First Author: Y.Ozdamar Erol TURKEY
Co Author(s): K. Tekin P. Yilmazbas
Back to previous
Posterior segment intraocular foreign bodies (IOFBs) are one of the most common causes of visual loss. IOFBs may lead to devastating consequences, including toxic effects, chronic inflammation, development of fibrocellular proliferation, detachment of the retina and retinal traction, endophthalmitis, or phthisis bulbi. The main goals of treating posterior segment IOFBs are to remove the foreign bodies, retain globe integrity, and provide better anatomic and visual outcomes. The aim of this study was to reveal the outcomes of 23-gauge (G) transconjuntival vitrectomies (TV) for the management of posterior segment IOFBs.
Ulucanlar Eye Training and Resarch Hospital
The study included 14 eyes undergoing 23-G TV for the removal of posterior segment IOFBs. In this study, all eyes underwent pars plana vitrectomy, and some underwent additional surgical approaches. All eyes had complete preoperative ophthalmic examinations, including testing of best-corrected visual acuity, measurement of intraocular pressure, and biomicroscopic anterior segment and dilated fundus examination. Patients were operated on under retrobulbar lidocaine anaesthesia with 23-G TV system. After core vitrectomy, the posterior hyaloid was removed in all the patients by the aid of triamcinolone acetonide, and the vitreous base was cleaned. To protect the posterior pole, 1 mL to 2 mL perfluorocarbon liquid was injected, and after the locations of the IOFBs were determined, one of the superior microcannulas was removed. Then this sclerotomy was enlarged with a 20-G microvitreoretinal (MVR) blade to facilitate removal of the IOFBs. All IOFBs were removed from the enlarged sclerotomy by using IOFB forceps. Cryoapplication, endolaser photocoagulation, or both were applied around the site of impact of the IOFBs or the possible retinal damage. Combined cataract surgery (phacoemulsification or lens aspiration) with vitrectomy was performed when there was a significant opacity of lenses or if needed for another reason.
All patients were male. The mean age of the patients was 36.6±11 years. The foreign body was in the vitreous in 11 eyes and in the retina in 3 eyes. Before 23-G TV, complicated cataract was detected in 6 eyes, vitreous haemorrhage was detected in 5 eyes and retinal detachment was detected in 1 eye. Foreign body sizes ranged from 3 mm to 7 mm, 12 foreign bodies were metallic and 2 were glass. As a tamponade agent, silicone oil was used in 5 eyes and gas tamponade (C3F8) in 4 eyes. The mean follow-up time was 8.15 ± 2.9 months. At the last examination, out of 14 eyes included in the study, 10 had a visual acuity (VA) of 0.1 or better, whereas VA of 4 eyes were less 0.1 since 2 eyes had peri-macular scar, 1 eye had massive sub-epiretinal membrane and 1 eye had retinal re-detachment.
The advanced vitreoretinal surgical techniques can save traumatized eyes with posterior segment IOFBs. TV reduces the surgical trauma and hastens postoperative recovery. Thus, 23-G TV is a safe and effective means of performing vitreoretinal surgery and can be effectively used to manage most cases with posterior segment IOFBs.