Intraocular Foreign Body Removal Research Articles

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 (IOL) blocking technique described for the removal of intraocular foreign bodies (IOFB) emerged as a result of an effort to prevent the foreign body from being retracted into the posterior segment due to 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 we describe a new approach to the IOL blocking technique. In this approach, the IOFB, 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 IOL. In all patients treated with this approach, IOFBs were successfully removed without intraoperative or postoperative complications, and postoperative IOL centralization was achieved in all patients. This approach may provide practicality to the IOL 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.

Наш опыт эндовитреального удаления внутриглазных инородных тел при выполнении хирургии тяжелых проникающих ранений глаз

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.].

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.

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.

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.

Outcomes of retained intraocular foreign body removal by pars plana vitrectomy

Outcomes of retained intraocular foreign body removal by pars plana vitrectomy

Retractable Urology Three-Pronged Grasping Forceps for Removal of Large, Non-Magnetic Intraocular Foreign Bodies.

To demonstrate the use of urology retractable three-pronged grasping forceps in the removal of a large, round, and non-magnetic 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. Due to the round and smooth surface, large size, and non-magnetic 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 non-magnetic IOFBs.

Commentary: Clinical profile, demographic distribution, and outcomes of ocular siderosis: Electronic medical record-driven big data analytics from an eye care network in India.

