Removal of a giant nonmagnetic intraocular foreign body using micro alligator forceps

PURPOSE

To introduce a new method for removal of a giant nonmagnetic intraocular foreign body using micro alligator forceps.

PATIENTS AND METHODS

Eleven patients underwent pars plana vitrectomy and lensectomy. The micro alligator forceps were used to grasp and extract the giant nonmagnetic intraocular foreign body through a sclerocorneal tunnel.

RESULTS

All patients underwent surgical removal of the intraocular foreign body successfully without any intraoperative complications. The alligator forceps were operational in the intraocular environment and effective in surgical maneuvers. There was no accidental slippage during the procedures.

CONCLUSION

Micro alligator forceps are a feasible option for removal of giant nonmagnetic intraocular foreign body during vitreoretinal surgery and offer advances in terms of operating stability and surgical safety.

[Analysis of outcomes of secondary intraocular lens implantation in open-globe injury after vitrectomy]

OBJECTIVE

To explore the time and method of secondary intraocular lens (IOL) implantation in open-globe injury after vitrectomy and to analyze the efficacies and relative factors of the treatment.

METHODS

This is a retrospective case series study. Clinical data of 78 eyes of 78 patients with open-globe injury who underwent secondary IOL implantation after vitrectomy in Tianjin Medical University General Hospital from 2007 to 2012 were analyzed. There were 27 eyes of 27 patients with penetrating injury, 36 eyes of 36 patients with intraocular foreign body (IFB), 4 eyes of 4 patients with ocular rupture, and 11 eyes of 11 patients with endophthalmitis. The IFB included magnetic foreign body in 23 eyes of 23 patients, glass foreign body in 6 eyes of 6 patients, and eyelash foreign body in 7 eyes of 7 patients. Thirty-one eyes of 31 patients were tamponade with silicone oil, and 47 eyes of 47 patients were tamponade with C3F8 during vitrectomy. The methods of IOL implantation included posterior chamber IOL implantation in 32 eyes of 32 patients and sulcus-fixed IOL implantation in 46 eyes of 46 patients. The examinations before IOL implantation mainly included visual acuity, slit lamp biomicroscope, direct and indirect ophthalmoscope, visual electrophysiology, corneal endothelium, B scan, ultrasound biomicroscope and intraocular pressure. Four eyes of 4 patients underwent suturing of peripheral iris, and 5 eyes of 5 patients underwent suturing of iris laceration. The visual acuity ranged from light perception to 0.1 before vitrectomy. The mean follow-up time was 15 ± 3 months with a range from 6 to 36 months.

RESULTS

The mean interval between IOL implantation and vitrectomy was 2.5 ± 0.2 months with a range from 1.5 to 6 months. The best corrected visual acuity was from 0.1 to 1.0 after vitrectomy. The uncorrected visual acuity ranged from 0.1 to 0.8, and the best corrected visual acuity was from 0.1 to 1.0 after IOL implantation. The postoperative complications mainly included mild anterior chamber exudates in 4 eyes of 4 patients, temporary intraocular pressure elevation in 7 eyes of 7 patients, and recurrent retinal detachment in 2 eyes of 2 patients.

CONCLUSIONS

The appropriate interval of secondary IOL implantation in open-globe injury after vitrectomy is important. Posterior chamber IOL implantation is performed in eyes with integrity of posterior capsule, and IOL sutured in the sulcus in eyes without posterior capsule support. It is safe and effective for secondary IOL implantation in open-globe injury after vitrectomy.

[Clinical observation of the vitreous surgery for open-globe injuries in different timing after the trauma]

OBJECTIVE

To evaluate the clinical efficacy and influential factors of vitrectomy for open-globe injuries in different timing.

METHODS

Prospective cohort study. The clinical effect and complication of the vitrectomy performed by the same surgeon for open-globe injury in different timing (2-4 d or 10-14 d) from April 2011 to January 2013 were compared.Emergent intraocular surgeries such as intraocular foreign body and traumatic endophthalmitis were excluded.

RESULT

A total of 33 patients (33 eyes) were included in the study with 15 cases in the early group (2-4 d) and 18 cases in routine group (10-14 d). The rate of retinal re-attachment showed that 11 of 13 eyes that had retinal detachment were re-attached in the early group.One of 13 eyes had retinal re-attachment after the second surgery and 1 eye failed to re-attach.Five of 15 eyes with retinal detachment had retina re-attached in the routine group. Four of 15 eyes had retina re-attached after second surgery and 6 eyes failed to re-attach. There was a statistical significance between the two groups (U = 46.500, Z = -2.638, P = 0.008). The eye-globe saving rate had no statistical significance (χ² = 3.48, P = 0.095).Fourteen eyes had been saved and 1 eye failed to have vitrectomy in the early group. Twelve eyes had been saved and 6 eyes failed to have vitrectomy in the routine group. The incidence of traumatic proliferative vitreo-retinopathy(TPVR) had statistical significance between the two groups (χ² = 12.34, P = 0.001).One eye occurred TPVR in the early group and 12 eyes occurred TPVR in the routine group. The visual acuity recovery showed that patients in the early group had better vision recovery than patients in the routine group (U = 61.500,Z = -2.858, P = 0.004). Complications like intraoperative bleeding and postoperative infection had no significant difference between the two groups.

