Intraocular Foreign Body Removal Research Articles

Avoid delaying vitrectomy by foregoing diagnostic testing if the intraocular foreign body is visible and endophthalmitis is incipient.

Intraocular foreign bodies (IOFBs) are known to cause endophthalmitis at a high rate. Media opacity (corneal edema, cataract, vitreous hemorrhage) and the need for diagnostic testing often prevent timely recognition of an infection; the resulting treatment delay worsens the prognosis. We present a case in which direct visualization of a posterior-segment IOFB and the incipient endophthalmitis allowed foregoing further testing (computed tomography), shortening the time to sight-saving vitrectomy. A 16-year-old male presented 19 h after a hammering-related injury. The media remained clear, permitting recognition of a large area of purulent retinal infiltrate adjacent to the intravitreal IOFB. Within one hour the patient underwent comprehensive surgery (wound closure, vitrectomy, IOFB removal, and intravitreal antibiotic injection). The development of full-blown endophthalmitis was prevented, even though the vitreous culture yielded Staphylococcus epidermidis. Final visual acuity at one year was 20/30, with the retinal injury approaching to within 1 mm of the fovea. In opaque-media eyes with a suspected IOFB treatment delay is common, due to waiting for computed tomography (CT) - instead of ultrasonography, which can safely identify the IOFB in over 90% of cases. Expediting surgery is the best prophylaxis against post-presentation endophthalmitis. Our case highlights the benefits of early vitrectomy based on direct inspection of the IOFB alone; instant ultrasonography instead of a CT-caused delay may save eyes with infection developing behind media opacity.

Use of Cohesive Viscoelastic Agents to Facilitate Safe Removal of Posterior Segment Intraocular Foreign Bodies.

Purpose: To assess the ability of viscoelastic agents and perfluoro-N-octane (PFO) to safely remove an intraocular foreign body (IOFB). Methods: A 23-gauge pars plana vitrectomy and lensectomy were performed in a porcine eye. A 5.0 mm metallic IOFB was inserted through a corneal paracentesis and dropped into the vitreous cavity. The posterior segment was filled completely with a balanced salt solution, cohesive viscoelastic, or dispersive viscoelastic or partially filled with PFO under a balanced salt solution. The IOFB was then brought anteriorly and released. Each test was repeated multiple times and videorecorded. Results: The IOFB fell with high velocity through the balanced salt solution-filled vitreous cavity. When the eye was filled with either of the 2 viscoelastic agents, the IOFB did not move or moved posteriorly extremely slowly. A vitreous cavity filled partially with PFO led to deflection of the object's path, with the peripheral retina being struck, or the IOFB dropping straight down and striking the macula. PFO and the cohesive viscoelastic were easily removed from the eye with the vitrectomy instrument. The dispersive viscoelastic could not be completely removed and repeatedly clogged the vitreous cutter. Conclusions: Filling the posterior segment with a cohesive viscoelastic agent may significantly increase the safety and ease of IOFB removal.

Predictive Factors for Structural and Functional Outcomes of 25-Gauge Pars Plana Vitrectomy (PPV) for the Removal of Posterior Intraocular Foreign Bodies (IOFBs): A Retrospective Data Analysis From North India.

To identify predictive factors for structural and functional outcomes of 25-gauge pars plana vitrectomy (25G PPV) for removal of posterior segment intra-ocular foreign body (IOFB). A retrospective data analysis was performed for patients undergoing 25G PPV for removal of posterior segment IOFB between August 2019 to June 2021. Necessary demographic details and data regarding pre-operative ophthalmic examination were recorded. Similarly, intraoperative surgical details were recorded.Postoperative outcome measures included final best corrected visual acuity (BCVA), retinal status, and epiretinal membrane formation at the last follow-up visit. A univariate analysis was applied to find the association of various independent variables with functional and structural outcomes. Thirty-nine patients were included in the study, with 37 males and two females. The mean age of the study group was 30.5+10.8 years. The most common zone of open globe injury was zone 1. Most of the impactions of IOFB were seen outside the macular area. Preoperative BCVA was 2.23+0.58 logarithm of the Minimum Angle of Resolution (logMAR), which improved significantly to 1.01+0.53 in the postoperative period (p-value <0.001). Anatomical success was achieved in 92.3% of patients at one year follow-up. The presence of impacted IOFB, associated endophthalmitis and IOFB >4mm were associated with poor visual outcomes (univariate analysis; p-value <0.05). None of the factors affected the anatomical success rates. The presence of impacted IOFB, associated endophthalmitis, and large IOFB (>4mm) were associated with poor visual outcomes with 25G PPV for removal of IOFB.

