A Modification of the Intraocular Lens Blocking Technique Without Posterior Capsulorhexis for Intraocular Foreign Body Removal.

PURPOSE: The intraocular lens blocking technique described for the removal of intraocular foreign bodies emerged as a result of an effort to prevent the foreign body from being retracted into the posterior segment because of the resistance encountered while removing it from the corneal incision. However, in the technique described, in addition to the difficulty of the surgical procedure, the new concern is to create a posterior capsulorhexis according to the size of the foreign body and to pass the foreign body through the capsulorhexis. METHODS: Here, the authors describe a new approach to the intraocular lens blocking technique. In this approach, the intraocular foreign body, which is held with intraocular forceps without any opening in the posterior capsule, is held in a perpendicular position to the long axis, lifted directly into the anterior chamber, and safely removed from the front of the monoblock foldable intraocular lens. RESULTS: In all patients treated with this approach, IOFBs were successfully removed without intraoperative or postoperative complications, and postoperative intraocular lens centralization was achieved in all patients. CONCLUSION: This approach may provide practicality to the intraocular lens blocking technique.

Comparing forceps and self-assembled intraocular rare earth magnet in removing metallic intraocular foreign bodies in 25-guage vitrectomy.

PURPOSE: To compare the efficacy and efficiency of self-assembled intraocular rare earth magnet and forceps in removing intraocular foreign bodies(IOFBs) undergoing 25-gauge(G) pars plana vitrectomy. METHODS: A total of 30 patients with metallic IOFB underwent 25-G PPV were enrolled into this study. Self-assembled intraocular rare earth magnet were used in 15 patients(bar group), and forceps were used in 15 patients(forceps group). Success rate of removing IOFB, time taken to remove IOFB, incidence of IOFB slippage and fall, iatrogenic retinal damages were compared between the two groups. RESULTS: There was no significant difference in success rate of removing IOFBs between the groups(93.3% and 100%, P > 0.99). The median time taken of removing FB was significantly shorter in bar group than in forceps group(112 and 295 s, P = 0.001). None of the patients in bar group had IOFB slippage and fall, or related iatrogenic retinal damage in the process of removal. In forceps group, IOFB slippage and fall during removal were observed in 7 of 15(47.6%) patients, related iatrogenic retinal injuries were recorded in 6 of 15(40.0%) patients, both were significantly higher than bar group(P = 0.003 and P = 0.017, respectively). CONCLUSIONS: Compared with forceps, the assembled intraocular magnet can greatly reduce the possibility of IOFB slippage and fall, prevent related iatrogenic retinal damage, and shorten the time taken to remove IOFB. The assembled intraocular magnet can be an useful tool in removing metallic IOFBs in PPV.

A rare intraocular foreign body resulting from a workplace accident.

A 54-year-old man presented to the ophthalmic emergency department of our center with eye pain and blurred vision in his right eye following a workplace accident. Examination revealed a penetrating corneal injury with the presence of an intraocular foreign body (IOFB) involving the corneoscleral limbus, perforating the cornea, iris, anterior lens capsule, and lens. Immediate surgical intervention was carried out with the extraction of the IOFB, identified as an 8mm mussel shell fragment, and the removal of the resulting traumatic cataract. Both preoperative and postoperative examinations showed an attached retina with no signs of retinal tears or vitreous hemorrhage. Appropriate management in this case, along with the timely identification of the agent, led to favorable outcomes despite the size of the intraocular foreign body.

ULTRASOUND BIOMICROSCOPY AND ECHOGENIC EXTERNAL MARKER ASSISTED INTRAOCULAR FOREIGN BODY REMOVAL.

PURPOSE: We report a novel method of intraoperative localization of a retained anterior intraocular foreign body (IOFB), using a combination of ultrasound biomicrosopy and an insulated needle. METHODS: A retrospective case report of a 56-year-old man who presented with a right eye IOFB. RESULTS: On presentation, vision was decreased in the right eye to count fingers with a small subconjunctival hemorrhage, but no other signs of a penetrating laceration. Orbital CT revealed an IOFB, and the initial vitrectomy failed to retrieve the IOFB. Then, during the subsequent vitrectomy, using an ultrasound compatible needle and an ultrasound biomicrosopy, we were able to precisely locate and remove the small anterior IOFB. CONCLUSION: Retained IOFBs can lead to severe irreversible vision loss if not promptly removed. Ancillary imaging modalities and localization techniques can help locate occult IOFBs in difficult cases.

