Posterior Segment Intraocular Foreign Bodies 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.

Clinical and imaging characteristics, outcomes and prognostic factors of intraocular foreign bodies extracted by vitrectomy

To investigate the clinical and computer tomography (CT) features and visual prognostic factors of pars plana vitrectomy (PPV) for management of retained posterior segment intraocular foreign body (IOFB). Medical records of 96 patients with IOFB removed by PPV between July 2017 and June 2021 were retrieved. The medical records, including demographic data, initial and final best corrected visual acuity (BCVA) using standard Snellen chart, characteristics of IOFB, CT findings, and surgical details, were reviewed. Outcome was evaluated according to the final BCVA and prognostic factors were obtained. The mean age was 42.31 ± 12.05 years (range 13–71 years) with 94 males (97.9%) and two females (2.1%). CT was sensitive of IOFB in 93.75% (90 eyes) and the locations were consistent with that found during PPV: 20 foreign bodies were located in vitreous, 6 near ciliary body, and 70 on or in retina. Mean diameter of IOFB removed by PPV is 3.52 mm ± 3.01 mm (range 1–22; median 3), and mean area is 6.29 ± 6.48 mm2 (range 0.5–40; median 3), which was statistically associated with the initial VA < 0.1 and endophthalmitis. Endophthalmitis was found in 24 (25.0%) eyes and large wound together with scleral entry site might be related to the endophthalmitis. Visual outcome < 0.1 was associated with relative afferent pupillary defect, initial VA < 0.1, and presence of endophthalmitis. Initial VA ≥ 0.1 was independent predictive factor for a better final BCVA. Relative afferent pupillary defect, initial BCVA < 0.1, and presence of endophthalmitis are poor visual prognostic factors.

REVIEW 5 TAHUN KARAKTERISTIK KLINIS PASIEN BENDA ASING INTRAOKULAR DI PMN RS MATA CICENDO

Introduction: Intraocular foreign bodies (IOFBs) are defined as intraocularly retained, unintentional projectiles that require urgent diagnosis and treatment to prevent blindness or globe loss. IOFBs account for 18–41% of open globe injuries, and frequently cause severe visual loss in patients with ocular trauma.The purpose of this study are is to describe the characteristics of open-globe injuries with posterior segment intraocular foreign bodies (IOFB). Subject and Methods: Retrospective data of all patients with posterior segment IOFBs from 2017 to 2022 was conducted. Data including demographics, mechanism of injury, type of IOFB, method of diagnosis, presenting examination, medical and surgical treatment, visual outcomes, and complications were recorded. Result: There were 39 patients (eyes) with IOFB, 38 (97,4%) were male, 10 (25,6%) were 46-55 years old. The most common IOFB occurred at workplace 30 patient (85,7%), 29 (74,3%) were insuranced, surgery were performed 1- 4 days in 15 (38,5%. The most Ocular trauma score were 3 (38,5%) and 2 (35,9%) initial VA were light perception – hand movement (25 or 64,1%), final VA with BCVA were &gt; 20/40 (30,8%) patients and 6/60-6/15 (25,6%). The posterior segment IOFB (51,3%, metallic IOFB 25 (61,5%). Cataract 74,3% and Endophthalmitis (20,5%) were found in initial examination patient with IOFB (13 or 37,1%). Late complication in post surgery IOFB patient was glaucoma 14,4%. Conclusions: The IOFB occurred most commonly in adults, men, at the workplace. The IOFB mostly was metallic, found in the posterior segment. Cataract and endoftalmitis were common in initial finding IOFB patients.

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.

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.

"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.

Management of Intraocular Foreign Bodies of the Posterior Segment to Maximize Anatomical and Functional Outcomes

Open globe injury (OGI) repair remains one of the most challenging surgeries in all of the eye surgery. Intraocular foreign bodies (IOFBs) constitute a subset with special treatment considerations. It is also clear that these operations can create a more complicated situation due to damage to the cornea or crystalline lens to ensure the safe removal of the posterior segment IOFBs. In these operations, indications, time, and surgical technique of removal of the IOFB should be planned in detail to maximize anatomical and functional success and prevent permanent vision loss of the patient. Several controversies exist in the management of IOFBs that will be reviewed in this article.

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 Characteristics and Prognostic Factors of Posterior Segment Intraocular Foreign Body: Canadian Experience from a Tertiary University Hospital in Quebec.