Advances in the management of intraocular foreign bodies.

Intraocular foreign bodies (IOFBs) remain a severe complication of ocular trauma commonly encountered worldwide. This literature review aimed to discuss current practice patterns, areas of controversy, and advances in the management of IOFBs. Injuries involving IOFBs carry significant ocular morbidity and management can be extremely challenging. A systematic approach to preoperative evaluation and IOFB surgical management is detailed in this article and should be applied in each case. The location and composition of an IOFB have important implications on surgical approach and timing, especially in cases of toxic metals and vegetable matter. The advantages, disadvantages, and previous literature regarding immediate versus delayed foreign body removal are presented. Surgical approaches are described, with an emphasis on posterior chamber IOFB management and removal via pars plana vitrectomy. Final visual acuity is variable, but approaches have been used to prognosticate outcomes including the Ocular Trauma Score. By synthesizing current IOFB literature, the goal is to provide practitioners with guidance that will maximize the chances of surgical success and patient outcomes.

Demystifying the role of magnetic resonance in identifying intraocular foreign bodies: a case of ocular siderosis

BackgroundOcular siderosis (OS) is a significant cause of visual loss due to retained ferrous intraocular foreign bodies (IOFB). Despite its rarity, OS can lead to severe visual impairment if not promptly diagnosed and treated. This case is notable due to the occult nature of the IOFB, which was undetected by standard imaging modalities, emphasizing the critical role of magnetic resonance imaging (MRI) in such scenarios.Case presentationA 51-year-old Caucasian male presented with progressive vision loss in his right eye over 20 days. Best corrected visual acuity (BCVA) was 20/1000 in the right eye and 20/20 in the left eye. Intraocular pressure (IOP) was 9 mmHg in both eyes. Slit-lamp examination revealed a small linear corneal wound and an iris defect in the right eye, along with a cataract featuring brownish deposits on the anterior capsule. The left eye was normal. Fundus examination of the right eye was hindered by media opacities. Ultrasonography showed a flat retina and choroid with no detectable IOFB. Despite a strong clinical suspicion of OS, computed tomography (CT) did not detect any IOFB. MRI subsequently identified an artifact in the inferior sectors of the right eye, indicative of a metallic IOFB. Surgical intervention involved a 23-gauge vitrectomy, phacoemulsification, IOFB removal and silicon oil (SO) tamponade resulting in a fully restored VA of 20/20 and normal IOP one month post-operation. SO was removed 2 months later. The retina remained adherent with no PVR development, and optical coherence tomography (OCT) scans showed a normal macula.ConclusionsThis case underscores the importance of considering OS in patients with unexplained vision loss and history of ocular trauma, even when initial imaging fails to detect an IOFB. MRI proved crucial in identifying the IOFB, highlighting its value in the diagnostic process. Early detection and surgical removal of IOFBs are essential to prevent irreversible visual damage. This case demonstrates that MRI should be employed when CT and ultrasonography are inconclusive, ensuring accurate diagnosis and timely intervention to preserve vision.

Surgical techniques for optimal lens management of posterior segment metallic intraocular foreign body removal: a case series.

We describe three different approaches for lens management in cases of metallic IOFBs involving the posterior segment. All consecutive posterior segment metallic IOFB cases from 2012 to 2023 at a single institution were included in this retrospective case series. Surgical outcomes and surgical videos are presented. A total of 25 metallic IOFB cases were included. In 9 cases, there was no significant lens involvement, therefore not requiring lens extraction at the time of IOFB removal. In 8 cases with traumatic cataract, lens extraction sparing the anterior lens capsule was performed with IOFB removal. In 8 cases, both lens extraction and lens capsule removal were required at the time of IOFB removal. We demonstrate our algorithm to capsular management in patients who present with IOFB with good visual outcomes in follow-up.

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.

Magnetized forceps for intraocular foreign body removal: which one is suitable?

