Extraction Of Intraocular Foreign Body Research Articles

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

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

Intraocular Foreign Body: Striving the Optimal Visual Outcome

Introduction: Intraocular foreign bodies (IOFBs) are defined as intraocularly retained, unintentional projectiles that require urgent diagnosis and treatment to prevent blindness or globe loss. Case Presentation: We report a case of IOFB due to occupational accidents. In this case, there were delays in extraction considering the health facilities and conditions related to COVID-19 infection. Initially, the patient underwent closure of the entrance wound, which was performed within the first 24 hours post-trauma. However, although there was no endophthalmitis, visual acuity at the end of the observation still showed an unexpected outcome. The patient was followed up for three months after IOFBs extraction. The timing of IOFBs removal depends on several factors, including the patient’s overall health status, the nature of the injury, and the composition of the IOFBs. The postoperative examinations focus on complications such as endophthalmitis, postoperative retinal detachment, proliferative vitreoretinopathy (PVR), and sympathetic ophthalmia. The numerical values can then be used to predict the expected visual acuity using the ocular trauma score system. Conclusions: Many factors could affect the outcome quality of visual acuity. Primary wound closure, foreign body extraction, and anatomic reconstruction of the holistic ocular should be performed as soon as possible. Delay in definitive treatment was thought to affect worsening prognosis due to tissue proliferation and the tendency for severe complications, including endophthalmitis.

Penetrating Ocular Injury Management in Intraocular Foreign Body (IOFB) and Traumatic Cataract

Highlight: The management of penetrating ocular injury with IOFB and traumatic cataracts needs a thorough examination of the mechanism of injury, location, size, and composition of IOFB. Endophthalmitis, retinal detachment, and development of PVR are potentially vision-threatment. Abstract: Most IOFB are metallic and found in males of productive age as a consequence of work-related accidents. A 45-year-old man complained of sudden blurred vision in the left eye (3/60 pinhole 5/12) after getting hit by a foreign body when cutting grass with a lawn mower. Anterior segment examination revealed a 10 mm long, one-plane, straight, full thickness, already sutured inferonasal corneal laceration, inferonasal traumatic iridectomy size 3x7 mm, and opaque lens. Head CT-scan revealed opacity with metallic density intraocularly. Ultrasonography revealed an echogenic lesion, particle-shaped with 100% RCS complex density, located at the inferonasal of the vitreous cavity. Focal laser photocoagulation was performed preoperatively because there was a tear at the superonasal of the retina. The patient underwent cataract extraction, intraocular lens implantation, vitrectomy, and IOFB extraction in a one-step procedure. IOFB was found at the inferonasal side of a vitreous cavity with size 3 x 1 mm, metallic, and not attached to the retina. Silicon oil tamponade was used as a precaution because there were retinal tears. Postoperatively, the left eye's visualacuity was 5/20. After 6 months, the silicon oil was evacuated and the visual acuity became 5/8.5.

Exploring Minimum Secondary Injury for the Treatment of Ocular Trauma With Giant Intraocular Foreign Bodies.