Purpose To identify predictive factors for visual outcomes of patients presenting with a posterior segment intraocular foreign body (IOFB). Methods A retrospective chart review was performed for all consecutive patients operated for posterior segment IOFB removal between January 2009 and December 2018. Data were collected for patient demographics, clinical characteristics at presentation, IOFB characteristics, surgical procedures, and postoperative outcomes. A multiple logistic regression model was built for poor final visual acuity (VA) as an outcome (defined as final VA 50 letters or worse [Snellen equivalent: 20/100]). Results Fifty-four patients were included in our study. Ninety-three percent of patients were men, with a mean age of 40.4 ± 12.6 years. Metallic IOFB comprised 88% of cases with a mean ± standard deviation (SD) size of 5.31 ± 4.62 mm. VA improved in 70% of patients after IOFB removal. Predictive factors for poor VA outcome included poor baseline VA, larger IOFB size, high number of additional diagnoses, an anterior chamber extraction, a second intervention, the use of C3F8 or silicone tamponade, and the presence of vitreous hemorrhage, hyphema, and iris damage. Predictive factors for a better visual outcome included first intention intraocular lens (IOL) implantation and the use of air tamponade. In the multiple logistic regression model, both baseline VA (p = 0.009) and number of additional complications (p = 0.01) were independent risk factors for a poor final VA. Conclusions A high number of concomitant complications and poor baseline VA following posterior segment IOFB were significant predictive factors of poor visual outcome.

Long-Term Outcome of Pars Plana Vitrectomy for Retained Posterior Segment Intraocular Foreign Body Secondary to Gunshot Injury.

PurposeTo report the long-term outcome of pars plana vitrectomy (PPV) for management of retained posterior segment intraocular foreign body (IOFB) secondary to gunshot injury.MethodsThis is a retrospective interventional case series including consecutive patients who had PPV for retained posterior segment IOFB secondary to gunshot injury. Main outcome measures were final best-corrected visual acuity (BCVA), long-term globe survival and detection of complications. Spearman correlation analyzed relationships between numerical data. Kruskal–Wallis test compared differences in initial BCVA and final BCVA across variables. Categorical variables were tested using Chi square or Fisher’s exact test. P value is significant at 0.05.ResultsThe study included 103 eyes of 103 patients. Mean baseline BCVA was 0.01 decimal unit (2 logMAR). Mean duration from primary repair to PPV was 3 weeks. Mean duration of post-operative follow-up was 60 months. Mean final BCVA was 0.04 decimal unit (1.3 logMAR), p 0.001. Post-operatively, BCVA improved in 58.2% of patients. Nineteen patients (18%) gained ≥2 lines of vision, and 15 patients (14.5%) achieved final BCVA of 0.4 decimal unit (logMAR 0.4). All complications were related to the original injury. These included macular scar (19%), macular pucker (6%), recurrent retinal detachment (4%), subretinal fibrosis (3%), consecutive optic atrophy (3%), and PVR (3%). Phthisis bulbi or sympathetic ophthalmia did not develop in any case.ConclusionPPV for removal of IOFB caused by gunshot injury yielded long-term favorable functional outcome with excellent globe survival. Poor initial BCVA, location of IOFB in the posterior pole, associated lens injury and retinal detachment are significant adverse prognostic factors for final BCVA but not for globe survival.

Intraocular Foreign Body: Diagnostic Protocols and Treatment Strategies in Ocular Trauma Patients.

Intraocular foreign bodies (IOFBs) are critical ophthalmic emergencies that require urgent diagnosis and treatment to prevent blindness or globe loss. This study aimed to examine the various clinical presentations of IOFBs, determine the prognostic factors for final visual outcomes, establish diagnostic protocols, and update treatment strategies for patients with IOFBs. We retrospectively reviewed patients with IOFBs between 2005 and 2019. The mean age of the patients was 46.7 years, and the most common mechanism of injury was hammering (32.7%). The most common location of IOFBs was the retina and choroid (57.7%), and the IOFBs were mainly metal (76.9%). Multivariate regression analysis showed that poor final visual outcomes (<20/200) were associated with posterior segment IOFBs (odds ratio (OR) = 11.556, p = 0.033) and retinal detachment (OR = 4.781, p = 0.034). Diagnosing a retained IOFB is essential for establishing the management of patients with ocular trauma. To identify IOFBs, ocular imaging modalities, including computed tomography or ultrasonography, should be considered. Different strategies should be employed during the surgical removal of IOFBs depending on the material, location, and size of the IOFB.

