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BRIEF REPORT
Year : 2006  |  Volume : 54  |  Issue : 2  |  Page : 125-126

Iris intraocular foreign bodies; safe and successful removal through limbus


Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Ansari Nagar, New Delhi - 110029, India

Correspondence Address:
Deependra Vikram Singh
Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Ansari Nagar, New Delhi - 110029
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0301-4738.25837

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  Abstract 

Metallic iris intra ocular foreign body (IOFBs) with minimal ocular damage pose an interventional challenge.
We report safe removal of metallic intraocular foreign bodies embedded on the iris, in three cases by use of intraocular magnets. Two eyes had a clear lens with best corrected visual acuity (BCVA) of 20/20, while the third eye had a BCVA of 20/200 with siderotic cataract. Ultrasound biomicroscopy confirmed the superficial impaction of IOFB into the iris. Foreign bodies were successfully removed via the limbal route with a 20 g intravitreal magnet atraumatically in all 3 cases with preservation of their pre-operative BCVA. Case series highlights the usefulness and safety of intraocular magnet for removal of metallic iris foreign bodies in selected cases. Prior ultrasound biomicroscopy to know the actual depth of penetration of IOFB into the iris and preoperative confirmation of magnetic property of IOFB are essential.

Keywords: Intraocular foreign body, iris foreign body, magnetic, ocular trauma.


How to cite this article:
Sharma YR, Singh DV, Azad RV, Chandra P, Pal N. Iris intraocular foreign bodies; safe and successful removal through limbus. Indian J Ophthalmol 2006;54:125-6

How to cite this URL:
Sharma YR, Singh DV, Azad RV, Chandra P, Pal N. Iris intraocular foreign bodies; safe and successful removal through limbus. Indian J Ophthalmol [serial online] 2006 [cited 2020 Jun 3];54:125-6. Available from: http://www.ijo.in/text.asp?2006/54/2/125/25837

The primary goal of surgery for removal of an intraocular foreign body (IOFB) is to conserve the anatomical integrity of the eye and restore visual function. Metallic IOFBs embedding into iris are rare[1],[2],[3] and most IOFBs that penetrate the cornea or sclera usually travel to get lodged in the crystalline lens or retina. Metallic iris IOFBs with minimal ocular damage pose an interventional challenge. We report 3 eyes with iris IOFB that were successfully and safely removed with the aid of a 20 g intravitreal magnet through the limbal route.


  Case Reports Top


Case 1: A 24-year-old male presented with complaints of redness, photophobia and appearance of a white lesion in the right eye after being hit by a flying iron particle one week back while working with hammer and chisel. Best corrected visual acuity (BCVA) was 20/20 in the right eye. Slit lamp examination showed an encapsulated IOFB visible as a small whitish lesion lodged in the iris between 4 and 5 o'clock position along with a self sealed corneal entry site overlying the IOFB [Figure - 1]A.

Case 2: A 28-year-old male visited our trauma clinic with complains of gradual diminution of vision left eye and history of some injury while working with hammer and chisel 3 months back. BCVA was 20/200 in the left eye and slit lamp examination showed IOFB lodged at 2 o' clock position in the iris. The patient also had siderotic changes (rust colored deposits) on the anterior capsule of the lens and endothelium [Figure - 1]B.

Case 3: A 25-year-old male complained of photophobia and redness in the right eye after being hit by a particle while working with hammer and chisel 10 days back. He had a BCVA of 20/20 right eye with an encapsulated IOFB lodged in the iris at 2 o'clock position and an overlying entry site corneal scar [Figure - 1]C.

Indirect ophthalmoscopic fundus examination was normal in all eyes. X-ray orbit revealed a single foreign body in each case [Figure - 2]D that was confirmed as magnetic using a Roper-Hall IOFB locater .[4] Ultrasound biomicroscopy (UBM) ruled out deep impaction into crystalline lens with all three IOFBs lodged superficially in the iris (within the anterior 1/3rd of stroma).

After informed consent all patients underwent surgery for IOFB removal. Superior limbal clear corneal 3.2 mm incision was made at least 90° away from the IOFB site. After injecting Healon GV® to maintain the anterior chamber, a 20 g intravitreal foreign body magnet (Synergetics,TM inc. USA) was introduced into the anterior chamber and IOFB was gently dislodged and extracted out via the incision [Figure - 2] c, d and e. Residual Healon GV® was expressed out by irrigation. No intraoperative bleeding or iridodialysis was noticed. The postoperative follow up at 1, 2, 6 and 12 weeks revealed minimal inflammation with all eyes retaining their preoperative BCVA [Figure - 1] D, E and F. No development of cataract was seen in case 1 and 3. Case 2 having rusty brown anterior capsule underwent phacoemulsification with single piece acrylic foldable intraocular lens implantation 3 months after the first surgery and regained BCVA of 20/40 in the left eye.


  Discussion Top


Iris is a rare site of lodgement for metallic IOFBs.[2],[3] A large series of 165 patients from China with anterior chamber foreign bodies collected over 22 years found only 55 (33%) to be metallic and out of all IOFBs, 97 (58.8%) were on the surface of iris.[1] This reflects the lodging of a metallic IOFB in the iris as a rare event since upto 75% IOFBs are known to reach the posterior segment.[3]

Prerequisites before removing the iris IOFB with the aid of a 20 g intravitreal magnet through the limbal route are ruling out deep impaction of IOFB in the iris or lens by UBM and the electronic confirmation that IOFB is magnetic. In our cases, the nature of injury suggested that the IOFBs were magnetic and this was confirmed by Roper-Hall IOFB locater.[4] UBM has been used to localize and detect anterior segment IOFBs.[5]

Such eyes with clear lenses and minimally affected or unaffected vision pose an interventional challenge. A variety of techniques have been described for removal of anterior segment IOFBs including forceps, intraocular lens forceps, magnet with or without gonioscope lens and dislodgment with saline or viscoelastic.[1],[2],[3] The complications like iris bleeding, tears in iris, ridodialysis and cataract are more likely to occur if forceps is used to remove such IOFBs. We were able to successfully and safely remove three metallic iris foreign bodies using 20 g intravitreal magnet as it allows removal with minimal manipulation. Preoperative determination of the size of the iris IOFB is also important for deciding the length of the corneal incision required. In view of the risk of siderosis, iris IOFBs like those in posterior segment should be removed as soon as possible even if they present late but have salvageable vision. The use of the rare earth intravitreal magnet has been well established for removal of posterior segment IOFBs.[2]

We conclude that use of intravitreal magnet offers a safe method to remove metallic iris foreign bodies.

 
  References Top

1.
Wen X, Si M. The analysis of foreign bodies in the anterior chamber in 165 cases. Yan Ke Xue Bao 1990;6:108-10.  Back to cited text no. 1
[PUBMED]    
2.
Lit ES, Young LH. Anterior and posterior segment intraocular foreign bodies. Int Ophthalmol Clin 2002;42:107-20.  Back to cited text no. 2
    
3.
Behrens-Baumann W, Praetorius G. Intraocular foreign bodies. 297 consecutive cases. Ophthalmologica 1989;198:84-8.  Back to cited text no. 3
[PUBMED]    
4.
Roper-Hall MJ. An intraocular foreign body locator. Trans Ophthalmol Soc UK 1966;77:239-50.  Back to cited text no. 4
    
5.
Looi AL, Gazzard G, Tan DT. Surgical exploration minimized by ultrasound biomicroscopy localization of intraocular foreign body. Eye 2001;15:234-5.  Back to cited text no. 5
[PUBMED]    


    Figures

  [Figure - 1], [Figure - 2]


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