Home Print this page Email this page Users Online: 243
Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Subscribe Contacts Login 


 
 Table of Contents  
BRIEF COMMUNICATION
Year : 2021  |  Volume : 9  |  Issue : 3  |  Page : 136-138

Posterior-segment intraocular foreign body removal preserving intraocular lens – A novel technique


Department of Retina, Matashree Netralaya, Bhopal, Madhya Pradesh, India

Date of Submission07-Aug-2020
Date of Decision24-Feb-2021
Date of Acceptance03-Mar-2021
Date of Web Publication27-Sep-2021

Correspondence Address:
Chahveer Singh Bindra
E-4/158 Arera Colony, Bhopal - 462 016, Madhya Pradesh
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jcor.jcor_153_20

Rights and Permissions
  Abstract 


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 2021 Nov 30];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).[1] Poor prognostic factors are poor visual acuity at presentation, large size of IOFB, posterior-segment IOFB, presence of retinal detachment, and endophthalmitis at presentation.[2] Postoperative retinal detachment, endophthalmitis, and proliferative vitreoretinopathy are noted to be late complications of IOFB.[3] 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[4] or 25G[5] vitrectomy has been employed for posterior-segment IOFB removal. Small and medium-sized IOFBs are normally removed through the sclerotomy.[6] However, enlarging sclerotomy is associated with complications such as hypotony, vitreous incarceration, and retinal detachment.[7],[8] 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.[6] 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 Top


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)

Click here to view



  Discussion Top


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.[9] Furthermore, technique of “magnet handshake” for removal of IOFB through sclerocorneal tunnel has been described.[10] 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.[10] 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

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Dannenberg AL, Parver LM, Brechner RJ, Khoo L. Penetration eye injuries in the workplace. The National Eye Trauma System Registry. Arch Ophthalmol 1992;110:843-8.  Back to cited text no. 1
    
2.
Bai HQ, Yao L, Meng XX, Wang YX, Wang DB. Visual outcome following intraocular foreign bodies: A retrospective review of 5-year clinical experience. Eur J Ophthalmol 2011;21:98-103.  Back to cited text no. 2
    
3.
Szijártó Z, Gaál V, Kovács B, Kuhn F. Prognosis of penetrating eye injuries with posterior segment intraocular foreign body. Graefes Arch Clin Exp Ophthalmol 2008;246:161-5.  Back to cited text no. 3
    
4.
Yuksel K, Celik U, Alagoz C, Dundar H, Celik B, Yazıcı AT. 23 gauge pars plana vitrectomy for the removal of retained intraocular foreign bodies. BMC Ophthalmol 2015;15:75.  Back to cited text no. 4
    
5.
Kunikata H, Uematsu M, Nakazawa T, Fuse N. Successful removal of large intraocular foreign body by 25-gauge microincision vitrectomy surgery. J Ophthalmol 2011;2011:1-4.  Back to cited text no. 5
    
6.
Yeh S, Colyer MH, Weichel ED. Current trends in the management of intraocular foreign bodies. Curr Opin Ophthalmol 2008;19:225-33.  Back to cited text no. 6
    
7.
Wani VB, Al-Ajmi M, Thalib L, Azad RV, Abul M, Al-Ghanim M, et al. Vitrectomy for posterior segment intraocular foreign bodies: Visual results and prognostic factors. Retina 2003;23:654-60.  Back to cited text no. 7
    
8.
Tomic Z, Pavlovic S, Latinovic S. Surgical treatment of penetrating ocular injuries with retained intraocular foreign bodies. Eur J Ophthalmol 1996;6:322-6.  Back to cited text no. 8
    
9.
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. 9
[PUBMED]  [Full text]  
10.
Dhoble P, Khodifad A. Combined cataract extraction with pars plana vitrectomy and metallic intraocular foreign body removal through sclerocorneal tunnel using a novel “Magnet Handshake” technique. Asia Pac J Ophthalmol (Phila) 2018;7:114-8.  Back to cited text no. 10
    


    Figures

  [Figure 1]



 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
Abstract
Case Report
Discussion
References
Article Figures

 Article Access Statistics
    Viewed156    
    Printed4    
    Emailed0    
    PDF Downloaded21    
    Comments [Add]    

Recommend this journal