CONCLUSION

Cases performing vitrectomy earlier had relatively good prognosis.

[Treatment for penetrating wound caused by metallic intraocular foreign body]

INTRODUCTION

Penetrating wounds with intraocular foreign body are ophthalmologic emergencies due to their severity and complexity and may require multiple surgeries for final resolution.

CASE REPORT

30-years-old patient with penetrating wound and metallic intraocular foreign body in the posterior vitreous requires successive operations for IOFB extraction, lensectomy, posterior vitrectomy for rhegmatogenous retinal detachment and then silicone oil extraction with final visual acuity 0, 4 PH.

Unusual presentation of an intraocular foreign body retained for sixty years

Intraocular foreign bodies may remain quiescent for many years particularly if they are not metallic. We report a case of a missed intraocular stone foreign body that had remained asymptomatic underneath the iris for 60 years and appeared during cataract surgery.

Functional and high resolution retinal imaging assessment in a case of ocular siderosis

PURPOSE

To report new findings in a case of ocular siderosis explored by high resolution angiography and adaptive optics (AO).

METHODS

We report data on a 40-year-old man with an intraocular foreign body (IOFB) embedded in the sclera after hammering.

RESULTS

Nine months after this accident, the patient presented with full-field electroretinogram (FF-ERG) abnormalities. Subsequent IOFB extraction was performed. One month after the surgery, high resolution angiography showed for the first time small iron particles all over the inner retinal surface. Spreading of these deposits was followed by inflammatory prepapillary new vessels and venous retinal vasculatis, which spontaneously resolved within a few months. ERG responses became slightly electronegative at this time. Clearance of the iron particles was followed over a year with AO and ERG recording. AO revealed an arterial tropism with a decrease in the amount of particles overtime, which may be consistent with macrophagic activity.

CONCLUSION

High resolution angiography and AO are new tools, combined with electrophysiology, to better understand ocular siderosis pathophysiology.

Clinical features of perforating eye injuries complicated with intraocular foreign bodies located at the posterior global wall

PURPOSE

To investigate the clinical characteristics and therapeutic effects of vitrectomy in patients with perforating eye injuries with foreign bodies at the exit wound in the posterior global wall.

METHODS

Fifty-two cases, diagnosed with perforating eye injury with foreign bodies at the exit of the posterior global wall and admitted to our hospital between June 2010 and June 2013, were enrolled in this study. All patients underwent vitrectomy and removal of intraocular foreign bodies and were followed up for 6 to 24 months. The causes of injuries were analyzed and postoperative visual acuity and overall treatment efficacy were evaluated.

RESULTS

Intraocular foreign bodies were successfully removed in all cases. The incidence of postoperative complication was low. Among 52 subjects, 46 showed alleviated symptoms after treatment with an overall efficacy of 88.46%.

CONCLUSION

Perforating eye injuries combined with residual foreign bodies in the posterior global wall are commonly observed in young people who perform physical labor. Vitrectomy has a high efficacy for the treatment of perforating eye injuries complicated with foreign bodies located at the posterior global wall, with a low incidence of postoperative complications.

A 55-mm object inside a 40-mm orbit

A 43-year-old man was struck in the left orbit with his board while surfing and sustained a 3-cm laceration above his left eyebrow. The laceration was sutured closed primarily at a local emergency room. When he presented to UCSD oculoplastics for suture removal, he complained of diplopia with upgaze and was found to have hypoglobus on clinical exam. An orbital CT demonstrated a hyperintense linear signal within the orbit. The patient underwent surgical exploration. A 55-mm-length piece of fiberglass from the patient's surfboard was removed from his orbit. This case demonstrates the importance of having a high index of suspicion for retained orbital foreign bodies, regardless of the size of the object inflicting the injury.

[Some important aspects about treatment of open globe injury]

Open globe injury is a common cause for blindness. Injured eyes with no light perception (NLP) should not be enucleated before exploratory vitrectomy. Some NLP eyes may attain light perception or better vision through the vitrectomy. The decision of enucleation should be determined during exploratory vitrectomy. The timing of vitrectomy in the open globe injury still has controversy, but more surgeons agreed that vitrectomy should be performed within 2 weeks after open globe injury. The deadline of timing of vitrectomy is 4 weeks after injury. Retinectomy around the edge of the wound and retinal re-attachment surgery are the key points to prevent proliferative vitreoretinopathy resulted from the injury.

[Regarding the so called posterior approach for posterior eye wall foreign body removal]

Disadvantages of the posterior approach for the optic nerve head foreign body removal, especially with associated intraocular hemorrhage, have been analyzed. In such circumstances the transvitreal approach is of an evident benefit since it also allows removing the intraocular hemorrhage which is a potential source of severe vitreoretinal proliferation.