Intraocular foreign bodies in children: A retrospective case series.

INTRODUCTION: Open globe injuries are a major cause of visual impairment in children, related to the severity of the trauma or secondary to induced amblyopia. Intraocular foreign bodies (IOFB) have been reported in approximately one third of cases of open globe injuries. As clinical presentation and management may differ between adults and children, data is lacking about IOFBs in children under 18years of age. The purpose of this study was to assess the clinical characteristics and visual prognosis of ocular trauma associated with intraocular foreign bodies in children. MATERIALS AND METHODS: This single-center retrospective study included patients under 18years of age treated for ocular trauma with IOFB. Demographic characteristics, complete initial and final ophthalmological examination, imaging data and details of medical and surgical management were collected. RESULTS: Fourteen patients were included (78.6% boys), with a mean age of 10.3years (min 7months-max 17years). In 92.9% of cases, patients were found to have a single IOFB, mostly metallic (71.4%). Posterior segment IOFBs were found in 50% of cases, anterior segment IOFBs in 28.6% and orbital IOFBs in 21.4%. The clinical examination permitted detection of the IOFBs in 50% of cases, while they were visible on CT scan in all cases. The mean initial visual acuity was 20/320, and the mean final visual acuity was 20/125. Endophthalmitis occurred in 2 cases (14%). DISCUSSION: Open globe injuries associated with IOFB are severe and sight-threatening. Localization of the IOFB in the posterior segment has a worse prognosis. CT scan is mandatory, especially in children, as the trauma history is often missing. Retinal detachment and endophthalmitis appear to be the main prognostic factors requiring urgent specialized pediatric ophthalmology management.

Ocular fish hook injuries.

PURPOSE: Fishing stands out as a widely enjoyed leisure pursuit. While ocular fishing injuries are infrequent, they carry the potential for severe ocular trauma, and safe extraction of a fish hook can pose challenges. We here in report a series of 21 cases of penetrating injury to the cornea by fish hook, detailing successful surgical interventions employed for their management. The report not only outlines different techniques for the removal of fish hooks but also provides clarification on terminologies associated with various components of a fish hook. METHODS: This was a retrospective study conducted at tertiary eye care centers in South India. Our hospitals cater to the states of Telangana, Andhra Pradesh, and Odisha. All medical records of patients who attended the emergency department from the period of 2003 to 2023 were evaluated and all patients with fish hook injury were included in the study. This is the longest and largest study in India. RESULTS: Twenty-one cases of ocular fish-hook injuries were presented to the emergency room between 2003 and 2023. Patients were between the ages of 9 and 59 years (mean, 29.4 years), and 90.4 % (19 out of 21) were males. Patient demographics, injury characteristics, surgical interventions, and visual outcomes were meticulously documented. Out of 21 cases, three cases (14.3 %) had blunt trauma, 17 cases (80.9 %) had penetrating injury and one case had lid laceration. Patients had better visual outcomes after the second surgery. Out of 21 cases, 7 (33.3 %) had post-operative visual acuity (VA) between 20/20 and 20/40. Three (14.3 %) had post-operative VA between 20/60 and 20/125. Five (23.8 %) had post-operative VA between 20/200 and 20/600. Six cases (28.6 %) had poor visual outcomes of which two had no perception of light (NPL), two had Hand movements and the other two had the perception of light present and projection of rays inaccurate CONCLUSION: This extensive case series underscores the complexity of ocular injuries caused by fish hooks and emphasizes significance of tailored surgical approaches for optimal visual outcomes. The hook can be successfully removed with minimal trauma to ocular structures by understanding structure of fish hook and by employing appropriate method of extraction.

Management and Clinical Outcomes of Eyes With Posterior Segment Intraocular Foreign Bodies Seen at a Tertiary Referral Center.

