A decade of intraocular foreign bodies

Application of ophthalmic magnets in the removal of magnetic intraocular foreign bodies

The aim of this study was to explore a new surgical method for removing magnetic intraocular foreign bodies(IOFB). We systematically reviewed 48 patients (48 affected eyes; 44 males and 4 females; aged 23-74 years, with a mean age of 44.8 ± 12.3 years) with magnetic IOFBs who were admitted to the Department of Ocular Trauma of Hebei Eye Hospital from January 2024 to June 2024. The most common cause of injury was ferrous foreign bodies resulting from working with metallic tools. Thirty-seven of the injuries were sustained in the patient's workplace, and 11 injuries occurred domestically. The patients presented to the clinic 40 min to 60 days after injury. The time from injury to surgery ranged from 1 h to 14 d. In the preoperative examinations and postoperative routine follow-ups, the basic conditions of the patients' eyes were evaluated through visual acuity examination using an international standard chart, slit lamp microscopic examination, anterior and posterior segment examinations with anterior slit lamp lenses, and intraocular pressure measurements. Before surgery, the foreign bodies were properly localized via horizontal and coronal localization CT scans, and type-B ultrasound scans were performed for patients with closed wounds. Ophthalmic magnets were used to remove magnetic IOFBs from 48 cases (48 eyes); in 44 cases, the foreign body was removed successfully during the stage I operation, representing a success rate of 91.7%. Among the included cases, 10 cases of anterior chamber IOFBs and crystalline lens IOFBs were all successfully removed during stage I surgery, for a success rate of 100%; in 38 cases of intravitreal IOFBs, 34 were successfully removed during stage I surgery via pars plana vitrectomy, and 4 cases failed to be removed in stage I surgery and were subsequently removed via stage II vitrectomy, for a stage I surgery success rate of 89.5%. Owing to their strong magnetic force, ophthalmic magnets have been demonstrated to be effective tools for the removal of magnetic IOFBs, enabling simple and time-conserving surgical procedures that are associated with less surgically induced trauma and fewer complications.

Multimodal imaging features of intraocular foreign bodies

Objective: To determine the imaging approach for evaluating intraocular foreign bodies (IOFBs) by comparing the ability of different modalities [plain film x-ray, computed tomography (CT), magnetic resonsance imaging (MRI), convetional ultrasound, and ultrasound biomicroscopy] to detect and characterize IOFBs.Methods & Design: Systematic review of the literature.Results: CT is the most practical first step for evaluating patients with suspected IOFBs because it can detect a wide range of IOFB types at small limitis of detection. MRI and ultrasound are best reserved as adjunctive tests in most cases although these tests may provide important insights especially with wood, plastic, and glass IOFBs. Imaging characteristics of metal, wood, glass, plastic, stone, concrete, and graphite IOFBs are reviewed.Conclusion: Understanding the limits of detection for each IOFB type and imaging modality as well as the characteristic features of different IOFBs is of paramount importance to optimizing the management of ocular trauma patients.

Endolaser Photocoagulation in Penetrating and Perforating Intraocular Foreign Bodies

Ten consecutive eyes that had undergone a pars plana vitrectomy and argon endolaser photocoagulation for penetrating or perforating posterior segment foreign bodies were reviewed. All eyes had undergone a pars plana vitrectomy plus or minus lensectomy, removal of the intraocular foreign body in those eyes with a retained foreign body, endolaser photocoagulation of posterior chorioretinal tears, and peripheral buckle for peripheral retinal pathology. Postoperatively (minimum follow-up, 6 months), all eyes had an attached retina. Eighty percent of the eyes had a visual acuity of 20/40 or better. Advantages of endolaser photocoagulation of posterior breaks include: microscopically controlled sealing of posterior tears, less destructive than posterior cryotherapy, effective when severe choroidal swelling is present, and absence of dispersion of viable retinal pigment epithelial cells which has been documented with external cryotherapy.