Management of intraocular foreign bodies: a clinical flight plan

A systematic review of the literature on the diagnosis and management of traumatic intraocular foreign bodies (IOFBs) is presented together with a schematic "flight plan" to assist in clinical decision making when confronted with an IOFB. Several large retrospective series of IOFB have been published recently, with relevant observations regarding prognostic factors, endophthalmitis and retinal detachment incidence, timing of surgical intervention, and preventative measures. Eye trauma and IOFB, in particular, remain poorly suited to prospective study because of their variability. With few exceptions, retrospective observational series represent the strongest clinical evidence to guide our approach to IOFB. Synthesis of the available literature into a general guideline for management of IOFB would be helpful considering the typically hectic first few hours after such a patient presents to the ophthalmologist.

[Mason's lacing cord. Potential danger of severe open ocular injuries]

BACKGROUND

Introduction of new working equipment or the modification of established working routines could induce new trauma mechanisms. In all of theses cases ophthalmologists are not only responsible for ocular treatment they also have to act as assessors. This might include legal aspects, e.g. to validate the circumstances of an accident.

METHODS

We present a new trauma mechanism caused by a mason's lacing cord which was fixed with nails. In addition to two case studies we collected experimental data (maximum tension and maximum elongation of various mason's lacing cords) about the triggering event using standard test conditions.

RESULTS

A tensile force of 96.2 N was needed to achieve maximum elongation of mason's lacing cords. With a cord length of 5 m, an elongation of 0.09 m was enough to cause penetrating injuries (for 10 m cord length the critical elongation was 0.13 m). Under these conditions a nail could be accelerated to a velocity of 18 m/s. This may lead to open eyeball injuries with severe visual loss.

CONCLUSIONS

Nails fixed to elastic mason's lacing cords are potential risk factors for occupational ocular injuries and severe loss of vision. Caution labels should be attached to the work equipment and proper eye protection should be used to prevent severe occupational ocular injuries.

[Impact of follow-up loss over visual deficiency in open-globe ocular trauma]

INTRODUCTION

Open-globe ocular trauma causes visual deficiency; calculating the magnitude of the latter often misses the estimation in patients without follow-up.

AIM

to identify the modification of the postoperative proportion of visual deficiency in open-globe ocular trauma, which would introduce considering the proportion estimated in patients without follow-up.

METHODS

Non-interventional, retrospective, longitudinal, analytical study. Visual outcome in eyes with open-globe trauma, with and without follow-up, was calculated using the Ocular Trauma Score. The observed postoperative proportion of visual deficiency was identified in eyes with follow-up; in eyes without follow-up, the postoperative proportion of visual deficiency was estimated using an analysis of scenarios: best (Ocular Trauma Score), mean (that of eyes with follow-up) and worst (last observation/no visual improvement). The estimated proportion of visual deficiency was added to that observed in eyes with follow-up, and the resulting proportion was compared with that expected in the sample, using the Ocular Trauma Score (χ(2)).

RESULTS

104 eyes, 70 without follow-up and 34 without it. In eyes with follow-up the expected proportion of visual deficiency was 58.6%, and the observed one was 71.4% (p = 0.1); the estimated proportion of visual deficiency in eyes without follow-up was 76.5%. The resulting postoperative proportion of visual deficiency in the sample would be 73.1%, which would overcome that expected by the Ocular Trauma Score (59.6%, p = 0.04).

CONCLUSIONS

In open-globe ocular trauma, the efficacy of surgery to reduce the proportion of visual deficiency would decrease with regard to the standard expected by the Ocular Trauma Score, if the deficiency estimated in eyes without follow-up were considered.

BILATERAL ORBITO-OCULAR GUNSHOT INJURY IN A NIGERIAN MALE: CASE REPORT AND REVIEW OF LITERATURE

Orbito-ocular injuries with retained intra-orbital foreign bodies affecting both orbits are uncommon in civilian practice. This case report aims to highlight an unusual presentation of bilateral orbito-ocularinjury with retained intra-orbital foreignbodies following accidental explosion of a locally fabricated dane gun. A 30-year-old male presented with a five day history of bilateral orbito-ocular injury sustained following an explosion of a dane gun he was fabricating. There was immediate loss of vision in both eyes, and initial treatment was sought at a nearby private general medical clinic. Visual acuity at presentation was no perception of light and light perception with inaccurate projection in the right and left eye respectively, and he had an open wound over the left cheek with retained intra-orbital foreign bodies on plain radiographs. He subsequently underwent wound exploration and closure with removal of the foreign bodies. Vision however remained poor and he was lost to follow-up after being referred for vitreo-retinal consultation. The attendant socio-economic impact on the individual and family following severe bilateral orbito-ocular injury could be enormous when it results in bilateral loss of vision in a young adult. Measures should thus be put in place to regulate the handling of firearms so as to possibly reduce the resultant morbidity from such injuries.