Проблемы локализации внутриглазного вколоченного инородного тела. Клинический случай

Abstract

The article describes a clinical case of an eye injury with presence an intraocular foreign body (IFB), the localization of which was problematic. Patient T was 28 years old, was admitted with complaints of lack of vision, redness and lacrimation from the left eye. From the anamnesis – while working, he hit metal with a hammer, and the scale flew off into the left eye. In addition to the standard ophthalmologic examination, electrophysiological examination, B-scan and UBM were performed. According to the B-scan data, high optical density IFB was detected in the shells 9 mm from the upper border of the optic disc, in the 1-hour meridian, approximately 3.5 mm long. According to the X-ray data of the orbit in 2 projections, an X-ray contrast shadow, metal density, up to 3.0 mm in size was revealed. Radiography of Baltin–Comberg was not performed due to the lack of technical capability. During a standard three-port vitrectomy in the area of possible foreign body occurrence, the retina was damaged, there was a local detachment, but the foreign body itself was not visualized. In addition, during a thorough, detailed examination using a sclerocompressor, no visible defects of the sclera were found transvitreally. In the early postoperative period, the patient was performed with a computed tomogram, where the presence of a foreign body was confirmed, which was adjacent to the posterior wall of the eyeball for 1 hour with clear contours, measuring 3х3 mm. Taking into account the non-standard situation, the absence of a foreign body in the vitreous cavity, it was decided to re-search and remove the foreign body by using of the diascleral method. For a clearer contrast, diaphanoscopy was used, which made it possible to visualize and accurately localize a foreign body in the layers of the sclera. Conclusion. In the presence of IFB for search and precise localization, it is first of all necessary to perform the radiological Baltin-Comberg method. In cases when FB is not visualized intraoperatively, is impaled into the layers of the eye and the radiological Baltin-Comberg method has not been performed, diaphanoscopy of the eye is the optimal auxiliary method for searching for «hidden» foreign bodies. Key words: intraocular foreign body, radiological method of Baltin-Comberg, diaphanoscopy of the eye.