraocular foreign body in a young patient with no known history of trauma or reason for the existence of metal in the eye area. Computed tomography scan was performed to confirm the presence of the intraocular foreign body, followed by optical coherence tomography and electroretinogram to assess visual status. It was determined that no surgical intervention was currently required as no visual impairment or ocular toxicity was identified. The patient continues to be monitored.

Conclusions and importance

This case presentation highlights the novel imaging features of a metallic intraocular foreign body, unexpectedly detected with MRI.

Acute ocular traumatic imaging: what the radiologist should know [corrected]

Acute ocular trauma accounts for a substantial number of emergency department visits in the USA, and represents a significant source of disability to patients; however, the orbits remain a potential blind spot for radiologists. The goal of this article is to review the relevant anatomy of the orbit and imaging findings associated with commonly encountered acute ocular traumatic pathology, while highlighting the salient information which should be reported to the ordering clinician. Topics discussed include trauma to the anterior and posterior chamber, lens dislocations, intraocular foreign bodies, and open and contained globe injuries.

Siderotic cataract with no signs of intraocular foreign body

BACKGROUND

Ocular siderosis is a clinical condition induced by deposition of an iron-containing intraocular foreign body. We report a unique case of histopathologically proven lens siderosis in a young woman with a preceding history of trauma but no signs of retained intraocular foreign body.

CASE PRESENTATION

A 32-year-old woman presented with an opacified lens showing brownish deposits on the anterior capsule and underwent cataract surgery. Preoperative ophthalmic examination did not show any retained intraocular foreign body. Histopathologic staining of the anterior capsule confirmed the presence of iron deposits and macrophages. Electroretinography examination performed in the postoperative period showed the changes characteristic of retinal degeneration in ocular siderosis.

CONCLUSION

This case illustrates the importance of close monitoring of patients with a history of trauma or previous penetrating injury to the eye, even if there is no intraocular foreign body, because they might develop ocular siderosis at a later stage. This case report underscores the importance of electroretinography and histopathologic analysis, in addition to ophthalmic examination, in the diagnosis of ocular siderosis.

UUnilateral corneal edema caused by a hidden foreign body

CASE REPORT

A middle-aged adult male was referred to our institution due to unilateral corneal edema for a possible corneal transplant. At first, the patient denied a history of trauma. A small foreign body, which had been overlooked by the primary ophthalmologist, was detected by gonioscopy, embedded in the anterior chamber angle. It was successfully surgically removed and visual results were good.

DISCUSSION

In any patient with unilateral unexplained corneal edema, it is necessary to rule out the presence of a foreign body in the anterior chamber.

Epidemiology and clinical outcome of intraocular foreign bodies in Hong Kong: a 13-year review

The purpose of this study was to describe the epidemiology, visual outcome and prognostic factors of intraocular foreign body (IOFB) injuries in a tertiary centre in Hong Kong. A retrospective review of 21 eyes in 21 patients with IOFB that presented to United Christian Hospital from January 2001 to July 2014 was performed. IOFB represented 16 % of all open-globe traumas. There was a high male predominance (90 %). The mean age was 42. Work-related injuries (86 %) were the main cause, where only 10.5 % had eye protection. Hammering was the commonest mechanism of injury (43 %). Most IOFBs were metallic (67 %). The IOFB was found in the anterior segment in 31 % and posterior segment in 69 %. 57 % presented with an initial visual acuity of ≥0.1, and up to 24 % of patients had an initial visual acuity of better than or equal to 0.5. Most cases (76 %) received prompt surgical intervention within 24 h, and there was a low (0 %) endophthalmitis rate. Forty-eight percent had an improvement in visual acuity, defined as final visual acuity more than or equal to 2 lines of improvement from initial visual acuity, and 48 % attained a final visual acuity of better than or equal to 0.5. One case underwent evisceration. A smaller IOFB size (<5 mm) was associated with a good final visual acuity of better than or equal to 0.5 (p = 0.048). It was also found that a posterior segment IOFB was more likely to give a final VA of less than 0.5 (p = 0.035). IOFB remains a significant complication of work-related injuries in Hong Kong. This is the first local study that explores the epidemiology of IOFB injuries in Hong Kong. The favourable visual outcome and low endophthalmitis rate may be related to early removal of IOFB. Despite legal ordinances for mandatory eye protection, the uptake of eye protection was low.

[Post-traumatic endophthalmitis]

Post-traumatic endophthalmitis is a rare but serious complication of open globe injury, representing a major turning point for the patient's visual prognosis. Risk factors for this complication are lens capsule rupture, an intraocular foreign body, type of eye trauma and especially a delay in initial management of the trauma. Although Staphylococcus epidermidis is the most common organism, as in postoperative acute endophthalmitis, other microorganisms are more frequently represented and the multi-microbial involvement is common. The diagnosis can be difficult in the presence of inflammatory signs of trauma. Aside from rapid globe repair, neither preventive nor curative treatment have been well delineated. The class of antibiotics, the dosage, route of administration, as well as surgical treatment by vitrectomy remain topics of discussion.

