Year : 1980 | Volume
: 28 | Issue : 3 | Page : 141--143
An unusual foreign body in the anterior chamber of the eye
SD Adrianwala, Gyanam Krishnamurthy
T. N. Medical College and B. Y.L. Nair Hospital, Mumbai, India
T.N. Medical College and B.Y.L. Nair Hospital, Mumbai-400 008
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Adrianwala S D, Krishnamurthy G. An unusual foreign body in the anterior chamber of the eye.Indian J Ophthalmol 1980;28:141-143
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Adrianwala S D, Krishnamurthy G. An unusual foreign body in the anterior chamber of the eye. Indian J Ophthalmol [serial online] 1980 [cited 2020 Nov 25 ];28:141-143
Available from: https://www.ijo.in/text.asp?1980/28/3/141/28245
Retained foreign bodies after intraocular surgery are a source of constant irritation to the iris and the cornea, resulting in postoperative iridocyclitis and corneal oedema.
The substances that can enter the anterior chamber during intraocular surgery are manifold viz: (i) Cotton fibres from swabs, surgical drapes or frayed pieces of gauze. (ii) Ointment smeared into the conjunctival cul-de-sac. (iii; Cilia lodged in the conjunctival fornices. (iv; Pieces of suture materials like virgin silk nylon, etc. We presume that these substances gain entry into the anterior chamber during surgery along with the instruments; saline or alpha-chymotrypsin solutions. Inadvertent introduction of cotton fibres into the anterior chamber during intraocular surgery has been reported. But entry of pieces of suture material, cilia, or ointment into the anterior chamber during surgery has been encountered in the recorded ophthalmic literature rarely.
We are reporting an interesting case of cataract extraction, where a piece of the plastic foil from the Peelapart over wrap of the Ethicon Virgin Silk 8/0 suture was detected in the anterior chamber postoperatively, creating a diagnostic dilemma, until its removal and chemical analysis proved the factual origin of the foreign body.
A 55 years female had an uneventful forceps intracapsular cataract extraction of the left eye. Ethicon Virgin Silk 8/0 38 cm suture was used for corneo-scleral suturing. Towards the end of first postoperative week, the operated eye showed corneal oedema, mild iritis and shallow anterior chamber.
Slit-lamp examination revealed gross oedema of the lower half of cornea with minute epithelial bullae and descemet's folds. A 7.5 mm x 5.0 mm, translucent material, folded on itself, lying on the iris surface with its anterior smooth curvature touching the endothelial surface of the cornea between 5 to 7 0' clock position, was noted in the anterior chamber [Figure 1]. There was no motility of this foreign body with the movement of the eye. Iris pigments were dispersed on the inner surface of the foreign body with a similar dispersion over the anterior face of the vitreous. Pupil was distorted. Intraocular pressure was 17.3 mm of Hg (Schiotz). Aphakic visual acuity was counting fingers 2 feet. Fundus was within normal limits. Right eye was normal except for an early senile immature cataract.
Patient was treated with subconjunctival steroids and myricin and systemic steroids. Due to the non-responsiveness of postoperative iritis and corneal oedema to the above medication, the foreign body was removed through a stab-knife limbal incision at 7 0' clock position on 9th March, 1978. Further postoperative period was uneventful and a corrected aphakic visual acuity of 6/9 was achieved in the left eye.
Macroscopic and microscopic examination [Figure 2][Figure 3], revealed the foreign body to be a piece of plastic foil from the Peel-apart over wrap of the Ethicon Virgin Silk 8/0 suture [Figure 4], which had inadvertently been introduced into the anterior chamber during the cataract extraction, causing post operative corneal oedema and iritis.
The great progress that has taken place in the plastics industry during the last 75 years has led to the wide use of plastics in the manufacture of medical instruments and appliances. The low-solubility and non-absorbable properties of plastics have increased their usage in various fields of surgery, including ocular surgery.
The reaction set up by various foreign bodies in the anterior chamber depends on their composition, shape, size together with the presence or absence of irritation to the adjacent structures i.e. corneal endothelium, iris and lens. Cotton foreign bodies in the anterior chamber have been considered to be well tolerated but on occasion can cause temporary mild iritis, corneal oedema, recurrent bullous keratitis and iridocyclitis. Though most of the thermoplastic substances like polymethyl methacrylate group (Perspex, Lucite, etc), the polyethylene group (Polythene etc), and the super polyamides (Nylon, etc), are inert when buried in body tissues, the other chemical added to them during manufacture may sweat out and cause a tissue reaction of some severity. On the other hand, the thermosetting plastics such as Bakelite and casein plastics usually cause a violent inflammatory reaction. Chemical analysis of the plastic foil removed from the anterior chamber of our case revealed it to be polyethylene [Figure 5]. The corneal oedema, bullous keratitis and mild iritis, noted in our case was due to the rub of the adjacent structures viz. corneal endothelium and iris by the inert plastic foil (Polyethylene).
An interesting case of cataract extraction where a piece of the plastic foil from the Peelapart over wrap of the Ethicon Virgin Silk 8/0 suture (the unusual foreign body) detected in the anterior chamber postoperatively causing corneal oedema, bullous keratitis and mild iritis.
|1||Brown S.I., 1968, Amer. J. Ophthalmol 65: 616. |
|2||Grant, W.M. 1962, Toxicology of the Eye, Springfield. Illinois, Thomas. p. 151. |
|3||Archer D.B., Davies M.S., and Kanski J.J., 1969, Brit. J. Ophthalmol. 53: 453.|