|Year : 2021 | Volume
| Issue : 3 | Page : 136-138
Posterior-segment intraocular foreign body removal preserving intraocular lens – A novel technique
Chahveer Singh Bindra, Parminder Singh Bindra, Preeti Bindra
Department of Retina, Matashree Netralaya, Bhopal, Madhya Pradesh, India
|Date of Submission||07-Aug-2020|
|Date of Decision||24-Feb-2021|
|Date of Acceptance||03-Mar-2021|
|Date of Web Publication||27-Sep-2021|
Chahveer Singh Bindra
E-4/158 Arera Colony, Bhopal - 462 016, Madhya Pradesh
Source of Support: None, Conflict of Interest: None
We report a case presenting with corneal tear with vitreous incarceration with intraocular foreign body (IOFB) impacted in the retina following hammer chisel injury. Following anterior-segment repair and anterior vitrectomy, standard 23G pars plana vitrectomy was performed, and impacted foreign body was released. Metallic IOFB was retrieved with the help of 23G magnet just behind the intraocular lens (IOL) following which serrated forceps was used for grasping. 23G magnet was now used via limbal incision to retrieve the foreign body in the anterior chamber through the preexisting posterior capsular rent. After stabilization of the anterior chamber with viscoelastic injection, IOFB extraction was done with the help of serrated forceps by extending the side port. This surgical technique appears to be safe and effective for retrieving fragile, slippery, large IOFB without explanting the IOL and extension of scleral incision with prompt recovery.
Keywords: Intraocular foreign body, magnet, magnet handshake, novel technique, trauma
|How to cite this article:|
Bindra CS, Bindra PS, Bindra P. Posterior-segment intraocular foreign body removal preserving intraocular lens – A novel technique. J Clin Ophthalmol Res 2021;9:136-8
|How to cite this URL:|
Bindra CS, Bindra PS, Bindra P. Posterior-segment intraocular foreign body removal preserving intraocular lens – A novel technique. J Clin Ophthalmol Res [serial online] 2021 [cited 2022 May 16];9:136-8. Available from: https://www.jcor.in/text.asp?2021/9/3/136/326786
Occupational eye injuries are common, accounting for more than 20% of all penetrating injuries. The majority of the patients are young males and more than 90% reporting not using safety eyeglasses. Approximately one-third of these sustain posterior-segment intraocular foreign body (IOFB). Poor prognostic factors are poor visual acuity at presentation, large size of IOFB, posterior-segment IOFB, presence of retinal detachment, and endophthalmitis at presentation. Postoperative retinal detachment, endophthalmitis, and proliferative vitreoretinopathy are noted to be late complications of IOFB. Pars plana vitrectomy (PPV) is the current treatment of choice for posterior-segment IOFB. With the advent of small-gauge vitrectomy, standard three-port 23G or 25G vitrectomy has been employed for posterior-segment IOFB removal. Small and medium-sized IOFBs are normally removed through the sclerotomy. However, enlarging sclerotomy is associated with complications such as hypotony, vitreous incarceration, and retinal detachment., Large IOFBs >4.0 mm × 4.0 mm × 4.0 mm cannot be removed through the sclerotomy and need to be removed through the scleral tunnel by sacrificing the lens. This study describes a novel technique for removing IOFB of size more than 4 mm impacted in the retina preserving the intraocular lens (IOL) and avoiding sclerotomy enlargement.
| Case Report|| |
A 48-year-old male presented with a history of hammer chisel injury with iron foreign body entering the right eye 1 day back. He was a harvester by occupation and was not using protective glasses. At presentation, best-corrected visual acuity (BCVA) was 2/60 in the right eye and 6/6 in left eye. Anterior-segment examination revealed traumatic corneal tear with vitreous prolapse from traumatic posterior capsular rent (PCR) with intact posterior chamber IOL implanted previously. Multimodal imaging analysis, including B-scan ultrasonography and X-ray orbit, revealed impacted IOFB over the retinal surface. Following anterior vitrectomy through side port to release the vitreous incarceration from corneal wound, corneal tear repair with 10-0 nylon was done. Standard 23G PPV was then performed, and impacted foreign body was released from the retinal surface. At the impacted retinal site, three confluent rows of laser barrage were done. Metallic IOFB was retrieved with the help of 23G magnet just behind the IOL following which serrated forceps was used with the other hand instead of endoilluminator to grasp the IOFB [Figure 1]a and [Figure 1]b. 23G magnet was now used via limbal incision and was directed behind the IOL to retrieve the IOFB in the anterior chamber through the preexisting traumatic PCR [Figure 1c and d]. The serrated forceps was gradually withdrawn as the metallic IOFB was attached to magnet. After stabilization of the anterior chamber with viscoelastic injection, IOFB extraction was done from the anterior chamber with the help of serrated forceps by extending the side port. The extended side port was later sutured with a 10-0 nylon suture. After checking the peripheral retina, fluid air exchange was done and nonexpansile perfluoropropane (14%) was exchanged with air. Postoperatively, antibiotics and steroids were given in tapering dose along with cycloplegics. The procedure involved uneventful corneal tear repair and IOFB removal post PPV preserving the posterior chamber IOL. There was no associated late postoperative complication. BCVA in the right eye improved to 6/9.
|Figure 1: Metallic intraocular foreign body was retrieved just behind the intraocular lens with the 23G magnet (a) and serrated forceps was used with the other hand to grasp the intraocular foreign body (b). 23G magnet was now used via limbal incision and was directed behind the intraocular lens to retrieve the intraocular foreign body in the anterior chamber through the preexisting traumatic posterior capsular rent (c). The 23G magnet was gradually withdrawn as the metallic intraocular foreign body attached to magnet (d)|
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| Discussion|| |
Surgical management of IOFB is a challenging scenario. Introduction of various newer surgical tools and techniques provides more choices to the surgeon and helps improve surgical outcomes. The challenge in this case was to remove the IOFB as early as possible without damaging the vital structures and preserving the IOL. Lifting of magnetic IOFB up to pupillary plane with magnet and then using forceps to grab and remove it through sclerocorneal tunnel has been described earlier. Furthermore, technique of “magnet handshake” for removal of IOFB through sclerocorneal tunnel has been described. In earlier surgical techniques, lens was sacrificed for removal of IOFB. 14.30% of patients were left aphakic while others were considered for either primary or secondary lens implantation. In our case, “magnet handshake” technique was used with the help of serrated forceps to guide the IOFB through existing traumatic PCR without sacrificing the implanted IOL. The use of magnet prevented advent fall of IOFB with easy retrieval to anterior chamber. This technique appears to be safe and prevents slippage of IOFB with avoidance of conjunctival dissection and large sclerotomy. Avoiding scleral extension resulted in better wound closure, with no wound-related complications.
To conclude, intraocular maneuvering with magnet and serrated forceps appears to be an effective, safe, and quick technique in the management of posterior IOFBs with intact IOL and needs further prospective studies to conclude the same. Beyond the fact that the use of magnet for lifting of the IOFB avoids major trauma to the retina, the avoidance of conjunctival dissection and extension of the scleral wound allows for minimal inflammatory reaction and prompt recovery in the postoperative stage.
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 initial s will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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