BACKGROUND AND OBJECTIVE: This study aimed to identify the prognostic factors regarding the visual and anatomic outcomes of eyes with posterior segment intraocular foreign body (PS-IOFB). PATIENTS AND METHODS: The medical records of 95 patients who underwent pars plana vitrectomy and PS-IOFB removal between 2004 and 2021 were retrospectively reviewed. Data on anatomical and visual outcomes, as well as preoperative, intraoperative, and postoperative variables were statistically analyzed. RESULTS: The mean age of the patients was 31.9 ± 12.3 years. The mean follow-up time was 21.9 ± 28.3 months. The median time interval from trauma to IOFB removal was 9 days. In univariate analysis, there was a positive correlation between initial visual acuity (VA) and final VA (P < 0.001). A higher ocular trauma score (OTS) was significantly associated with both anatomical and functional success (P < 0.001). Linear regression analysis showed that OTS was not superior to initial VA in predicting final VA (r = 0.625 vs r = -0.601). Anatomic and functional outcomes were not affected by the injury site, nature of PS-IOFB, or timing of PS-IOFB removal (P > 0.05 for all). Subretinal IOFB location, the need for silicone oil tamponade, and endophthalmitis (P = 0.005, P < 0.001, P = 0.044, respectively) were risk factors for poor visual outcome. CONCLUSIONS: The initial VA, the extent of the initial ocular damage, and the presence of endophthalmitis are important prognostic factors for functional success. [Ophthalmic Surg Lasers Imaging Retina 2024;55:434-442.].

Visual outcomes and prognostic factors of early pars plana vitrectomy for open globe injury.

OBJECTIVES: To identify the clinical features and outcomes of early vitrectomy in patients with open globe injury (OGI) and the prognostic factors for visual outcome. METHODS: This retrospective observational case series included 390 eyes in 389 patients diagnosed with OGI receiving vitrectomy within four days after injury. Preoperative parameters included the injury types, wound locations, consequent tissue damages, initial visual acuity (VA), and ocular trauma score. Postoperative outcome measures included surgical procedures, retinal (re)attachment, complications, and final VA. The logistic analysis evaluated the prognostic factors for visual outcome. RESULTS: Intraocular foreign bodies (59.2%) and penetrating injuries (28.7%) were the most common injury types. Among the 165 eyes with retinal detachment (RD), 121 (73.3%) had retinal reattachment during early primary vitrectomy, and 32 (19.4%) were repaired during a second or subsequent surgery. Thirteen eyes (3.3%) were enucleated. The final VA improved from the initial level in 207 eyes (55.2%), remained unchanged in 123 (32.8%), and decreased in 45 (12.0%). Multivariable regression revealed that the injury zone, initial VA, RD, and endophthalmitis were associated with poor visual outcomes (P < 0.05). CONCLUSIONS: Higher zone injury, low initial VA, RD, and endophthalmitis are predictors of poor visual outcome in eyes undergoing early vitrectomy for OGI.

Report of endophthalmitis caused by Paradictyoarthrinium diffractum after plant trauma: A case involving left enucleation.

During outdoor work in April 2022, a 48-year-old man was stabbed by a tree branch and underwent intraocular foreign body extraction and repair of the scleral wound with sutures and amniotic membrane graft at a local hospital. Steroid therapy with prednisone was prescribed after a diagnosis of uveitis. Vitrectomy was performed in June 2023; a fungal culture was positive, and ITS sequencing identified the organism as Paradictyoarthrinium diffractum. Empiric antifungal therapy did not have an effect, and, because of deterioration of the condition, the left eye was enucleated in October 2023. P. diffractum is a mangrove host-specific saprophytic fungus that has not been reported in humans.

Spontaneous resolution of a wooden foreign-body granuloma in the conjunctiva of a child.

A conjunctival foreign-body (FB) granuloma may result following trauma with synthetic and non-synthetic materials including organic and non-organic objects. Children usually manifest with FB granulomas that develop due to inoculation of FBs from soft toys, blankets or woollen clothes. Encapsu- lation of these FBs following a granulomatous inflammatory response results in a nodular swelling in the conjunctiva. Reports of a wooden FB granuloma in the conjunctiva in children are anecdotal. A 5-year-old boy suffered an un- witnessed direct ocular trauma to his left eye (OS) with a wooden arrow while playing. He developed redness and nodular swelling at the inferotemporal aspect of the OS without any visual complaints. The diagnosis of a wooden FB granuloma is a challenge to ophthalmologists and may go undetected in children who neglect their symptoms. It characteristically presents as a unilateral conjunctival nodule. Surgical excision is the definitive management. However, spontaneous extrusion of the FB might be observed due to protective blinking and tearing mechanisms in the eye.

Bifid Pupil Iridodialysis Secondary to Airsoft Gun Injury.

This case report describes a diagnosis of iridodialysis in an 11-year-old boy who presented with decreased vision and inflammation after direct blunt trauma to the left eye.