First described in 1890 by Bunge, ocular siderosis (OS) occurs due to a retained ferrous intraocular foreign body (IOFB) that causes iron deposition in the ocular tissues.[1] OS may develop from 18 days to years after a penetrating ocular trauma. Common causes are profession involving hammering, chiseling, lathe turning, electric welding, and so on.[1,2] OS may be a “direct siderosis” with tissue alterations occurring close to an IOFB or an “indirect siderosis” where the OS features develop away from the IOFB location. OS in an eye with ferrous IOFB is caused by the interaction between trivalent iron ions and proteins. Iron deposition causes hydroxyl radical formation. The pathomechanism of metallic-induced damage to cells and tissues of the eye consists in the deposition of ferritin complexes in the cellular cytoplasm, especially in the form of siderosomes and possibly an increased oxidative stress combined with excessive glutamate release. This causes an increased calcium influx which damages photoreceptors and the retinal pigment epithelium (RPE). Also, iron damages the retinal vessels with consequent inner retinal layer degeneration.[2,3] Excess free iron interferes with cellular enzymatic activity, causing lysosome breakdown. Consequently, pyknosis and degeneration of photoreceptors and RPE ensues. Rods are more susceptible to iron toxicity than cones due to different protective systems against oxidative and retinopathic factors.[3,4] Ferrous ions migrate across the vitreous in a posterior–anterior way to the aqueous. Then, they penetrate the deep cornea layers and trabecular meshwork, which allows them to reach the suprachoroidal space and diffuse to the choroid and Bruch’s membrane until reaching the RPE posteriorly. Chronologically, three phases characterize OS development. First, a latent period following injury without manifested clinical signs, which is variable from a few weeks to some years. Then, iron spreads within the intraocular tissues with a high affinity for epithelial cells. Finally, tissue degeneration occurs, particularly in the retina and RPE.[1] The development of OS and its different manifestations and severity depend on several factors such as IOFB dimension, shape, and composition.[1] Clinically, the common signs are iris heterochromia, pupillary mydriasis, cataract development, and retinal arteriolar narrowing with pigmentary retinal degeneration.[5] The pupil can be dilated and nonreactive to light. This phenomenon is named “iron mydriasis,” and it is a parasympathetic neuropathy due to iron precipitation in the sphincter and iris dilator muscle.[6] Glaucoma may be the presenting feature of eyes with OS. It is due to either iron deposits in the trabecular meshwork or the production of albuminous aqueous by the ciliary body, which increases the intraocular pressure. In late stages, trabecular fibrosclerosis can develop. Glaucoma in OS is usually medically uncontrollable and may require surgery.[2] OS can manifest as uveitis. It can also cause retinal arteriolar narrowing and sheathing with pigmentary retinal degeneration, similar to retinitis pigmentosa. Further, OS is known to present as optic neuritis and optic disk edema. A careful history and detailed ophthalmic examination can give a clue to a case of OS. Multiple imaging modalities, such as orbital computed tomography (CT), ultrasonography, ultrasound biomicroscopy (UBM), and even optical coherence tomography (OCT), may help in detection of ferrous IOFB. Orbital CT without contrast is the gold standard to identify ferrous IOFBs, as it provides information about its localization (intraocular, extraocular, or retroocular) and its size, with a very high sensitivity.[7] Sagittal and coronal thin (1.0–1.5 mm) scans through the orbit are ideal for detection. Magnetic resonance imaging (MRI) is contraindicated if metallic/iron IOFB is suspected, and its use for diagnosis should be reserved for very select cases only.[7] B-scan is a dynamic examination providing real-time, two-dimensional images of the ocular and adjacent tissues with a high resolution (0.1–0.01 mm). However, B-scan tends to overestimate IOFB size, so it should not be used for measuring purposes. B-scan is also useful in identifying associated tissue injuries such as choroidal and vitreous hemorrhages or retinal detachment.[8,9] UBM has an increased sensitivity to identify IOFBs located in the anterior chamber.[8,9] It can detect anteriorly located IOFBs, for example, in the angle or near the ciliary body, ciliary processes, and retrolental space.[9] Electroretinography (ERG) is the gold standard to detect and follow-up retinal toxicity secondary to OS. When an iron IOFB has not been found during ophthalmological evaluation, an ERG can provide with a clue to the diagnosis of OS. Full-field ERG (ffERG) is the gold standard for assessing retinal damage by iron IOFB, as it can detect functional abnormalities of the retina before any pathological changes are visible by fundus examination or fluorescein angiography.[10] Early-phase ffERG shows an increased a-wave (hypernormal) or an increased implicit time, indicative of subtle retinal toxicity.[11] Gradually, the b-wave decreases with a reduction in the b-wave/a-wave ratio (b/a ratio). Finally, in advanced cases of OS, the amplitudes of the a-wave and b-wave progressively decrease to become undetectable.[11] Oscillatory potential amplitude reduction on ERG is another early finding in OS. Following successful ferrous IOFB removal, ERG amplitudes may increase, demonstrating that iron toxicity is reversible, especially in the early period of the disease.[12] ffERG is also useful for follow-up of patients in whom surgery for removal of the ferrous IOFB is not possible. Recently, multifocal electroretinography (mfERG) has been noted to reveal subtle electrophysiological retinal dysfunction in eyes affected by OS, even before ffERG.[10] Definitive treatment of OS and its prevention lie in the removal of ferrous IOFB. The route and ability to remove it often depend on the location. Anterior segment IOFBs can be removed with intraocular magnet (IOM) or forceps through the limbus. As regards to posterior segment IOFB, pars plana vitrectomy has to be performed, followed by removing the IOFB with IOM or forceps through an enlarged sclerotomy or the limbus.[10,13] The present study[14] described the epidemiology, clinical presentation, and outcome of siderosis in 58 Indian eyes. Because of the large number of eyes with siderosis in the present study, it contributes significantly to our information and understanding about OS in India.

Clinical profile, demographic distribution, and outcomes of ocular siderosis: Electronic medical record-driven big data analytics from an eye care network in India.