Copper Intraocular Foreign Body: Diagnosis and Treatment

Copper intraocular foreign bodies (IOFB) are relatively common after penetrating eye injuries. Ocular signs and symptoms vary greatly in relation to the copper content, ranging from chronic uveitis and severe visual loss for IOFB containing more than 85% copper, to local copper deposits with no severe ocular damage for less toxic alloys. Reported here is the case of a ten-year-old boy who suffered from recurrent chronic uveitis five months after a perforating eye injury due to copper wire. Diagnostic ultrasound and computerized tomography revealed an IOFB within the lens and X-ray spectrometry (DXS) indicated the nature of the IOFB as copper, and accurately measured the dissolution of the metal. The patient underwent cataract extraction and standard three-port pars plana vitrectomy with gas-fluid exchange. Twelve months after surgery the retina was flat and visual acuity had risen to 20/60. Undiluted vitreous samples obtained in the course of the intervention, studied by immunohistochemical techniques, showed an inflammatory reaction with a prevalence of PMN-N and CD3 T-lymphocytes. DXS thus appears to be a new and reliable diagnostic tool for the early detection and management of copper and other toxic metal IOFB.

The Value of Skull Radiography in Ophthalmology

Skull radiographs and special views are still requested in ophthalmology despite the increasing availability of other radiological investigations such as CT, MR imaging and ultrasound. In order to assess the value of skull radiography in ophthalmology we retrospectively studied the use of skull radiographs and CT images in our department. In only one instance was patient management based purely on skull radiograph findings. Over 50% of CT examinations had been preceded by skull films which made no contribution towards management. In some cases the skull films had been misleading by not showing significant pathology and had consequently created considerable delay before diagnosis was reached. It is therefore unjustifiable to use skull films as a method of screening for orbital or intracranial disease and there is little indication for skull radiography in ophthalmology, except in detection of intraocular foreign bodies, facial and orbital fractures and simple sinusitis.

Intraocular foreign bodies: A review

Intraocular foreign body injuries may result in a wide range of intraocular pathology and visual outcomes based on the mechanism of injury, type of foreign body, and subsequent complications. We have reviewed the literature to describe the epidemiology and mechanisms of such injuries; types of foreign bodies; imaging tools for diagnosis; current trends in management, presurgical, and surgical interventions; as well as visual prognosis and potential complications. The purpose of this review is to familiarize clinicians with the recent advances in diagnosis and management of such injuries.

Intraocular foreign bodies extracted by pars plana vitrectomy: clinical characteristics, management, outcomes and prognostic factors

Background

Intraocular foreign bodies (IOFBs) are an important cause of visual loss within the group of working age population. We aim to present the clinical features and the algorithm according to which we manage the foreign bodies that are located in the posterior segment of the eye. We define the outcomes and the prognostic factors that influenced the final visual acuity and globe survival in patients with IOFBs that we extracted by pars plana vitrectomy (PPV) over a 5-year period.

Methods

We reviewed the medical records of all the cases with IOFBs that we removed by PPV, over 5 years (2009–2013). We extracted the following parameters: age, gender, wound anatomy, IOFB characteristics, ocular lesions, initial and final visual acuities. We used the program SPSS version 20.0.0. for the statistical analysis of our data.

Results

During 5 years, we treated 21 IOFBs by PPV, representing 12.20 % of all the open globe injuries. All the patients were males with the median age of 36 years. The foreign body was located in the vitreous - 11 cases (52.38 %), retina - seven cases (33.33 %) and perforating - three cases (14.28 %). Retinal detachment (RD) at presentation was identified in eight cases (38.09 %) and endophthalmitis, in six cases (28.57 %). The visual outcome was significantly worse in patients with RD at presentation (p = 0.012) and with IOFBs larger than 3 mm (p = 0.042). Endophthalmitis did not influence the visual outcome.

Conclusions

The worse prognostic factors were: RD at presentation and large foreign body.

Trial registration number

IRCT2015040418966N3 / Apr. 9/2015

Intraocular glass foreign body-Retained amiss!

Open globe injuries with intraocular foreign bodies are important cause of visual morbidity. Timely detection of foreign body is must to improve the visual outcome and to prevent eye from developing complications. It is important to understand the need of meticulous history taking and thorough examination besides other investigations to detect foreign body. Glass foreign bodies are little difficult to visualize because of its transparent nature. The best time to detect foreign body is at the time of primary repair. Until one suspects the presence of foreign body, it is missed most of the time. We chose to report this case as it is unusual to miss big IOFB in anterior chamber impacted in lens matter at the time of primary corneal repair. It is important to remember that an ounce of vigilant vision is worth a pound of care.