Magnetic intraocular foreign bodies can be removed with magnetized disposable forceps. Aim of this study is to compare the forceps magnetizability of different size, form and manufacturer. The forceps were magnetized using an established procedure. The inducible magnetic flux density was measured at the tip of the forceps. The mass that can be lifted with the magnetized forceps was then tested using steel balls in BSS solution. The weight of the metal parts of the forceps was measured. The magnetic flux density that could be induced, the weight of the steel balls that could be lifted and the mass of stainless steel used in the forceps were as follows: Alcon end-grasping 23G: 7.12 mT, 87.43mg, 1191mg; Alcon end-grasping 25G: 6.43 mT, 87.43mg, 1189mg; Alcon serrated: 4.39 mT, 63.78mg, 1284mg; Alcon serrated 23G: 3.62 mT, 13.74mg, 1200mg; Alcon serrated 25G: 2.4 mT, 13.74mg, 1195mg; DORC end-grasping 23G: 5.52 mT, 32.54mg, 153mg; Synergetics end-grasping 23G: 4.35 mT, 16.37mg, 193mg; Vitreq BV end-grasping 23G: 2.65 mT, none, 88mg. The magnetizability of a disposable microforceps seems to depend on the mass of steel at the tip of the forceps. The structure of the iron lattice could have an even greater influence. Not every disposable forceps can be sufficiently magnetized for this technique.

Letter to the editor on 'Combined Phacovitrectomy with Metallic Intraocular Foreign Body Removal through Corneal Incision Using A Novel "Magnetic Conduction" Technique'.

Letter to the editor on 'Combined Phacovitrectomy with Metallic Intraocular Foreign Body Removal through Corneal Incision Using A Novel "Magnetic Conduction" Technique'.

Microsurgical Vitrectomy with Pars Plana Incision for the Removal of Posterior Segment Intraocular Foreign Bodies.

This study describes a pars plana incision surgical technique combined with 23 or 25-gauge vitrectomy in the management of intraocular foreign bodies (IOFBs) and to assess its anatomical and functional results. Sixteen patients with ocular trauma complicated with IOFB were enrolled in our study. The mean preoperative visual acuity was 2.01 ± 0.55 LogMAR, and the mean postoperative visual acuity at the final visit was improved to 0.91 ± 0.58 LogMAR (p < 0.001). Until the last follow-up, all IOFBs were successfully removed and anatomic success was obtained. Complications, such as endophthalmitis, silicone oil-dependent, and ocular hypotonia, were not observed. Microsurgical vitrectomy with modified pars plana incision is a safe and effective procedure in the treatment of retained IOFB, especially associated with transparent lens and posterior segment injury.

A Modification of the Intraocular Lens Blocking Technique Without Posterior Capsulorhexis for Intraocular Foreign Body Removal.

The intraocular lens blocking technique described for the removal of intraocular foreign bodies emerged as a result of an effort to prevent the foreign body from being retracted into the posterior segment because of the resistance encountered while removing it from the corneal incision. However, in the technique described, in addition to the difficulty of the surgical procedure, the new concern is to create a posterior capsulorhexis according to the size of the foreign body and to pass the foreign body through the capsulorhexis. Here, the authors describe a new approach to the intraocular lens blocking technique. In this approach, the intraocular foreign body, which is held with intraocular forceps without any opening in the posterior capsule, is held in a perpendicular position to the long axis, lifted directly into the anterior chamber, and safely removed from the front of the monoblock foldable intraocular lens. In all patients treated with this approach, IOFBs were successfully removed without intraoperative or postoperative complications, and postoperative intraocular lens centralization was achieved in all patients. This approach may provide practicality to the intraocular lens blocking technique.

Subconjunctival deferoxamine for corneal rust deposits associated with ocular siderosis: A case report

Introduction: Ocular siderosis is a vision-threatening condition resulting from intraocular iron toxicity. This case re-establishes a role for subconjunctival deferoxamine, a chelating agent uncommonly used in ophthalmology, as an adjunctive treatment for ocular siderosis. Case Report: A 37-year-old healthy male presented two months after an injury at work with intermittent pain and blurry vision in the right eye. Presenting visual acuity (VA) was 20/100 in the right eye. With delayed presentation, the patient already had ocular siderosis with corneal rust deposits and retinal damage. The patient underwent pars plana vitrectomy (PPV) with surgical view impaired by corneal deposits and intraocular metallic intraocular foreign body (IOFB) that disintegrated upon attempted removal. At six months postoperatively, VA was 20/70 in the right eye, and examination revealed worsened diffuse, pigmented subepithelial deposits in the central cornea, iris atrophy, cotton wool spots, optic nerve pallor, and a residual IOFB in the anterior vitreous, consistent with worsened ocular siderosis. Superficial keratectomy was performed in combination with repeat PPV to improve surgical visualization and aid in IOFB removal. An amniotic membrane was placed and a subconjunctival injection of deferoxamine was administered. The cornea was well-healed with significantly improved siderosis and no epithelial defects on 2-week postoperative follow-up. Visual acuity was 20/60 at last follow-up two months postoperatively after second surgery. Conclusion: In treating ocular siderosis, subconjunctival injection of deferoxamine can be a useful addition to surgical IOFB removal to prevent the accumulation of iron deposits in the anterior segment of the eye.

