|Year : 1992 | Volume
| Issue : 2 | Page : 38-40
Vitrectomy for intra ocular foreign body removal
Jasvinder Singh Saroya, RR Sasikanth, T Agarwal, Sunita Agarwal, Amar Agarwal
Eye Research Centre, 13 Cathedral Road, Madras-600 086, India
Dr Agarwal's Eye Institute. 13 Cathedral Road. Madras - 600 086
Source of Support: None, Conflict of Interest: None
Ten consecutive cases of perforating ocular injuries with retained intraocular foreign bodies over a period of 2 years were reviewed retrospectively in this study. All cases were operated upon by a 3 port pars plana vitrectomy and if necessary endolaser done. All ten cases (100%) were successful in terms of intraocular foreign body removal through the pars plana sclerotomy but ultimately we lost three  [30%] cases of which two had retinal detachments with P.V.R. D-3 preoperatively and the other had endophthalmitis. Of the seven (70%) successful cases four eyes (40%) had a post-operative vision of 6/12 or better while 2 [20%] had 6/24 and the last had 6/60 [10%]. Nine cases [90%] had a magnetic Intraocular foreign body. Various complications of Intraocular foreign bodies like vitreous haemorrhage, retinal incarceration, cataract and retinal detachment were noted preoperatively. Silicone oil was used in three (30%) cases. Sulfur Hexafluoride was used in 5 cases (50%). Endolaser photocoagulation was done in 7 cases (70%).
|How to cite this article:|
Saroya JS, Sasikanth R R, Agarwal T, Agarwal S, Agarwal A. Vitrectomy for intra ocular foreign body removal. Indian J Ophthalmol 1992;40:38-40
| Introduction|| |
Intraocular foreign bodies constitute a large percentage of all ocular traumas and require the use of advanced diagnostic and surgical techniques to properly evaluate and successfully manage them ,[3 Vitreous microsurgery allows excellent visualisation, prevention of post-operative transvitreal proliferation, and removal of blood, lens matter and organisms if present. Techniques and trends in the management of intraocular foreign bodies have been examined in numerous clinical studies abroad ,,,,,,, and in India 
| MATERIAL AND METHODS:|| |
Ten consecutive patients who underwent surgery for intraocular foreign bodies over the period of two years were studied through a retrospective review. All patients were examined for the presence of retained intraocular foreign bodies pre-operatively using where applicable, indirect ophthalmoscopy, X-Ray orbit, ultrasonography, and C T Scan. In all ten cases, a 3 port trans-pars plana vitrectomy was done to free the intraocular foreign body from adhesions and clear a path for magnetic or intra-vitreal forceps removal. Pars plana lensectomy was done in four cases [40%] where cataract formation obscured the view. Sulfur-hexafluoride gas for internal tamponade was used in 5 cases [50%] and silicone oil in 3 cases.[30%]
| Results|| |
In our series of ten cases, the patient's ages ranged from 17 to 35 years (average 22 years). All the patients were males. 9 of the injuries were due to metallic foreign bodies (90%) all of which were magnetic. All of the injuries by magnetic metallic foreign bodies were caused by "hammer on chisel or metal mechanism". One case was due to a glass intraocular foreign body. [Table - 1]. The site of the intraocular foreign body was intravitreal in 2 cases, subretinal in 2, and embedded in the retina in 6 cases [Table - 2]. As for the complications, apart from two cases in which the retina could not be settled due to inoperable proliferative vitreoretinopathy Grade D3 the retina was flattened in the remaining 8 cases. One of these [Case 7] developed a retinal incarceration by the intraocular foreign body which was subsequently treated with retinectomy, fluid-air exchange, endolaser and silicone oil injection [Table - 3].
Only 2 cases had a pre-operative visual acuity of 6/12 or better while 4 cases recovered visual acuity of 6/12 or better post-operatively. 2 cases retained a visual acuity of 6/24 and one had 6/60. In 3 eyes, no vision could be restored. Two of these had a retinal detachment with PVR D3 and one endophthalmitis pre operatively [Table - 4]. The operative procedures done are shown in [Table - 5]. [Figure - 1] shows the pre-operative photograph of Case 2 and [Figure - 2] the post-operative photograph of the same case after vitrectomy and intraocular foreign body removal. [Figure - 3] shows the foreign body removed from the same case. [Figure - 4] shows the track the foreign body had made in case 6. The foreign body was subretinal and was removed through a retinotomy. The foreign body was quite posterior and so was removed through the pars plana approach. [Figure - 5] shows Case 9 in which the foreign body was present in the vitreous.
| Discussion|| |
The advent of vitreous microsurgical techniques has revolutionised the management of penetrating ocular injuries with retained posterior segment intra ocular foreign bodies. In many cases, vitrectomy allows a more precise visual localisation and a more controlled removal of the intra ocular foreign body than was previously possible using an external magnet or less precise intraocular manipulations. The exact approach should be individualised for each case with prompt decisions taken on the table. Retinopexy, fluid-air exchange, internal drainage of the subretinal fluid, endolaser photocoagulation, air-gas exchange or scleral buckling should be done where applicable.
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[Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4], [Figure - 5]
[Table - 1], [Table - 2], [Table - 3], [Table - 4], [Table - 5]