PurposeTo investigate the clinical therapy for giant intraocular foreign bodies (IOFBs) and evaluate the best treatment method with minimum secondary injury.MethodsWe retrospectively analyzed the data of 73 eyes of 73 patients with ocular trauma caused by giant IOFBs between January 2016 and December 2018. The IOFB size, localization, shape, and magnetic properties were recorded. The best corrected visual acuity (BCVA), ocular tissue injuries, entrance wound, interval time from injury to second phase surgery, silicone oil removal, and globe recovery were also observed. The cases were divided into three groups based on the following IOFB extraction paths: limbus path, the pars plana path, and the entrance wound path. The BCVA, IOFB size and shape, the wound, endophthalmitis, and silicone oil removal were compared among the three groups.ResultsThe IOFBs were 46 cases of magnetic and 27 cases of nonmagnetic, with a shape of thin flat in 19 cases, thick flat in 12 cases, long in seven cases, and irregular in 35 cases. Multiple damages were caused by the giant IOFBs, mainly involving the severe cornea, lens, and retina injuries. The postoperative BCVA increased compared with the preoperative BCVA (z = −6.06, P < 0.01). The rate of recovery from blindness was 40.85% (29/71). The thin flat IOFB and long IOFB resulted in a better postoperative BCVA than the other two IOFB shapes (all P < 0.05). The irregular IOFB had a poorer silicone oil removal rate than the other three IOFB shapes (all P < 0.05). The IOFB extraction followed the limbus path in 18 cases, pars plana path in 27 cases, and entrance wound path in 28 cases. The IOFB length and width in the pars plana path group were significantly lower than that in the limbus path group (all P < 0.05), the preoperative BCVA of the pars plana path group was superior to that of the limbus path group (P < 0.05), and the IOFB length, width, and entrance wound length in the pars plana path group were significantly lower than in the entrance wound path group (all P < 0.05). But the postoperative BCVA in the pars plana path group was not better than that in the other two groups (all P > 0.05). The postoperative BCVA of the entrance wound path group was significantly superior to that of the limbus path group (z = −2.01, P = 0.04), while there was no difference between the two groups in IOFB length, width, entrance wound length, or preoperative BCVA (all P > 0.05).ConclusionThe entrance wound path would benefit to minimize secondary injury in giant IOFB extraction procedure, compared with the limbus and pars plana path.

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

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. 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. 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). 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.

Value of Ocular Endoscopy in Extraction of Intraocular Foreign Bodies of Cilia in Patients with Open Ocular Trauma.

BackgroundThe aim of this study was to analyze the value of ocular endoscopy in detecting and extracting intraocular cilia in patients with ocular trauma.Material/MethodsWe retrospectively analyzed data on identification and extraction of 46 intraocular cilia in 16 eyes with open-globe injury during endoscope-assisted vitrectomy.ResultsA total of the 16 patients with open-globe injury were operated on from September 2002 to June 2019. The cornea in 14 eyes was cloudy. Two eyes had endophthalmitis and 13 eyes had retinal detachment. A total of 46 cilia were extracted through direct observation under the ocular endoscope during vitrectomy 1 to 68 weeks after injury. The number of cilia per eye varied from 1 to 10. Most of the cilia were located in or near the wound. Postoperative IOP was normal in 14 patients. The follow-up after surgery showed hypotony in only 2 eyes (7.2 and 5.8 mmHg, respectively). Compared with preoperative intraocular pressure, there was a statistically significant difference. The postoperative visual acuity improved in 12 eyes and remained unchanged in 3 eyes. The vision after surgery was significantly improved compared with that before surgery (P=0.006). The intraocular pressure increased significantly after operation (P<0.001). And no glaucoma or retinal detachment or endophthalmitis was found. No eyes needed additional vitreous surgery.ConclusionsOcular endoscopy allows surgeons to detect intraocular cilia that were no undetected by CT or B-ultrasound preoperatively in time and to extract them effectively. It improves performance of vitrectomy in the presence of a cloudy cornea and also prevents exogenous endophthalmitis. The vision of patients with ocular trauma was improved.

Отдаленные результаты отсроченного удаления внутриглазного инородного тела при открытой травме глазного яблока с поражением заднего сегмента

Purpose. To study the clinical efficacy of the long-term results of a step-by-step method of surgical treatment of open eye trauma complicated by the presence of the intraocular foreign body (IFB) in the posterior segment, including primary surgical treatment (PST) and delayed vitreoretinal surgery with IFB extraction within 24 hours after PST. Material and methods. The clinical efficacy of delayed IFB removal within 2 years was studied in 32 eyes with open trauma of the eyeball complicated by the presence of IFB in the posterior segment. Concomitant traumatic complications included partial hemophthalmos (84.4%) and rhegmatogenous retinal detachment (RD) (59.4%). Results. By the end of 2 years of follow-up, the anatomical effect was observed in all examined 21 eyes, including 15 eyes (71.4%) with hemophthalmos and 13 eyes (61.9%) with traumatic retinal detachment. In this case, recurrence of RD occurred in 7 eyes, post-traumatic traction RD- in 3 eyes. Functional effect with improved visual acuity was in 12 eyes (57.1%). At the same time, the MCVA was 0.3±0.05 (0.15–0.5). Conclusion. The presented method made it possible to achieve a stable anatomical effect and stable functional results, even in the presence of severe trauma complicated by total hemophthalmos and retinal detachment, in the long term. Key words: open eyeball injury, intraocular foreign body, primary surgical treatment, transvitreal intraocular foreign body extraction, post-traumatic traction retinal detachment.

