|Year : 1983 | Volume
| Issue : 4 | Page : 417-420
Techniques in the removal of retained intraocular foreign body
K Ravishankar, SS Badrinath
Sankara Nethralaya Medical Research Foundation Madras, India
Sankara Nethralaya 18 College Road, Madras-6
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Ravishankar K, Badrinath S S. Techniques in the removal of retained intraocular foreign body. Indian J Ophthalmol 1983;31:417-20
|How to cite this URL:|
Ravishankar K, Badrinath S S. Techniques in the removal of retained intraocular foreign body. Indian J Ophthalmol [serial online] 1983 [cited 2020 Aug 5];31:417-20. Available from: http://www.ijo.in/text.asp?1983/31/4/417/27569
Eyes with retained intraocular foreign bodies carry ultimately a relatively poor prognosis due to toxicity from the chemical nature of the foreign body and the associated perforating injuries like cataract, vitreous haemorrhage, vitreous organization. infection and retinal detachment. Conventional techniques are not always helpful in extraction of the retained intraocular foreign bodies and the associated complications. Pars plana surgery has opened a new route for their removal and yields better functional results in such complex cases.
| Materials and methods|| |
The technique and results in 10 eyes with retained intraocular foreign bodies which were removed by pars plana surgery at Sankara Nethralaya, Madras over a period of 22 years from February 1980 to June 1982, is presented. Most of the patients were in the age group of 20-30 years and all were males [Table - 1].
In 5 cases, the injury occurred while at work with hammer and a chisel : in 2 cases. due to cracker injuries and in the other 3 cases. the mechanism of injury were not known. The foreign body could be localised by the indirect ophthalmoscopy in 2 eyes and by ultrasonography in another 2 eyes. Both these techniques helped in assessing any associated trauma to the other structures. Plain x-ray of the orbit helped in locating the foreign body in 6 eyes. Pars plana surgery was done in all the cases, the indications being vitreous haemorrhage, foreign body reaction with fibrosis, endophthalmitis and retinal detachment. Preoperative evaluation showed vitreous haemorrhage in 6 eyes, foreign body reaction with fibrosis in 4 eyes, retinal detachment in 2 eyes and siderotic deposits in the corneal endothelium in 1 eye [Table - 2]. In all the cases, varying degrees of cataract was present. The interval between the date of injury to the date of foreign body removal varied from 13 days to 22 years. In all the cases, the foreign body was found to be in the posterior segment either in the vitreous cavity or on the retina.
| Technique|| |
All the foreign bodies were approached through the pars plana and depending upon their size and shape, removed either through the pars plana or the limbus [Table - 3]. Three sclerotomies 3.5 mm. from the limbus were made for the ocutome probe, endoilluminator and the infusion cannula. The lens was removed in all the ten cases either because it was cataractous or obstructed the view of the posterior segment A subtotal vitrectomy was done in all the cases. The opaque vitreous was cut and removed until the foreign body was visualized. The foreign body was then freed from the surrounding adhesions by performing a careful vitrectomy close to the foreign body. The sclerotomy site was then enlarged with a superblade to accommodate the intra vitreal forceps of Medical Workshop, Holland, which was used to grasp and remove the foreign body under direct visualization. The fibreoptic light pipe provided an excellent reflex free visualization which allowed precise movements of the instruments near the retina. In the 2 eyes. where the foreign body was large and irregular in size and shape and could not be removed through the pars plana route, a limbal incision was made, the foreign body brought to the anterior chamber through the transpupillary space and then removed. In 1 eye, the foreign body was situated in the subconjunctival space in the Tenons tissue, but was thought to be intraocular preoperatively. Scleral buckling was done in 3 eyes at the time of foreign body removal where retinal detachment was noted either preoperatively or on the table. Scleral buckling was done in another 3 eyes, where retinal detachment was detected postoperatively.
| Observations|| |
Out of 4 eyes where lensectomy, vitrectomy and intraocular foreign body removal was done, 3 eyes showed a final visual recovery of 6/ 12 or more. 1 eye showed a visual recovery of 6/24 where scleral buckling was [Table - 4]. In 5 eyes, the visual recovery was poor due to macular pucker and inoperable retinal detachment which was due to massive vitreous retraction in 2 eyes and a giant retinal tear with a tractional retinal detachment in 1 eye. One patient did not come for follow up after the surgery. Complications which occurred during and following surgery were retinal hole in I eye, retinal tears with a retinal detachment in 4 eyes and a giant tear with a tractional retinal detachment in l eye. Scleral buckling was done in 6 cases in 3 cases the retina was attached ; in 2 cases the retina was redetached and in 1 case there was failure of follow up.
| Discussion|| |
In any case of an opaque vitreous with a retained intraocular foreign body, vitrectomy should be performed and the foreign body removed by using various forms of intravitreal forceps., In our series also, the opaque media which was due to either vitreous haemorrhage, foreign body reaction with fibrosis or endophthalmitis, vitrectomy was done followed by the removal of the foreign body.
Corneoscleral incisions are usually preferred for removing foreign bodies when the foreign body is very large or irregular in shape, as it is undesirable to make very large opening in the pars plana.
Extractions of a magnetic foreign body by conventional means as with the help of an electromagnet is no longer as useful as it was thought to be in the past. The direction and the strength of the magnetic attraction is not always predictable and controlled. There is usually some damage to the eyes due to the injury and by trying to remove the foreign body by a magnet, it will only cause aggravation of the conditions due to the unpredictable results with the magnet. Moreover, electromagnet is not useful in cases of opaque vitreous and in nonmagnetic foreign bodies.' Eventhough 5 of the foreign bodies were magnetic, we preferred to use the intravitreal forceps.
| Summary|| |
The technique and results of intraocular foreign body removal in 10 eyes is presented. The management of associated problems like retinal detachment, vitreous haemorrhage is described. The results and the advantage of this technique over conventional methods are discussed.
| References|| |
William Hutton : Management I.O.F.B. by P.P. Vitrectomy; In Ocular Trauma (H. Mackenzie Freeman) 202, 1979.
Steve Ryan and Boyd : Contributions and Techniques of vitrectomy; Management of trauma, I.O.F.B: In Highlights of Ophthalmology, Benjamin F Boyd, Volume I (25th) Silver anniversary edition, 74.
William H. Havener, Salli C. Gloeckner; Atlas of diagnostic technique and treatment of I.O.F.B. 76, 1979.
Stallard's Eye surgery, 6th edition, 783.
[Table - 1], [Table - 2], [Table - 3], [Table - 4]