Ultrasound Biomicroscopy and echogenic external marker assisted Intraocular Foreign Body Removal.

We report a novel method of intra-operative localization of a retained anterior intraocular foreign body (IOFB), using a combination of ultrasound biomicrosopy (UBM) and an insulated needle. A retrospective case report of 56-year-old male who presented with a right eye IOFB. On presentation, vision was decreased in the right eye to count fingers with a small subconjunctival hemorrhage but no other signs of a penetrating laceration. Orbital CT revealed an IOFB and the initial vitrectomy failed to retrieve the IOFB. Then during the subsequent vitrectomy, using an ultrasound compatible needle and a UBM, we were able to precisely locate and remove the small anterior IOFB. Retained IOFBs can lead to severe irreversible vision loss if not promptly removed. Ancillary imaging modalities and localization techniques can help locate occult IOFBs in difficult cases.

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Purpose. To evaluate efficiency and safety of transvitreal removal of intraocular foreign bodies (IOFB) when performing vitrectomy after penetrating eye injuries. Material and methods. 12 patients (12 eyes) with penetrating ocular trauma with IOFB were included in this study. In 2 eyes, IOFB was removed in our clinic on the same day during an emergency surgical treatment, immediately upon admission of patients: in 10 eyes – delayed. At the time of admission to the Khabarovsk branch of the S. Fyodorov Eye Microsurgery Federal State Institution, we registered low visual acuity or blindness in all 12 eyes: in 8 eyes – from 0.001 to 0.4; in 4 eyes – from LP to NLP. A standard three-port 25-gauge vitrectomy was performed in all patients, during which IOFB was localized. Results. In all eyes IOFB was correctly removed; in 3 eyes with retinal detachment, it was possible to achieve its total reattachment. In 7 eyes, IOFB removal was performed using intraocular forceps: 5 eyes – through the corneal tunnel – the pupillary zone – posterior capsulorhexis at the stage of phacoaspiration, 2 eyes – through the port; in 3 eyes – with the help of a vitreotom; in one eye – with the help of an magnet through the pupillary zone before implantation of the IOL RSP-3 (Russia), and in one eye – with the help of scleral forceps. Conclusion. The IOFB entry wound in 12 eyes were: corneal – 5 eyes, scleral – 5 eyes, corneoscleral – 2 eyes. In 11 eyes IOFB were metallic (9 magnetic and 2 non-magnetic), in 1 eye – non-metallic. The volume and tactics of vitreoretinal surgery in each case of IOFB removal was determined by the initial severity of eye injuries, size, and location of the IOFB, the degree of secondary trauma to the intraocular structures after their removal during the primary wound repair. Key words: ocular trauma, intraocular foreign body, penetrating eye injury, vitrectomy

Improved intraocular foreign body localization using orbital computed tomography data

Background: Detection and localization of an intraocular foreign body (IOFB) are essential for assessing the severity of injury and selecting an appropriate method for IOFB removal. Purpose: To improve the method of IOFB localization through the use of the Komberg-Baltin prosthesis while performing orbital computed tomography (CT) scans. Material and Methods: We reviewed the medical records of 6 patients with a penetrating corneal and/or scleral injury and an IOFB in the posterior segment. Patients had ultrasonography of the ocular anterior and posterior segments and Komberg-Baltin prosthesis-assisted CT of the orbit as per our method reported previously to verify the location of the IOFB. Orbital radiography was performed at the point of care. The results of radiography, ultrasonography and CT for each case were reviewed and compared. The final verification of IOFB location was performed preoperatively during a standard three-port 25-G pars plana vitrectomy with IOFB removal. Results: In 3 cases, intraoperative visualization during vitrectomy confirmed the results of preoperative IOFB imaging (radiography, ultrasonography and orbital CT). In these cases, an IOFB was a metallic fragment measuring 0.9 to 2.5 mm. In one case, a metallic IOFB was found by ultrasonography, but not by radiography. CT, when performed by our method, found an IOFB measuring 0.2 x 0.3 mm preretinally. In a patient with an IOFB (a wire measuring 10.0 x 1.0 mm, at 20 mm from the anatomical axis, and 9-11.5 mm from the limbal plane) and local retinal detachment, there was a discrepance between the foreign body location indentified by radiography and that identified by CT with the use of the Komberg-Baltin prosthesis. Large differences in the distance between the IOFB and the limbal plane and between the IOFB and the anatomical axis (4 mm and 5 mm, respectively) were caused by the mobility of the foreign body located beneath the retina. Conclusion: Localizing an IOFB using Komberg-Baltin prosthesis-assisted CT is advantageous to radiography due to an opportunity for accurate localization of a mobile IOFB with a patient in the position as similar as possible to his position during IOFB removal surgery (i.e., the supine position).