Perfluorocarbon liquid-assisted intraocular foreign body removal

Traumatic ocular injury is an uncommon yet leading cause of monocular blindness among the working-age group. Retained intraocular foreign body (IOFB) are associated with 41% of open globe injuries. Pars plana vitrectomy is often required for posterior segment IOFB removal. Advances in vitreoretinal surgical techniques and instrumentation have resulted in better treatment outcomes with reduced ocular morbidity. We report a case of modified ILM forceps with perfluorocarbon liquid-assisted non-magnetic IOFB removal in a young man after a motor vehicle accident with zone one open globe injury and a large glass IOFB in the right eye. We describe the use of perfluoro-N-octane to slide the IOFB extramacularly and reorient the IOFB plane for stable and safe retrieval by ILM end-gripping forceps. The modified design of the ILM end-gripping forceps with adjunctive use of perfluorocarbon liquid in pars plana vitrectomy reduces slippage during IOFB extraction and prevents collateral iatrogenic retinal injury.

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

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

Party Poppers and Balloons: Fun and Games or Lives and Limbs?

Abstract&#x0D; We report two cases of ocular trauma caused by recently popular party poppers and LED balloons, commonly used in parties nowadays. One case depicted a closed globe injury as a result of a party popper spray over the eye. The pressure of the spray resulted in a blunt trauma causing full thickness macular hole which was later treated with Pars Plana Vitrectomy (PPV) surgery. The second case is an example of an open globe injury caused by the bursting of LED balloon over the eye of a young child resulting in corneal perforation, traumatic cataract, vitreous hemorrhage with an intraocular foreign body (IOFB). It was successfully treated with corneal suturing, lens extraction, PPV surgery and removal of IOFB followed by a secondary lens implantation. Both of the sustained injuries were completely avoidable hence emphasizing the requirement of eye safety awareness programs and diligence in the use of these gadgets in everyday lives.

线套法联合玻切术取出眼内巨大异物1例

线套法联合玻切术取出眼内巨大异物1例

Comparison of the efficacy of two methods to extract intraocular magnetic foreign bodies

Objective To compare the efficacy of two different methods of intraocular magnetic foreign body extraction. Methods From Jan.2016 to Dec.2017, the data of 165 cases who received intraocular magnetic foreign bodies extraction in our hospital were analyzed retrospectively. All cases were randomly divided into two groups. Group A, 89 cases, received extraction of magnetic foreign bodies through the original wound, and group B, 76 cases, received extraction of intraocular magnetic foreign bodies through the vitreous. Postoperative the follow-up time was 12-15 months. Results The visual acuity of group A improved in 64 eyes (71.91%), remained unchanged in 6 eyes(6.74%). Visual acuity was improved in 66 eyes (86.89%) of group B, unchanged in 7 eyes(9.21%). The difference in visual acuity improvement rate was not statistically significant between the two groups (χ2=0.055, P=0.801). The rates of complication of the two groups were similar. Conclusion The efficacies of two methods of extraction of intraocular magnetic foreign bodies are similar. Key words: Foreign body, intraocular, magnetic; Extraction, magnetic attration, original wound; Extraction, through the vitreous

Vitrectomy combined with extraction of large intraocular foreign body through corneal limbus incision