Alterações oculares decorrentes de picada de abelha na córnea / Ocular changes due to corneal bee sting

RESUMO O propósito deste estudo foi reportar as alterações oculares observadas após picada de abelha com ferrão retido na córnea. Destacamos o tratamento e o desfecho de uma lesão de córnea incomum e sua patogênese. Trata-se de relato de caso e revisão da literatura de lesões oculares por picada de abelha. Paciente do sexo feminino, 63 anos, procurou atendimento oftalmológico de urgência devido à picada de abelha na córnea do olho direito há 6 dias. Queixava-se de embaçamento visual, dor e hiperemia ocular. Apresentou acuidade visual de vultos no olho afetado. Ao exame, notaram-se hiperemia moderada de conjuntiva bulbar, edema corneano com dobras de Descemet e presença do ferrão alojado na região temporal, no estroma profundo da córnea. A paciente foi internada para ser abordada no centro cirúrgico sob anestesia geral. Durante a cirurgia, o ferrão teve que ser retirado via câmara anterior, mediante a realização de uma paracentese e uma lavagem da câmara anterior, com dupla via e solução salina balanceada. Ainda não existe na literatura um tratamento padrão na abordagem de pacientes com lesões oculares por picada de abelha, sendo importantes a identificação e o reconhecimento precoce de possíveis complicações que ameacem a visão.

ABSTRACT The purpose of this study was to report the ocular changes observed after a bee sting with a stinger retained in the cornea. We show the treatment and outcome of an unusual corneal injury and its pathogenesis. This is a case report and literature review of ocular injuries caused by bee stings. A 63-year-old female patient sought emergency ophthalmic care because of a bee sting on the cornea of her right eye six days before. She complained of blurred vision, pain, and ocular hyperemia. She had glare sensitivity on visual acuity in the affected eye. Examination revealed moderate hyperemia of the bulbar conjunctiva, corneal edema with Descemet's folds and a stinger lodged in the temporal region, in the deep stroma of the cornea. The patient was admitted to the operating room under general anesthesia. During surgery, the stinger had to be removed via the anterior chamber, by performing a paracentesis and washing the anterior chamber with a double flushing and balanced saline solution. There is still no standard treatment in the literature for patients with eye injuries caused by bee stings, and early identification and recognition of possible sight-threatening complications is important.

Retirada de projetil de arma de fogo alojado em assoalho infraorbitário com preservação do globo ocular: relato de caso / Removal of a firearm projectile lodged in the infraorbital floor with preservation of the eyeball: case report

Objetivo: relatar um caso de ferimento por arma de fogo (FAF), com projétil balístico alojado em região infraorbitária à esquerda, relatando tratamento cirúrgico de urgência para exérese do projetil por acesso subciliar. Relato do caso: Paciente do gênero masculino, 18 anos, foi encaminhado ao pronto socorro do Hospital Universitário por conta de ferimento por arma de fogo. Ao exame clínico, foi verificado discreto aumento de volume em região cervical e hemiface à esquerda, ausência de sangramento em face; presença de limitação para infraversão de olho esquerdo. O orifício de entrada do projetil foi identificado em região de tórax superior posterior à esquerda; após realização de tomografia de face, confirmou-se fratura de assoalho orbitário esquerdo, assim como projétil alojado abaixo do globo ocular. O ato cirúrgico foi realizado com caráter de urgência pela equipe de Cirurgia e Traumatologia Bucomaxilofacial. Discussão: estudos descrevem a importância da realização do adequado manejo de lesões traumáticas decorrentes de FAF seguido de remoção do projetil com urgência, visto que as complicações ao postergar o tempo cirúrgico só agravam o quadro clínico do paciente, além das afecções futuras que podem surgir com o decorrer da resolução do caso clínico. Conclusão: ratifica-se a importância da multidisciplinariedade entres as clínicas médicas, assim como, o correto manejo do paciente traumatizado, baseado nos critérios que conduzem o plano de tratamento.(AU)