Pellet impaction at identical site in both orbits

Intra orbital foreign bodies are relatively uncommon and constitute 2.9% of ocular injuries. Pellet injury of orbit is also uncommon and constitutes 2.4% of orbital injuries We present an unusual case of bilateral orbital pellet injury where both the pellets were seen at identical positions in both orbits.

Surveillance of intraocular foreign bodies in the UK

AIMS

To estimate the incidence of penetrating injuries with retained intraocular foreign bodies (IOFBs) in the United Kingdom, and to provide epidemiological data on the aetiology, management, and visual outcome of such injuries.

METHODS

Cases were identified prospectively by active surveillance through the British Ophthalmological Surveillance Unit reporting card system, for the 12-month period June 2004 to May 2005 inclusive. Questionnaire data were obtained from UK ophthalmologists at presentation and 6 months following presentation.

RESULTS

Data were available on 97 patients at presentation and 95 patients at follow-up. The minimum estimated incidence of IOFBs in the United Kingdom identified in this study was 0.16 per 100 000. All patients were male. Hammering was the most common mechanism of injury, occurring in 62% of patients. The IOFB was found in the anterior segment in 24%, the posterior segment in 73%, and involved both segments in 3%. Endophthalmitis was diagnosed in 9% of patients. Best-corrected visual acuity of the injured eye at final follow-up was 6/12 or better in 67%, 6/18 to 6/60 in 11%, and worse than 6/60 in 22%. Prognostic factors for a poor visual outcome included poor visual acuity at presentation, prolapse of intraocular tissue, development of endophthalmitis, development of retinal detachment, and large size of IOFB.

CONCLUSIONS

The incidence of IOFB in the United Kingdom appears to have reduced compared to previous studies. The majority of patients (67%) retain good visual acuity in the injured eye; however, a significant minority (22%) sustain long-term severe visual loss.

Phthisis bulbi with a large protruding foreign body--a rare complication of penetrating injuries

Spontaneous extrusion of a retained intraocular foreign body is a rare occurrence. An unusual case is described in a 30-year-old male, where a foreign body remained in the eye for four years and then, as phthisis set in, the foreign body gradually extruded, causing constant irritation of the upper lid. Such a situation has not been documented before. Its management along with the histopathologic features are discussed in the light of the available literature.

Intraocular foreign bodies: management, prognostic factors, and visual outcomes

OBJECTIVE

To determine prognostic factors and visual outcomes in patients with intraocular foreign bodies (IOFBs).

DESIGN

Retrospective, noncomparative, interventional case series.

PARTICIPANTS

Fifty-nine consecutive patients undergoing removal of an IOFB with a minimum of 6 months of follow-up.

INTERVENTION

Surgical removal of the IOFB and repair of associated ocular trauma.

MAIN OUTCOME MEASURES

Final best corrected visual acuity was the main outcome measured. Ocular findings at presentation were compared with final visual acuity to determine prognostic factors for visual outcome.

RESULTS

Final best corrected visual acuity of 20/40 or more was obtained in 42 patients (71%) and ambulatory vision (>5/200) was achieved in 50 patients (85%). Presenting visual acuity was predictive of final visual outcome (P < 0.01). Prognostic factors for a better visual outcome (P < 0.05) included better presenting visual acuity and hammering metal on metal as the mechanism of injury. Prognostic factors for a poor outcome (P < 0.05) included poor presenting visual acuity, the presence of an afferent pupillary defect, and vitreous hemorrhage.

CONCLUSIONS

Final visual outcomes were excellent in 71% of patients. Presenting visual acuity was the strongest predictor of final visual outcome in this series. Additional predictive factors included the mechanism of injury, the presence of an afferent pupillary defect, and vitreous hemorrhage.