Objective To observe 23-gauge vitrectomy combined with extraction of large intraocular foreign body (IOFB) through corneal limbus incision. Methods The data of 10 eyes of 10 patients of large IOFB with injury of lens who underwent 23-gauge vitrectomy between Jan. 2017 and Jun. 2018 were retrospectively analyzed. Results IOFB of all eyes were extracted in once operation. The follow-up time was 6-12 months. The BCVA after surgery in all patients improved significantly(χ2=5.495, P=0.019). There was no other intraoperative or postoperative complication. Conclusion Conclusion 23-gauge vitrectomy combined with extraction of larger IOFB through corneal limbus incision is effective. Key words: Foreign body, intraocular; Limbus corneal; Vitrectomy, 23-gauge

Review of extraction of intraocular foreign bodies in posterior segment

It is controversial that the surgical time of extraction of introcular foreign bodies in posterior segment.In general, according to the operative conditions and the specific condition of oneself, it’s necessary to extract the foreign bodies as soon as possible.Pars plana vitrectomy(PPV) combined with extraction of intraocular foreign bodies is the major surgical approach.Endoscope-assisted PPV is used to extract the foreign bodies in the cases with corneal edema.The larger foreign body may cause endophthalmitis and retinal detachment with poor prognosis. Key words: Extraction, intraocular foreign bodies, posterior segment; Pars plana vitrectomy; Endoscope; Review

Analysis on the efficacy of different operation methods of intraocular foreign bodies extraction

Objective To analyze the efficacy of different surgical treatments of intraocular foreign bodies extraction. Methods The clinical data of 69 eyes of 69 cases with intraocular foreign bodies from Jan.2011 to Dec.2015 were collected. The different operative methods and the efficacy were analyzed retrospectively. Results The intraocular foreign bodies were extracted successfully by vitrectomy combined surgery and external route magnetic extraction in the stage of phaseⅠ. The intraocular foreign bodies were extracted at the stage phase Ⅱ in 32 eyes. After surgery, the visual acuity reached counting figure -1.0 in 58 eyes (84.06%). Conclusion Severe intraocular foreign bodies should be extracted actively as soon as possible. The appropriate operation method is choosed, according to analyze the position of intraocular foreign bodies and the complications. Key words: Intraocular foreign bodies; Vitrectomy; Magnetic extraction

The application efficacy of filtered air as the tamponade in the extraction of intraocular foreign bodies

Objective To evaluate the application efficacy of filtered air as the tamponade in the exatraction of posterior intraocular foreign bodies. Methods It was a prospective, nonrandom and consecutive cases study. Seventeen eyes of 17 patients with posterior segment intraocular foreign bodies received vitrectomy combined with extraction of intraocular foreign bodies from Oct. 2016 to Apr. 2017. All cases were applied with filtered air or silicone oil according to the illness. The efficacy of two surgeries were compared. Results The foreign bodies of all cases were extracted in the first surgery. The filtered air was filled in 7 eyes and silicone oil tamponade in 10 eyes. The follow-up time was at least 2 months. The retinal detachment, vitreous hemorrhage and endophthalmitis weren’t found in cases with filtered air tamponade. The retinal detachment due to proliferative vitroretinopathy occurred in 2 eyes with silicone oil tamponade. Conclusion In cases of posterior segment intraocular foreign bodies patients with small retinal holes and no retinal detachment , filtered air as tamponade maybe effective and safe. Key words: Foreign bodies, intraocular, posterior segment; Tamponade, intravitreal, filtered air; Vitrectomy, 23 gauge

First identification of Gordonia sputi in a post-traumatic endophthalmitis patient \u2013 a case report and literatures review

BackgroundWe present a case of post-traumatic endophthalmitis with relatively good prognosis caused by Gordonia sputi, which, to our knowledge is the first case in the literature.Case presentationA 24 year old man, who underwent an intraocular foreign body extraction half a month before presentation in the left eye, was referred to us complaining of blurred vision and slight pain for 5 days. His first presentation showed moderate intracameral and intravitreous purulent inflammation with a best corrected vision of counting fingers. After gram staining of the intravitreous samples revealed a gram-positive bacilli infection, a combination of amikacin and vancomycin was initially injected intravitreously. The left eye kept stable for three days but deteriorated on the 4th day. On the 5th day after presentation conventional culture characterized the bacterium as an Actinomyces sp. while 16S ribosomal RNA gene sequencing confirmed it as Gordonia sputi. Thereby a complete pars plana vitrectomy combined with lensectomy and silicone oil tamponade was performed. During the surgery an intraocular irrigation with penicillin G was adopted, followed by administration of intravenous penicillin G twice one day for a week. A relatively normal fundus with slight intracameral inflammation was observed a week after the operation, and the best corrected vision recovered to 0.15. One year later his vision remained 0.1.ConclusionGordonia sputi should be taken into consideration in patients with post-traumatic endophthalmitis especially due to foreign body penetration. Compared to conventional laboratories, molecular methods are recommended for an accurate diagnosis. A comprehensive strategy of antimicrobial agents and vitrectomy may render a satisfactory result.

