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BRIEF COMMUNICATION
Year : 2019  |  Volume : 7  |  Issue : 1  |  Page : 22-24

Multiple retained intraocular glass foreign body with late-onset retinal detachment


Sankara Eye Centre, Coimbatore, Tamil Nadu, India

Date of Submission10-Sep-2017
Date of Acceptance07-Dec-2018
Date of Web Publication12-Mar-2019

Correspondence Address:
Prabhushanker Mahalingam
Sankara Eye Centre, Sathy Road, Sivanandapuram, Coimbatore - 641 035, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jcor.jcor_101_17

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  Abstract 


Successful management of intraocular foreign body (IOFB) is deemed possible by the advent of superior surgical procedures, even in those patients who present late. We report a case of a 46-year-old male, who presented with sudden onset of defective vision in his right eye of 2 days duration and with a previous history of trauma following bulb blast at the age of 5 years. Examination revealed retinal detachment with multiple intraocular glass foreign body in his right eye. The primary management, in this case, was phaco-aspiration of lens through limbal tunnel, scleral buckling, 23G pars plana vitrectomy, IOFB removal through anterior segment, endolaser, and silicone oil injection. After 6 months, silicone oil was removed, and posterior chamber intraocular lens was implanted. This is a rare case wherein multiple glass IOFBs had remained quiescent in the eye for more than four decades resulting in retinal detachment at a later date and successful management with good visual outcome was possible.

Keywords: Intraocular glass foreign body, pars plana vitrectomy, retinal detachment


How to cite this article:
Mahalingam P, Topiwalla T, Ganesan G. Multiple retained intraocular glass foreign body with late-onset retinal detachment. J Clin Ophthalmol Res 2019;7:22-4

How to cite this URL:
Mahalingam P, Topiwalla T, Ganesan G. Multiple retained intraocular glass foreign body with late-onset retinal detachment. J Clin Ophthalmol Res [serial online] 2019 [cited 2019 Sep 15];7:22-4. Available from: http://www.jcor.in/text.asp?2019/7/1/22/253986



Intraocular foreign bodies (IOFBs) have been found to be present in up to 40% cases with ocular trauma.[1] Penetrating ocular trauma with a retained IOFB, even though managed efficiently, may still carry a poor prognosis. The presence of IOFB can further be complicated by the development of retinal detachment, uveitis or the most dreaded of all, endophthalmitis. Pars plana vitrectomy remains the leading method for the surgical management of IOFB.[2],[3] Like any other surgery, the management of such cases also requires thorough preoperative workup and patient counseling.

We are reporting this case for being rare with the presence of retained IOFB for a long quiescent period of more than four decades and causing retinal detachment at a later date. The patient was managed successfully with good visual outcome till the end of the 1-year follow-up.


  Case Report Top


A 45-year-old known diabetic male patient visited our hospital with complaints of sudden onset defective vision in the right eye for 2 days. His best-corrected visual acuity in the right eye was 4/60 and 6/12 in the left eye. His intraocular pressures were 13 and 15 mm of Hg in the right and left eyes, respectively. Anterior segment examination revealed no abnormality. Dilated fundus examination of the right eye showed inferotemporal retinal detachment involving the macula with retinal breaks and a chorioretinal scar in the inferior retina with multiple intraocular glass foreign body in the vitreous cavity. The left eye was normal. B-scan showed the presence of IOFBs with retinal detachment in the right eye [Figure 1]. On further probing, the patient gave a history of bulb blast in childhood at the age of 5 years. He only had redness after trauma and was treated with topical medications, the details of which are not known.
Figure 1: The B-scan report of the right eye suggestive of retinal detachment along with intraocular foreign bodies

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The management strategy decided was phaco-aspiration of lens through limbal tunnel, scleral buckling, 23G pars plana vitrectomy, primary posterior Capsulotomy, IOFB removal through anterior segment, endolaser, and silicone oil injection.

Preoperative routine hematological investigations were done, and physician's fitness was obtained. The surgery was performed as planned. Intraoperatively, four glass foreign bodies were found in the vitreous cavity which were removed initially through a 3–4 mm posterior capsulotomy, and then, the limbal tunnel [Figure 2]. Postoperatively, the patient was started on prednisolone acetate eye drops 1% six times a day, gatifloxacin eye drop 0.03% six times a day, cyclopentolate eye drop three times a day. On the first postoperative day, the patient's intraocular pressure was 16 mmHg. Anterior segment examination showed mild chemosis. On fundus examination, retina was attached. The patient was continued on the same medications and was reviewed after 1 week. At 2 weeks' follow-up, the uncorrected visual acuity was 3/60. The topical medications were tapered. The patient was reviewed after a month. The best-corrected visual acuity improved to 6/36 with +8D sphere. Retina remained attached, and the patient was continued on same medications. At 45 days' review, the best-corrected visual acuity remained stable at 6/36.
Figure 2: The intraoperative picture during pars plana vitrectomy with removal of the glass foreign body through the limbal route