Controversies in the management of open-globe injuries involving the posterior segment

There are numerous unresolved issues and controversies regarding the management of open-globe injuries involving the posterior segment. These areas include, but are not limited to, the following issues. Although vitrectomy has been shown to improve visual outcomes and allow retention of the eye in many cases, the extent of visual improvement is often limited because of the nature of the injury. Timing of vitrectomy surgery has been and will continue to be debated by proponents of early versus delayed intervention. The multiple features of acute ocular injury make it very difficult to interpret retrospective data regarding the most appropriate timing for surgical intervention. The use of prophylactic cryotherapy, in the setting of a scleral laceration with possible retinal damage, is not as controversial at present, as there is now sufficient data indicating that cryotherapy may actually exacerbate intraocular proliferation and worsen the situation. The role and benefit of a prophylactic scleral buckle is very widely contested, and it is not known if it truly decreases the risk of subsequent retinal detachment. Another area of debate centers on the use of antibiotics. When there is a known clinical infection, intravitreal antibiotics are the mainstays of therapy. However, in the absence of clinical infection, the use of prophylactic antibiotics and their routes of administration are quite controversial. Although there are significant data regarding the use of antibiotics in the postoperative setting, this information cannot be extrapolated into the setting of open-globe injuries, as organisms and virulence factors differ. Similarly, the use of vitrectomy versus vitreous tap in the setting of traumatic endophthalmitis is not fully resolved, although vitrectomy is used in most cases to repair concurrent damage from the injury itself. Finally, the placement of intraocular lenses in the acute trauma setting is controversial, as the risk of complications is quite high. Prospective, controlled clinical studies have not been done. This article reviews pertinent data regarding these management issues and controversies, and provides recommendations for treatment based on the available published data and the authors' personal experience.

Eyelid foreign body mimics an intraocular foreign body on plain orbital radiography

Localization of a foreign body detected on plain orbital radiography may be achieved by comparing radiographs taken with the eyes in upgaze and downgaze. Movement of the foreign body with ocular rotation is considered to indicate localization either within the globe itself or within the soft tissues of the orbit closely related to the globe. A case is reported that demonstrates that this radiologic feature may also occur when a foreign body is located within an eyelid because the position of the eyelids also changes on vertical eye movements. An eyelid foreign body may therefore mimic an intraocular foreign body on plain orbital radiography.

Visual outcome and prognostic factors after magnetic extraction of posterior segment foreign bodies in 40 cases

AIMS

To evaluate the clinical features as well as the visual and anatomical outcome in eyes with magnetic posterior segment foreign bodies, to identify prognostic factors after removal using an electromagnet.

METHODS

The records of 40 patients with posterior segment foreign bodies were retrospectively reviewed for 6 years (1989-94). Post-traumatic cataracts and secondary retinal detachments were treated using conventional surgical techniques. Pars plana vitrectomy was used only for late complications. The mean follow up was 30 months (6-71). Clinical factors were studied using univariate analysis.

RESULTS

The most common findings before treatment of these 40 eyes were lens wound, hyphaema, vitreous haemorrhage, and retinal impairment. The foreign body was in the vitreous (85%) or minimally embedded in the retina (15%). Initial visual acuity was worse or equal to 20/40 in 70% of the cases. Subsequent to surgical treatment, a cataract was reported in 60% of the patients. Postoperative complications included retinal detachment (15%) and phthysis (5%). The prognosis was worse in cases with intraocular foreign body of largest diameter > or = 3 mm, an initial visual acuity less than 20/200, or the presence of post-traumatic retinal detachment. Presence of initial intravitreous haemorrhage, hyphaema, or intraocular tissue prolapse did not appear to affect the prognosis.

CONCLUSION

The long term visual acuity results indicated that wound repair associated with conventional magnet extraction in an emergency is a viable treatment for posterior segment magnetic foreign bodies in this selected group. At the time of diagnosis, size of foreign body (< 3 mm) and initial visual acuity > or = 20/200 were predictors of good visual outcome after primary magnetic extraction.

Lens preservation after intraocular foreign body injuries

PURPOSE

Ocular missile injuries often involve the lens. Some have suggested that lens capsular violation by a foreign body is an indication for immediate lens removal. Sometimes, however, the resultant lens opacity may remain localized without visual compromise. The authors report a series of patients who had lens capsular disruption from an intraocular foreign body that resulted in visually insignificant lens opacities.