Minimally Invasive Surgery for the Removal of Posterior Intraocular Foreign Bodies.

This is a prospective clinical assay that included six patients who were diagnosed with penetrating corneal injury, traumatic cataract, and posterior segment intraocular foreign body (IOFB). Following anterior segment repair and extraction of traumatic cataract by clear cornea phacoemulsification, a standard 25-gauge transconjunctival pars plana vitrectomy was performed to find and release the IOFB. With active suction using a 25-gauge silicone tipped cannula, the foreign body was retrieved and safely placed in the anterior chamber. After stabilization of the anterior chamber with viscoelastic injection, IOFB extraction through the main phaco incision was easily performed, followed by placement of an intraocular lens. Of the six patients, 66.6% showed a significant improvement of visual acuity. No complications associated directly with the surgical procedure occurred. Our surgical technique is a safe alternative for handling and removing a posterior IOFB. There was no need for a scleral incision.

Effect of the time of the intraocular foreign body extraction on the occurrence of endophthalmitis

Objective To investigate the effect of the time of the intraocular foreign body(IOFB) extraction on the occurrence of endophthalmitis. Methods The medical records of 370 eyes of 370 patients with IOFB treated in the Second Hospital of Jilin University from Jan.2009 to Aug. 2014 were reviewed. The incidence rate of endophthalmitis was calculated on the time of the IOFB extraction, using the χ2 test to identify the relationship between each group. Results The endophthalmitis incidence was 14.75%. The incidence of endophthalmitis in the group IOFB extraction less than 24 hours was 10.45%, and the incidence in the group IOFB extraction more than 24 hours was 19.77%.The incidence in ≤24 hours group had significant difference compared with that in more than 24 hours group (χ2=6.404, P=0.011). The incidence of endophthalmitis in the group IOFB extraction in 2 days-2 weeks was significantly lower than that in the group IOFB extraction in 3 weeks-3 months (χ2=4.446, P=0.035). Conclusion The incidence of endophthalmitis in the group IOFB extraction≤24 hours is lower than that in the group IOFB extraction>24 hours. When the IOFB can’t be extracted in less than 24 hours, the extraction in 2 days-2 weeks can also reduce the risk of endophthalmitis after the repair of the wound and use of antibiotics. Key words: Extraction of intraocular foreign body; Time of extraction; Endophthalmitis

Risk factors and prevention countermeasures of postoperative infection after intraocular foreign body extraction

Objective To investigate postoperative infection risk factors after intraocular foreign body extraction and to discus its countermeasures of prevention. Methods Totally 246 eyes of 246 cases who underwent intraocular foreign body removal surgery were reviewed retrospectively, which were in patient department cases from June 2012 to May 2014. The risk factors and preventive measures of postoperative infection were analyzed. Results Postoperative infection occurred in 2 cases of 246 cases(246 eyes). Conclusion The risk factors of postoperative infection included unenough hand disinfection of surgeon staffs, unstandardized aseptic technique, unstrictly access limitation to operating room, diagnosis, untimely surgery, underlying disease and the decreased patient's body resistance. The early diagnosis, accurate location of foreign body, early operation, strict surgical environment, and aseptic manipulation are the effective ways to prevent postoperative infection in patients with intraocular foreign body. Key words: Extraction, intraocular foreign body; Infection; Factors, risk; Countermeasures, prevention