To describe the demographics, clinical profile, and outcomes of ocular siderosis in patients presenting to a multi-tier ophthalmology hospital network in India. This cross-sectional and hospital-based study included 3,082,727 new patients who presented between August 2010 and December 2021. Patients with a clinical diagnosis of ocular siderosis in at least one eye were included. Overall, 58 eyes of 57 patients (0.002%) were diagnosed with ocular siderosis. The majority were men (96.49%) and had unilateral (98.25%) affliction. The most common age group at presentation was during the third decade of life with 24 patients (42.11%). A clear history of ocular trauma was documented in 47 patients (81.03%). Major clinical signs included corneal pigment deposition in nearly half of the eyes (27/58 eyes, 46.55%), corneal scar (20/58 eyes, 34.48%), cataract (22/58 eyes, 37.93%) and retinal detachment (11/58 eyes, 18.96%). The intraocular foreign body (IOFB) was anatomically localized in a majority of the eyes (i.e., 45/58 eyes, 77.59%). The most common location of the IOFB was in the posterior segment (22/58 eyes, 37.93%). The eyes that underwent a vitreoretinal surgery with removal of IOFB had a slightly better BCVA (1.0 ± 1.01) when compared to eyes with non-removal of IOFB (1.58 ± 1.00). Ocular siderosis is a rare sight-threatening entity, with half of the affected eyes exhibiting severe visual impairment. Majority of the eyes in ocular siderosis will have a detectable IOFB. Surgical removal of IOFB may lead to a better visual gain when compared to non-removal.

Open Globe Injury (OGI) with a Presence of an Intraocular Foreign Body (IOFB)-Epidemiology, Management, and Risk Factors in Long Term Follow-Up.

The purpose of the study was to evaluate visual outcomes and consider management strategies in the eyes with an intraocular foreign body (IOFB). In a single-center, retrospective case-control study, 36 eyes of 36 patients who suffered from open globe injury (OGI) with IOFB were admitted to the Department of Vitreoretinal Surgery of Medical University of Lublin, Poland from January 2015 to December 2020. Most frequent primary procedure was the pars plana vitrectomy (PPV) with IOFB removal (n = 28). Retinal detachment (RD) developed in nine eyes soon after injury or as a further complication. Recurrent retinal detachment occurred in eight of these nine cases. Final VA 0.1 or better was observed in 21 eyes (58%). Fifteen patients had BCVA of less than 0.1. One eye was not included in the final VA assessment due to the short follow-up period. In 25 out of 28 patients who underwent any kind of pars plana vitrectomy (ppV) a BCVA of <0.4 was observed. The prognosis after an IOFB injury is uncertain due to multiple factors in a peri- and postoperative period. Factors predisposing to poor visual outcomes are: IOFB localization in the posterior segment, retinal detachment, vitreous hemorrhage and prolonged silicone oil tamponade.

Microbiological study on foreign body and vitreous samples of patients with intraocular foreign body

To evaluate the relationship between the microbiological results of the vitreous humor and those of foreign body specimens in patients with intraocular foreign body (IOFB). Seventy-one patients with an IOFB were included in this descriptive prospective case series. All patients underwent immediate IOFB removal. Vitreous sampling was performed during vitrectomy. Foreign bodies were placed directly into culture media for microbiological study. Thirteen (18.3%) patients developed endophthalmitis. The results of microbiological analysis of IOFB and vitreous humor specimens were negative in nine patients and positive in four. Fifty-eight (81.6%) patients with an IOFB had no evidence of endophthalmitis. Among them, seven patients showed positive microbiological results of foreign bodies with no manifestations of endophthalmitis. In five patients, a Staphylococcus epidermidis strain was observed in the culture of the IOFB specimen. Two patients had only positive smear test results of their vitreous humor specimen. A correlation appears to be present between the microbiological results of the vitreous humor and IOFB specimens in patients with clinical findings of endophthalmitis but not in patients with a pure IOFB without clinical features of endophthalmitis. This may justify early use of intravitreal and intravenous antibiotics before the development of endophthalmitis.