METHODS

A series of five patients with lens capsular disruption as a result of an intraocular foreign body injury were reviewed retrospectively.

RESULTS

All five patients had lens injury from a small foreign body in a peripheral lenticular location. In three patients the foreign body was intralenticular, whereas in the other two patients the foreign body transversed the lens and was located in the posterior segment. In two patients, the foreign body was not removed. Three of the patients required pars plana vitrectomy. In all patients, final visual acuity was at least 20/40, and the lenticular opacity remained localized to an eccentric location.

CONCLUSIONS

A progressive, visually significant cataract is not the inevitable result of lens injury by an intraocular foreign body. When indicated, surgical removal of the foreign body may be attempted using a lens-sparing procedure.

Intraocular foreign body missed by radiography

Images

Localisation of corneal foreign bodies

Of 50 patients attending the eye casualty department with a corneal foreign body (FB), 41 were able to say where they felt the FB and 78% of these were localised correctly for side or level of cornea. Patient handedness did not influence FB location. Indicating the upper lid was a particularly poor guide to localisation, whereas FB sensations within the palpebral fissure, in the lower lid or medially or laterally were good guides to actual FB location. A simple method of recording FB location by zone and clock hour is proposed.

The management of intraocular foreign bodies

This study of 69 cases of retained intraocular foreign body confirms that eyes with anterior segment foreign bodies fare better than those with posterior segment foreign bodies, that eyes with smaller foreign bodies fare better than those with larger, and that the magnet is the safest method of removal. There is no evidence to support primary vitrectomy in every case of posterior segment foreign body. Computerised tomography is the best method of localisation, but a foreign body can be missed on computerised tomography, and a plain x-ray is still the best method of detection.

Prognosis of perforating eye injuries with intraocular foreign bodies

The long-term results of 95 consecutive eyes with a perforating eye injury and an intraocular foreign body (IOFB) treated with or without pars plana vitrectomy are reported. With the mean follow-up time of 30.0 months (median 22.8 months) 10 eyes (11%) were enucleated and another 17% became blind (visual acuity less than 0.05). The enucleation rate was considerably decreased and the visual outcome improved as compared with previous studies in Finland. The visual outcome was affected unfavourably by posterior location of the perforation, blunt injury, prolapse of intraocular tissue and poor initial visual acuity. There was no significant difference in the visual outcome between eyes with posterior segment IOFBs treated with or without vitrectomy. In the posterior perforation group the visual outcome was slightly better in eyes in which vitrectomy was performed (P = 0.336), and early vitrectomy within 1 week gave best visual results (P = 0.692). In 79% of the non-enucleated eyes the retina was attached. The anatomic success rate was similar regardless of the timing of vitrectomy.

Results and prognostic factors in penetrating ocular injuries with retained intraocular foreign bodies

Of 105 eyes with ocular injuries involving retained intraocular foreign bodies, 63 (60%) had a final visual acuity of 20/40 or better; 20 (19%) were 20/50 to 5/200; and 15 (14%) were worse than 5/200. Six eyes (6%) were enucleated. The extent of visual recovery was limited in selected cases by the characteristics of the initial injury. Multivariate analysis was used to identify prognostic factors. Predictive of a good visual outcome (greater than or equal to 20/40) were: (1) initial visual acuity better than 20/40 and (2) the need for only one or two operations in the treatment of the injury. Predictive of a poor visual outcome (less than 5/200) were: (1) initial visual acuity worse than 5/200 and (2) a wound 4 mm or longer in length, independent of wound location. The visual outcome in this series of patients was compared with other large series of intraocular foreign bodies reported before the development of vitreous microsurgical techniques. The percentage of patients with a visual outcome of 20/40 or better has remained the same, whereas the incidence of enucleation has diminished.

Management of intraocular foreign bodies

Thirty-five consecutive cases of perforating ocular injuries with retained intraocular foreign body (IOFB) are examined in this retrospective study. Of the 35 cases with injuries, 30 (86%) were due to metallic foreign bodies. Of these, 25 (83%) involved foreign bodies of ferromagnetic origin. Magnetic extraction in combination with pars plana vitrectomy (or when possible, magnetic extraction alone) was successfully used to remove these foreign bodies. Even in cases where posterior vitrectomy is indicated, magnetic extraction allows good control of the foreign body during removal minimizing surgical trauma and the subsequent postoperative inflammatory response.