Aim: to report a case of gunshot wound, with ballistic projectile lodged in the left infraorbital region, reporting emergency surgical treatment for projectile exeresis by subciliary access. Case Report: An 18-year-old male patient was referred to the emergency department of the University Hospital due to a gunshot wound. On clinical examination, it was found slight increase in volume in the cervical region and left hemiface, absence of bleeding in the face; presence of limitation to infraversion of the left eye. The entrance hole of the projectile was identified in the posterior left upper thorax region; after a tomography of the face, a fracture of the left orbital floor was confirmed, as well as the projectile lodged below the eyeball. The surgery was urgently performed by the Oral and Maxillofacial Surgery team. Discussion: Studies describe the importance of performing the proper management of traumatic injuries resulting from FAF followed by removal of the projectile with urgency, since the complications to postpone the surgical time only aggravate the clinical picture of the patient, in addition to future problems that may arise with the resolution of the clinical case. Conclusion: the importance of multidisciplinarity among medical clinics is ratified, as well as the correct management of the traumatized patient, based on the criteria that lead to the treatment plan.(AU)

Remoção de um corpo estranho incomum decorrente de trauma orbital: relato de caso / Removal of an unusual strange body arising from orbital trauma: case report

Introdução: Trauma contuso e penetrante na região orbital pode ter um efeito devastador, tanto funcional quanto estético para a órbita e estruturas adjacentes. Uma inspeção meticulosa das pálpebras e do globo deve ser realizada e, se houver suspeita de retenção de um corpo estranho dentro dos tecidos moles orbitais, deve ser obtida uma tomografia computadorizada (TC). O objetivo do presente estudo foi relatar um caso clínico de trauma óculo-orbitário severo ocasionado por acidente com animal. Relato de caso: paciente de 22 anos do gênero masculino apresentou-se em um hospital de referência em trauma na cidade de Campina Grande-PB, com história de acidente com cavalo e colisão em cerca de madeira. A tomografia revelou que havia a presença de um corpo estranho (CE) de madeira que apresentava uma forma pontiaguda e proximidade com estruturas como músculos, vasos e nervos da órbita, além da presença de fratura no assoalho da órbita. Considerações finais: A presença de CE de madeira deve sempre ser investigada quando há trauma direto na cavidade orbitária, pois a madeira é áspera e contém uma grande quantidade de bactérias e parasitas. Sendo assim, deve ser removido o mais precocemente possível a fim de se evitar complicações infecciosas... (AU)

Introduction: Blunt and penetrating trauma to the orbital region can have a devastating effect, both functional and aesthetic for the orbit and adjacent structures. Meticulous inspection of the eyelids and the globe should be performed and, if a foreign body is suspected to be retained within the orbital soft tissues, a computed tomography (CT) scan should be obtained. The aim of the present study was to report a clinical case of severe oculo-orbital trauma caused by an accident with an animal. Case report: a 22-year-old male patient presented at a trauma referral hospital in the city of Campina Grande-PB, with a history of accident with a horse and collision on a wooden fence. The tomography revealed that there was the presence of a wooden foreign body (EC) that had a pointed shape and proximity to structures such as muscles, vessels and nerves in the orbit, in addition to the presence of a fracture in the orbit floor. Final considerations: The presence of wood CE should always be investigated when there is direct trauma to the orbital cavity, as the wood is rough and contains a large amount of bacteria and parasites. Therefore, it should be removed as early as possible in order to avoid infectious complications... (AU)

¿Cuerpo extraño o tumor ocular? Presentación de un caso / Foreign body or eye tumor? Case presentation

RESUMEN Se presenta el caso de una paciente femenina, de 15 años de edad, cuyo motivo de consulta fue la sensación de cuerpo extraño y aumento de volumen de coloración oscura en el globo ocular derecho. Antecedentes personales de trauma no referidos. Al examen físico se encontró una masa alargada, oscura, de bordes regulares y dura a la palpación, por debajo de la conjuntiva bulbar. Se realizó tratamiento quirúrgico y se extrajo un cuerpo extraño subconjuntival compatible con la punta de un lápiz, englobado en su extremo distal por un tejido fibrovascular, oscuro y con brillo metálico. Se exponen algunas consideraciones que pudieran ser la explicación para el comportamiento tisular adyacente al cuerpo extraño. Por lo poco común del caso se decidió su presentación.

ABSTRACT The case of a 15-year-old female patient is presented, whose main complaint was the sensation of a foreign body and increased volume of dark coloration in the right eyeball. Personal history of trauma not reported. On physical examination, an elongated, dark mass with regular edges and hard on palpation was found below the bulbar conjunctiva. Surgical treatment was performed and a subconjunctival foreign body compatible with the tip of a pencil was removed, encompassed at its distal end by a dark, fibrovascular tissue with metallic luster. Some considerations that could be the explanation for the tissue behavior adjacent to the foreign body are exposed. Due to its unusual nature, the presentation of the case was decided.