First Author: F.Ghazala UK
Co Author(s): S. Tarafdar
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Penetrating eye injury with an intraocular foreign body (IOFB) can have devastating sight threatening sequelae for a patient. Management involves prompt surgical removal of the IOFB, potentially out of hours and with limited support. Each case will present unique challenges and in order for the surgeon to have the best chance of successful removal he/she must be familiar with the challenges presented as well as the techniques utilized. A patient presented out of hours with a metal IOFB passing through the limbus, damaging the iris and lodging in the vitreous. We present the ensuing surgical management.
Gartnavel General Hospital - tertiary centre for VR services in the West of Scotland, UK.
A limited peritomy created around the entry wound. Scleral wound at the limbus explored. Iris was repositioned at area of iridodialysis. Vicryl suture used to close 3mm limbal wound. Standard phacoemulsification of lens was carried out. Posterior capsulotomy, anterior and core vitrectomy performed using 23G vitrector. Foreign body removed from vitreous cavity with forceps through posterior capsulotomy and anterior corneal incision. Posterior vitreous detachment induced and vitrectomy completed. Endolaser to area of retinal haemorrhage. Cryotherapy to suspicious area of retina. SF6 25% in vitreous cavity. 10-0 nylon suture to close main corneal incision. Intracameral cefuroxime 0.1ml.
The intraocular foreign body was removal successfully.
Intraocular foreign body removal can present challenging surgical considerations. We demonstrate the removal of a metal foreign body lodged in the vitreous cavity. An area of posterior lens touch was noted preoperatively signifying cataract will almost certainly result. Doing phacoemulsification and rupturing the posterior capsule to allow passage of the foreign body into the anterior chamber was planned to remove the foreign body. The surgeon must be prepared and aware it is likely a large foreign body may pose difficulty removing through modern smaller gauge vitrectomy wounds.