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After 6 months, a second surgery was performed, where silicone oil was removed, and secondary posterior chamber intraocular lens (IOL) implantation in the sulcus was done using a single-piece polymethylmethacrylate IOL. Surgery was uneventful. Postoperatively, the patient was continued on topical antibiotics and steroids. After 15 days, the patient was reviewed. The best-corrected visual acuity was 6/36 with −2 D sphere. The anterior segment was normal, and retina was attached. At 1 month, the best-corrected visual acuity improved to 6/18 with −2 D sphere and near vision of N8 with +2.5 D near addition. Intraocular pressure remained normal throughout the follow-up period. At 1 year, the patient maintained the best-corrected visual acuity of 6/18 with attached retina.


  Discussion Top


The presence of IOFB is fraught with various technical limitations and difficulties. The prognosis depends on a lot of factors including the type of foreign body, whether metallic or inert, the size of foreign body and the location inside the eye, presence of other complications such as retinal detachment, the availability of modern surgical instrumentation, and the expertise of the surgeon.[1] Before the advent of modern-day vitrectomy systems, all inert or glass IOFBs were mainly managed conservatively. Surgical removal of IOFB is an unpredictable surgery, but with the improvement and advancement in surgical techniques, the removal of IOFB is now associated with better prognosis.[2] A detailed history is important to determine the time of injury, mode of injury, and the composition of the expected IOFB.[4] Special emphasis should be given on the decision about proper surgical planning. If more than one surgery is planned, then it is imperative to counsel the patient for the same.

Preoperatively, rigorous efforts should be made to localize all the IOFB. In the event of nonvisualization due to hazy media because of cataract, hemorrhage, or exudates, imaging modalities such as X-ray, ultrasonography, computed tomography, or magnetic resonance tomography should be employed.[5] It is also important to complete all medico-legal formalities. The development of endophthalmitis should be prevented at all costs.[6] In our case, we decided to remove the IOFB in the same surgical sitting, even though they were lying quiescent for many years because they are always a risk factor for further retinal tears and detachment. In addition, as the IOFB were in the vitreous, they were hindering the retinal view during vitrectomy and endolaser. Furthermore, performing vitrectomy was essential to attach the retina, so in one surgery, both the retinal detachment and removal of IOFB could be tackled.


  Conclusion Top


We reported a case of a 46-year-old-male who presented with sudden onset of defective vision with a previous history of trauma by bulb blast at the age of 5 years. There was the presence of multiple intraocular glass foreign body with retinal detachment. The surgery was done in two stages. Foreign-body removal with the management of retinal detachment was performed in the first stage followed by silicone oil removal with posterior chamber IOL implantation after 6 months as the second stage of surgery. Thus, good surgical outcomes are possible with the superior surgical techniques even with long duration of IOFB.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Parke DW 3rd, Flynn HW Jr., Fisher YL. Management of intraocular foreign bodies: A clinical flight plan. Can J Ophthalmol 2013;48:8-12.  Back to cited text no. 1
    
2.
Falavarjani KG, Hashemi M, Modarres M, Parvaresh MM, Naseripour M, Nazari H, et al. Vitrectomy for posterior segment intraocular foreign bodies, visual and anatomical outcomes. Middle East Afr J Ophthalmol 2013;20:244-7.  Back to cited text no. 2
[PUBMED]  [Full text]  
3.
Mahapatra SK, Rao NG. Visual outcome of pars plana vitrectomy with intraocular foreign body removal through sclerocorneal tunnel and sulcus-fixated intraocular lens implantation as a single procedure, in cases of metallic intraocular foreign body with traumatic cataract. Indian J Ophthalmol 2010;58:115-8.  Back to cited text no. 3
[PUBMED]  [Full text]  
4.
Williams DF, Mieler WF, Abrams GW, Lewis H. Results and prognostic factors in penetrating ocular injuries with retained intraocular foreign bodies. Ophthalmology 1988;95:911-6.  Back to cited text no. 4
    
5.
Babineau MR, Sanchez LD. Ophthalmologic procedures in the emergency department. Emerg Med Clin North Am 2008;26:17-34, v-vi.  Back to cited text no. 5
    
6.
Chaudhry IA, Shamsi FA, Al-Harthi E, Al-Theeb A, Elzaridi E, Riley FC, et al. Incidence and visual outcome of endophthalmitis associated with intraocular foreign bodies. Graefes Arch Clin Exp Ophthalmol 2008;246:181-6.  Back to cited text no. 6
    


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  [Figure 1], [Figure 2]



 

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