Metallic intraocular foreign body removal assisted through the extrusion line

AbstractPurpose: To describe an alternative vitreoretinal surgical manoeuvre, to remove metallic intraocular foreign bodies.Methods: Two patients, at different time lines, underwent vitrectomy to remove a metallic intraocular foreign body (IOFB). A 3‐port vitrectomy was performed, a 23‐G constellation vitrectomy equipment was used in both procedures, careful core vitrectomy was first done, vitreous adhesions and vitreous detachment was carefully done, retina was partially detached at the IOFB location, vitreous adhesions were cut and released gently not to increase the retinal detachment. Liquid prefluorocarbon was placed on the macula. As the vitreous adherences were cut, the IOFB was free from all potential tractional forces, the soft silicone tip cannula was held on to its surface, and at maximal vacuum aspiration, the IOFB was brought up to the anterior chamber, switching the light pipe for forceps in the other hand, and removed out of the eye. A complete as possible vitrectomy was performed, intraocular laser around the retinal brakes was performed, an intraocular lens was placed in the ciliary sulcus with the optic within the anterior capsule, and silicone oil was used as tamponade.Results: No signs of intraocular inflammation were recorded postoperatively. Intraocular silicone oil removal was done at the third post‐operative month in both cases, retina remained attached through follow up, both patients had over 9 months follow‐up visits, visual acuity improved from initial presentation, and also improved after the silicone oil tamponade removal.Conclusions: Active aspiration through the soft silicon tip cannula can be used to reach, and assist removal of metallic intraocular foreign bodies, being this manoeuvre safe, reproducible, possibly time‐saving, and also it could potentially avoid the risk of IOFB mobilization, avoiding further damage to the retina.

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.

Endophthalmitis, Visual Outcomes, and Management Strategies in Eyes with Intraocular Foreign Bodies.

PurposeOcular trauma with intraocular foreign body (IOFB) can have devastating visual consequences. Management and antimicrobial strategies remain variable due to the infrequency and heterogeneity of presentation. Our goal was to identify risk factors for endophthalmitis and poor visual outcomes in cases of IOFB and investigate management strategies.Patients and MethodsA retrospective chart review was conducted in 88 eyes of 88 patients suffering traumatic injury with IOFB at the University of Michigan between January 2000 and December 2019. Medical records were reviewed to characterize the injuries and IOFBs as well as how clinical presentation and treatment modalities were associated with outcomes.ResultsDelayed presentation (P=0.016) and organic IOFB (P=0.044) were associated with development of endophthalmitis. Retinal detachment (P=0.012), wound length greater than 5 mm (P=0.041), and poor presenting visual acuity (P=0.003) correlated with poor final visual outcome. Antibiotic prophylaxis was given to all patients, though agents and routes of delivery varied. Endophthalmitis developed in 4.9% of the eyes after initial management, with primary and secondary removal of posterior segment IOFBs associated with similar rates of endophthalmitis (P=1.000).ConclusionPoor presenting visual acuity and severity of injury, as measured by large wound and retinal detachment, correlate with poor visual outcome. Prompt globe closure and antimicrobial prophylaxis are critical for infection prevention. In cases where IOFB removal and globe closure cannot be performed concurrently, primary globe closure with aggressive antibiotic prophylaxis offers a reasonable alternative to prevent endophthalmitis.

INCIDENCE AND RISK FACTORS OF POSTOPERATIVE ENDOPHTHALMITIS AFTER PRIMARY SURGICAL REPAIR COMBINED WITH INTRAOCULAR FOREIGN BODY REMOVAL.

To analyze the incidence and risk factors of postoperative endophthalmitis after primary surgical repair and intraocular foreign body (IOFB) removal within 24 hours of injury. The records of all patients treated surgically for open globe injury and IOFB removal at the Eye Hospital of Shandong First Medical University between January 1, 2015, and June 30, 2020, were retrospectively reviewed. Variables included time from injury to operation, cause of injury, details of surgical repair, and follow-up. The incidence and risk factors of endophthalmitis after IOFB removal were studied. During 5 years, 99 patients with IOFB were reviewed. Of these, 19 patients were diagnosed with endophthalmitis on admission, and 5 were suspected of having endophthalmitis during operation. Fifty-four cases had no clinical signs of endophthalmitis on admission and during operation and were treated with operation within 24 hours after the injury. Two patients (2 of 54; 3.70%) developed endophthalmitis after IOFB removal, and the causative agent in both cases was Bacillus cereus. The incidence of infectious endophthalmitis after primary surgical repair combined with IOFB removal (≤24 hours) was 3.70% in patients who received a series of standard treatments, and B. cereus infection might be a risk factor.