A 6 1/2-years survey of intraocular and intraorbital foreign bodies in the North-west Frontier Province, Pakistan

A survey of 198 patients (210 eyes) with intraocular or intraorbital foreign bodies is presented. Most were males between 16 and 30 years of age, and 6.1% of cases were bilateral. The commonest cause was a flying particle while using a hand hammer, followed by fragments of bomb and mine blasts. Intraorbital foreign bodies occurred in 78 eyes and intraocular foreign bodies in 132 eyes. Irreparable damage caused 13 eyes (6.2%) to be enucleated. Ten eyes developed severe endophthalmitis or panophthalmitis requiring evisceration. One hundred and thirty-four (63.8%) foreign bodies were removed, and 76 (36.2%) foreign bodies could not be removed. The causes of non-removal, the various complications, and the pattern of foreign bodies in the eye or orbit in Pakistan are discussed and compared with those of other regions.

Long-term visual acuity results after penetrating and perforating ocular injuries

Of 33 consecutive patients (30 males and three females, ranging in age from 5 to 48 years) with penetrating ocular injuries, 13 had retained metallic intraocular foreign bodies. The remaining 20 had no retained foreign bodies and their injuries were generally more severe lacerating or double perforating injuries. Magnet extraction was used for foreign body extraction when possible, and pars plana posterior vitrectomy was used only for late complications. The long-term visual acuity results indicated that wound repair, conventional magnet extraction, and removal of traumatic cataract and anterior vitreous blood through a limbal incision is still a viable treatment for many such injuries.

The visual prognosis of a perforation of the eyeball: a retrospective study

In the literature there is agreement about the variable prognosis of an ocular perforation, but analysis of the factors which affect the prognosis is rare. In this article the factors which determined the final visual in 60 perforation cases are discussed. One third of the total number of eye lost useful vision (visual acuity less than 0.1) while 43% retained good sight (visual acuity greater than 0.8). The visual outcome is considered for each prognostic factor. It is striking that the three most unfavourable prognostic factors often occur together: a traffic accident, a large to extremely large perforation and a corneo-scleral localization. Suggestions for the prevention of the most frequent causes are made, and early therapeutic measures are described which should be able to be performed in every large clinic.

A 10-year survey of eye injuries in Northern Ireland, 1967-76

Ocular injuries of sufficient severity to necessitate admission to the Eye and Ear Clinic, Royal Victoria Hospital, Belfast, were sustained by 1707 male patients and 325 female patients. Blunt injury occurred in 1063 eyes (49.2%), perforating injury in 1037 (48%), and intraocular or intraorbital foreign bodies in 181 eyes (8.4%). More than three-quarters of the patients (77.4%) were less than 36 years of age and 84% of all injuries occurred in males. Normal visual acuity (6/6 or better) was regained by 41.2% of the patients in whom the final visual outcome was known. The benefit of wearing seat belts in road vehicles and protective goggles in industry and sport should receive more publicity on radio and television and via poster campaigns. Compulsory fitting of laminated windscreens in all road vehicles is recommended. The vulnerability of children to ocular injury should be highlighted through the mass media, schools, and health centres.

Vitrectomy in the management of intraocular foreign bodies and their complications

Twenty-six eyes with intraocular foreign bodies (IOFB) and/or their sequelae were treated by pars plana vitrectomy and associated surgery. One-step removal of the IOFB in combination with pars plana vitrectomy resulted in early visual rehabilitation and minimal complications. Of 11 eyes with IOFB treated by primary vitrectomy at the time of IOFB removal 20/50 or better visual acuity was obtained in 10 (91%). Four of these eyes had retinal injury, 3 of which were successfully repaired without subsequent complication and with retention of good visual function. In 3 eyes IOFBs were not removed owing to chronic retinal encapsulation. These eyes continue to retain good visual acuity, and ERG studies show no evidence of retinal toxicity. Of 12 eyes in which vitrectomy was performed for sequelae of IOFB only 5 (41%) showed visual improvement better than 20/50. Only in 2 of 7 eyes with tractional retinal detachment could the retina be reattached. In cases of retinal injury primary vitrectomy, cryocoagulation, and scleral buckling are suggested for prevention of late traction retinal detachment.