Combined Phacovitrectomy with Metallic Intraocular Foreign Body Removal through Corneal Incision Using A Novel "Magnetic Conduction" Technique.

To describe a "magnetic conduction" technique for the removal of metallic intraocular foreign bodies (IOFBs) in the posterior segment combined with cataract extraction and pars plana vitrectomy and to report its outcomes. We retrospectively analyzed the data of 42 eyes of 42 patients with posterior metallic IOFBs between April 2020 and February 2022. In all patients, cataract extraction was combined with pars plana vitrectomy. With an external magnet, the IOFBs were captured by a magnetized vitrectomy cutter, delivered to the anterior chamber, and then extracted through a corneal phacoemulsification incision. All patients were men, with a mean age of 45.6 ± 10.7 years. The mean size of the IOFBs was 3.5 ± 1.7 mm (range, 1.5-8.9 mm) in their longest dimension. A final best-corrected visual acuity of 20/200 or better was noted in 24 of 42 patients (57.1%). Postoperatively, recurrent retinal detachment was seen in three eyes. There were no other intraoperative or postoperative complications. The "magnetic conduction" technique combined with phacovitrectomy is a safe and feasible approach to removing IOFBs in the posterior segment.

Double Reverse Overlapping Scleral Trapdoor (DROST) Technique for the Removal of Juxtalenticular Intraocular Foreign Body.

We describe the double reverse overlapping scleral trapdoor (DROST) technique, a novel minimally invasive technique for the removal of very anterior intraocular foreign bodies without the need of pars plana vitrectomy. [Ophthalmic Surg Lasers Imaging Retina 2023;54:600-602.].

Removal of Intraocular Foreign Bodies Using a Modified Flute Needle

Purpose: To describe the construction of a novel intraocular snare and evaluate its effectiveness in intraocular foreign body (IOFB) removal. Method: This is a retrospective consecutive case series. Five patients underwent pars plana vitrectomy and IOFB removal using the intraocular snare constructed from modified flute needle. Results: All IOFBs were successfully engaged and removed with the snare on the first attempt. Three of the 5 cases (60%) enjoyed good visual outcome (0.4–1.0) postoperatively. No complication related to the use of the snare was encountered in this case series. Conclusion: Intraocular foreign body snare is simple, safe, and effective in IOFB removal.

NOVEL TECHNIQUE FOR INTRAOCULAR FOREIGN BODY REMOVAL: Magnetized Disposable Microforceps. A Systematic Approach and First Clinical Result.

To verify whether disposable microforceps can be magnetized to atraumatically attract and then grasp intraocular foreign bodies. An effective magnetization protocol was developed. The clinical relevance was tested, and a first practical application was performed. The magnetic flux density (MFD) of a bar magnet and an electromagnet was measured. Steel screws were used to determine the magnetization protocol. Disposable microforceps was magnetized, MFD generated at the tip was measured, and the weight that can be lifted was tested. Foreign body removal with such forceps was performed. The electromagnet MFD was much higher than the bar magnet. The most effective magnetization protocol was to pass the screw from the end along the shaft and back over the electromagnet. Magnetized microforceps had a 7.12 mT change in MFD at the tip. Steel balls up to 87 mg could be lifted in buffered saline solution. In clinical use, the intraocular foreign body could be attracted and grasped safely. Disposable microforceps can be easily and inexpensively magnetized. The achievable MFD is clinically relevant to attract typical intraocular foreign bodies. An electromagnet is best suited for this purpose. With such prepared forceps, foreign bodies can be attracted atraumatically and grasped securely.

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.