Penetrating Ocular Trauma with Retained Intraocular Foreign Body: Management, Follow-up and Medico-legal Evaluation

Ocular trauma is the leading cause of acquired monocular blindness, accounting for 1.97-6% of such cases. Particularly, penetrating ocular injuries are among the most common eye injuries with this kind of outcome. Early diagnosis and prompt management are crucial to avoid complications, and the especially dreaded enucleation. In this article, the authors describe the clinical management, and evaluate the visual and anatomical results obtained in a case of ocular injury with retained intraocular foreign body (IOFB) in a 20-year old female patient. The course of treatment involved a combination of penetrating keratoplasty with a temporary keratoprosthesis, phacoemulsification with intraocular lens implantation and pars plana vitrectomy. At three years from the initial injury, the patient was able to count fingers at 30 centimetres and anatomical restitutio ad integrum of the globe had been achieved.

A peculiar case of a retained inert piece of fireworks as an intraocular foreign body in the anterior chamber

This is a descriptive case report of a seven-year-old boy presented in January 2007 with decreased vision in the right eye, for 2 months after sustaining a trauma while he was playing with fireworks during the Eid holiday. He was treated in a suburban hospital for corneal laceration and was prescribed a topical antibiotic and a topical steroid. When the child presented to us, a slit lamp examination revealed a thread in the anterior chamber, his un-aided visual acuity was 6/60 on a Snellen chart. Surgery to remove the foreign body was scheduled, but the patient never attended. The patient was lost to follow-up and returned in January 2011 with an un-aided visual acuity of 6/12, although the foreign body was retained in the anterior chamber (AC) with a quiet eye and good vision. At that time, we decided to follow the patient without any surgical intervention. Again, the patient was lost to follow-up and returned with almost full vision in September 2012, with a visual acuity of 6/6 without correction. Thus, we concluded that thread like IOFBs in the AC can be considered inert materials that may not need any surgical intervention in a quiet eye that does not show any signs of inflammation and where the IOFB is non-mobile and located away from the endothelium.

Unusual presentation of an intraocular foreign body retained for sixty years

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.

Two cases of accidental dislocation of the silicone sleeve of an extrusion cannula into the vitreous cavity

Background

Fluid-air exchange during vitreoretinal surgery is often used as a tool for subretinal fluid endodrainage. Soft-tipped flexible extrusion cannulas are commonly used to aspirate the posterior subretinal fluid.

Methods

This is an observational two-case series describing two patients who underwent 20-G pars plana vitrectomy complicated by the accidental fall of the silicone sleeve of a soft-tipped extrusion cannula into the vitreous cavity. In the first case, the cannula had inadvertently been subjected to sterilization process.

Results

While withdrawing the soft-tipped extrusion cannula from the eye, following internal drainage of transvitreal and subretinal fluid, the loose silicone sleeve probably got entangled at the inner lip of the sclerotomy and finally fell on the retinal surface. In both cases, the silicone sleeve was held and removed with an intraocular forceps.

Conclusions

This rare complication has been reported in the literature only once previously. Sterilization of disposable subretinal fluid cannulas is not advisable because of the risk of dislocation of the silicone sleeve into the eye. Besides this, it is important to check the integrity of the silicone sleeve before and after surgery.

An overview of penetrating ocular trauma with retained intraocular foreign body

Penetrating trauma is one of the common causes of ocular morbidity world wide. Violation of the globe integrity, also known as a ruptured globe is an ocular emergency that universally threatens vision. Prompt recognition and management is prudent. Here we report a case of a 26-year-old-female, university teacher, who presented with pain and sudden loss of vision in the left eye of 2 h duration subsequent to a test tube blast in the chemical laboratory. Examinations revealed a ruptured globe with vitreous haemorrhage and an intraocular glass foreign body in the left eye. Primary repair was done with good post operative visual recovery. We report this case to emphasize that protective measures should be taken to prevent such eye traumas.

Long-term corneal complication of retained anterior chamber-angle foreign body

A 33-year-old patient referred to the cornea and anterior segment department to evaluate inferior corneal edema related to a retained intraocular foreign body (IOFB) in the anterior chamber-angle. The foreign body, which was a single piece of glass caused by an exploded light bulb twenty years back, was surgically removed; edema resolved and vision improved to 20/30. In the presence of an anterior chamber IOFB; long-term adverse effects should be considered. We would advise removal of the FB regardless of the inertness and location facts, as long as the risk and benefits of the surgical intervention are carefully evaluated.