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.

Outcomes of vitreoretinal surgery in patients with posterior segment intraocular foreign body

Outcomes of vitreoretinal surgery in patients with posterior segment intraocular foreign body

Posterior Segment Retained Intraocular Foreign Body: A Study from Western Nepal.

Posterior segment retained Intraocular foreign body (IOFB) management is challenging. Facility of pars plana vitrectomy (PPV) and availability of well trained vitreo retina surgeons are the basic need to accomplish this work. Encircling band provide permanent 360° support to close the anterior retinal break and prevent traction on the retina. The objective of this study is to analyse the clinical characteristics and predictors of the final visual outcome and survival of the globe in cases of retained IOFB in the posterior eye segment. A hospital based retrospective observational study was conducted. All the patients of retained IOFB in the posterior segment presented from January 2016 to June 2019 were enrolled. Patients presented with visual acuity of NPL were excluded. Statistical analysis was performed using a variety of tests using SPSS version 21. Forty eyes of 40 patients were included. The mean age was 27.08±10.68 years (range 5-66). 95% of our patients were male. Most of them (52.5%) worked on the farm. 26(65%) of 40 eyes had Zone I injury. The median time spent before presentation was 13.5 day. Retinal detachment, vitreous hemorrhage, and endophthalmitis were present in 15, 23 and 5 eyes, respectively, before IOFB removal. The mean LogMAR visual acuity was improved significantly from 2.50±0.87 to 1.33± 1.01 (p=0.003). Poor presenting visual acuity, retinal detachment and large diameter of IOFB were found as the predictor of poor final visual acuity. Pars plana vitrectomy by a vitreo retinal surgeon can give encouraging results in the cases of retained posterior segment IOFB. Poor presenting visual acuity, large diameter of IOFB and RD before IOFB removal are predictors of poor visual outcome.

Posterior-segment intraocular foreign body removal preserving intraocular lens – A novel technique

Posterior-segment intraocular foreign body removal preserving intraocular lens – A novel technique

Posterior segment intraocular foreign body with secondary retinal detachment in a phakic eye: a case report

Intraocular foreign bodies (IOFBs) are an important cause of visual loss. The current case describesa case of retained intraocular foreign body with secondary retinal detachment in a phakic eye in a38-year-old man. The foreign body was safely removed through the sclerotomy port withouttouching the crystalline lens. The current case report wanted to show the anatomic and visualoutcomes of vitreoretinal surgery in such cases.

Surgical outcomes of the removal of posterior segment metallic intraocular foreign bodies

BackgroundPosterior segment metallic intraocular foreign bodies (IOFBs) are a leading cause of visual morbidity and blindness, especially among young and middle-aged working populations. Here, we aimed to evaluate the surgical outcomes of the removal of such IOFBs that result from injuries.MethodsIn this retrospective study, 39 patients injured by metallic posterior segment IOFBs and who underwent primary repair procedures, vitrectomies, and IOFBs removal with or without procedures for traumatic cataract removal, scleral buckling and intraoperative tamponade application from January, 2008 to January, 2019. We analyzed the preoperative, intraoperative and postoperative related factors that affect the final visual outcomes.ResultsThe mean age of the 39 patients was 40.51 ± 12.48 years with the male being predominent (100%).The mean preoperative vision measured 1.50 [Snellen Equivalent (SE), 20/645] ± 1.12 logMAR with the mean final vision measuring 0.93 (SE, 20/172) ± 1.09 logMAR. The related factors that were determined to affect the final visual outcomes included preoperative vision (P = 0.025), IOFB-related macula injuries (P = 0.001) and the development of postoperative complications (P = 0.005) especially retinal detachment (P = 0.002) with the mean final vision measuring 2.12 (SE, counting finger to hand motion) ±1.23 logMAR. Concerning the preoperative signs, the patients with preoperative endophthalmitis also obtained poor mean final vision measuring 1.30 (SE,20/400) ± 1.40 logMAR.ConclusionIOFB-related macula injuries and postoperative retinal detachment were important related factors of poor final visual prognoses in cases involving posterior segment metallic IOFBs. Removing IOFB as early as possible may prevent preoperative endophthalmitis which could lead poor final visions even without significance.