Ultrastructure of traumatic cataractogenesis in the frog: a comparison with mouse and human lens

Normal and needle-punctured lenses of Rana pipiens were examined with the electron microscope in order to characterize the sequence of ultrastructural changes that follow the injury over a 5-month period. Results were compared with those obtained previously in experimentally injured mouse and accidentally injured human lenses. The normal adult frog lens was found to have a morphology similar to that of mammalian lenses. As in the human, frog lens epithelial cells contained scattered microfilaments and were connected by desmosomes and gap junctions. They differed from mouse cells, which had been shown to lack desmosomes and to have microfilaments organized into dense bundles. These differences are postulated to be related to the degree of accommodative deformation of the lens displayed by these species. After injury, cellular debris and fibrin, accumulated in the wound, were phagocytized by extrinsic cells derived from the blood and ocular tissues. Leucocytes, pigmented cells and fibroblasts remained in the wound for eight weeks, along with epithelial cells which proliferated and migrated from the wound margins.Epithelial cells showed an increase in those organelles associated with protein synthesis and transport, and in microfilaments. In cataractous lenses, epithelial cells showed changes in matrix, and lens fibers became organized into smaller, denser compressed units. At five months, considerable healing had taken place, but localized opacities persisted in many frog lenses.

Vitrectomy in the treatment of ocular perforating injuries

Using pars plana (closed) vitrectomy with related procedures we achieved improved vision in certain catagories of perforating ocular injuries. These procedures were particularly useful in removing retained nonmagnetic foreign bodies and correcting retinal detachments associated with traction bands and opaque vitreous. Limited success was obtained with longstanding injuries, double perforations from shotgun injuries, and large corneoscleral lacerations. Early vitreous surgery produced the best results.

Ultrastructural studies of traumatic cataractogenesis: observations of a repair process in mouse lens

Lenses of CFI mice were studied with the transmission electron microscope at frequent intervals through 13 months following a transcorneal needle injury to the lens. While this kind of injury causes a high incidence of traumatic cataract in the human and frog, it elicits a repair process in the mouse lens whereby the damaged capsule, epithelium and lens fibers are rapidly renewed and permanent lens opacity seldom occurs. Ultrastructural changes in lens epithelial cells adjacent to the wound, which precede and accompany localized cellular proliferation and production of new capsule, involve a rapid increase or enlargement of organelles associated with protein synthesis and assembly. The capsule and epithelium are repaired within a couple of months. Cortical lens fibers in the wound area undergo conformational changes into smaller, ordered arrays of "membranous sacs". These are replaced within a week by normal appearing lens fibers. There is minimal degeneration or hyperplasia noted, and except for a few fibroblastic cells on the lens surface, little evidence remains of the injury by two months. Ultrastructural differences between mouse and human lens, such as presence or absence of dense bundles of microfilaments and desmosomes are considered in relation to lens shape and tension, and susceptibility to injury-induced cataract.

Two remarkable events in the field of intraocular foreign body: (1) The reversal of siderosis bulbi. (2) The spontaneous extrusion of an intraocular copper foreign body

Two unusual events concerning intraocular foreign bodies are presented. The first patient had an occult or unsuspected intraocular foreign body. He showed iridoplegia with mydriasis, siderosis iridis, and an intraocular piece of iron lying posteriorly near the retina. The foreign body was removed and the patient regained normal iris color and pupillary activity. His vision remains 20/15 six years postoperatively dispite ensuing retinal detachment one year after removal of the foreign body. The second patient was a young boy injured by a blasting cap explosion. He lost one eye from the injury and had a piece of intraocular brass in his left eye. In spite of the development of chalcosis and a mature cataract the lens gradually shrank in the pupillary space permitting a clear aphakic area and 20/25 vision. The brass fragment migrated forward and inferiorly and was finally extruded under the conjunctiva five years later, where it was removed and chemically analyzed by x-ray diffraction.