Total Filling of the Vitreous Cavity With a Cohesive Ophthalmic Viscosurgical Device to Support the Removal of the Intraocular Foreign Body.

To evaluate the effectiveness of loading the vitreous cavity with a cohesive ophthalmic viscosurgical device in aiding the removal of the posterior segment intraocular foreign body (IOFB). Seven consecutive patients underwent a small-gauge vitrectomy due to eye trauma with the IOFB between January 2019 and December 2019. The IOFB removal was initiated after total filling the vitreous cavity with the ophthalmic viscosurgical device (Eyefill C or Bio-Hyalur Plus) to facilitate maneuvering and slow the descent in cases of the unintendedly released IOFBs. The eye examination was performed at presentation and at 1 day, 7 days, 1 month, and 3 months after surgery. The best-corrected visual acuity and intraocular pressure were evaluated. In all eyes, IOFBs were elevated into the center of the vitreous cavity and could be securely gripped while suspended in the ophthalmic viscosurgical device to allow the surgeon for successful and harmless removal. In the 3-month follow-up, the best-corrected visual acuity was 20/20 in 5 patients and 20/25 in 2 patients. In the early postoperative period, the elevation of intraocular pressure did not occur. No patient developed endophthalmitis. The authors demonstrated that this uncomplicated technique is an effective surgical option for more reliable removal of posterior segment IOFBs.

Indirect choroidal neovascularization secondary to a posterior-segment intraocular foreign body \u2013 case report

BackgroundWe reported a rare case of indirect choroidal neovascularization (CNV) secondary to a posterior-segment intraocular foreign body (IOFB) that was not located in the area of direct injury but in the fovea. After intravitreal injections (IVIs) of aflibercept, the choroidal neovascularization (CNV) lesion disappeared and vision improved.Case presentationA 26-year-old male patient suffered from a fast-shot metallic IOFB in his right eye. He underwent primary corneal repair, pars plana vitrectomy, IOFB removal and an IVI of antibiotics in the right eye. Two weeks later, cataract surgery was performed on the right eye for traumatic cataract after an episode of acute phacolytic glaucoma. The best-corrected visual acuity (BCVA) of the right eye improved to 20/20 5 months after the first surgery. However, the vision of the right eye worsened suddenly with metamorphopsia 1 year after the first surgery. Color fundus images showed a whitish lesion with faint retinal hemorrhage and surrounding sensory elevation. Fluorescein angiography (FA) revealed a lesion with early- and late-phase severe leakage. Optical coherence tomography (OCT) demonstrated a CNV lesion with surrounding subretinal fluid. The patient received an IVI of aflibercept every 8 weeks for 3 times. Finally, the BCVA of the right eye improved to 20/25.ConclusionsFor rare cases of fovea-spared injury by a metallic IOFB, it is still necessary to pay close attention to the foveal microstructure to avoid possible CNV formation. Treatment with IVIs of anti-VEGF, aflibercept, as early as possible could provide good visual outcomes.

Vitrectomy for the removal of intraocular foreign bodies: visual outcomes and prognostic factors

Penetrating ocular injuries with intraocular foreign bodies may result in severe visual loss. The posterior segment IOFBs are best treated by pars plana vitrectomy.To correlate the shape, size and location of posterior segment intraocular foreign bodies with visual outcome and its prognostic factors.Tertiary care center of ophthalmology, Ahmedabad , India This is a prospective study of 40 eyes of 40 patients who underwent Pars Plana Vitrectomy for the removal of posterior segment intraocular foreign bodies in Regional Institute of India. We studied the following parameters: age, gender, wound site, IOFB characteristics (shape, size, location), initial and final visual acuity.Among the study participants, 19 worked in factories, 6 were housekeepers, 7 were farmers and the remaining 5 patients were either unemployed or retired at the time of the injury. The foreign body was embedded in the surface of the retina (32.5%), located in the vitreous (55%) and in the sclera (12.5%). Nine patients (22.5%) developed delayed Retinal Detachment, which was the largest single cause of blindness in this group.Our study concludes that the larger the size of posterior segment IOFB, presence of pre-existing or secondary RD, vitreous hemorrhage poorer the prognosis. We also emphasize the use of protective eye equipments at workplace in preventing this disability caused by penetrating ocular injury.