A s

Fig. 2.13.5 The need to adjust the lOFB's position if a forceps or a snare is used. a,b The initial grab: the IOFB is grasped in its mid section to allow for maximal stability and control. c For the actual extraction, the IOFB has to be grabbed at its end. This means that the grab is insecure, but the length of the extraction sclerotomy can be short

• As in all eyes with choroidal and scleral involvement, the risk of PVR is sufficiently great to warrant at least consideration of prophylactic chorioretinectomy to prevent a developing scar from incarcerating the retina and lead to tractional retinal detachment (see Chap. 2.14).

• The remaining steps of surgery have been described above. Nonmagnetic IOFBs

For the roughly 20% of IOFBs that are not ferrous, the forceps or the snare are available as extraction tools (see above; Fig. 2.13.5). An epiretinally located IOFB can also be floated up by PFCL and then removed.

O Pitfall

If PFCL is used to bring an epiretinal object closer to the sclerotomy, there is always a danger that the heavy liquid will be layered on top of, rather than underneath, the object (see Chap. 2.7). If an IOFB with a sharp edge must be removed, an additional danger is that the PFCL will first push it sideways, causing a retinal lesion.

despite a negative slit lamp examination, assume that a wound is present if the injury was caused by a sharp object; even if the visual acuity is good and the media are clear, a retinal injury may be present, making it certain that a scleral wound has occurred consider immediate surgery to remove the IOFB and the infected medium if the injury poses a high risk of endophthalmitis; otherwise, an individual decision regarding the timing of the intervention must be made consider prophylactic chorioretinectomy if the IOFB has caused a deep impact

forgo ordering a CT if the slightest doubt exists about the possibility of a retained FB

let the magnet's power to rip the IOFB free from a capsule or even to "cut through" the choroid; controlled opening of the capsule and choroid with a sharp instrument is much less traumatic or risky use an EEM to extract a ferrous IOFB; a strong IOM provides complete surgeon control and reduces the risk of iatrogenic damage substantially


Penetrating and JOFB injuries have a lot in common, but the latter cause vastly more concern to the patient - and to the ophthalmologist -because of the presence of a foreign object in the eye. Although these injuries have an increased risk of endophthalmitis their prognosis is relatively good, presumed the recommended rules of management are followed.


[ 1 ] Ambler J, Meyers S (1991) Management of intraretinal metallic foreign bodies without retinopexy in the absence of retinal detachment. Ophthalmology 98: 391-394 [2] Boldt H, Pulido J, Blodi C et al. (1989) Rural endophthalmitis. Ophthalmology 101: 332-341

[3] Brown I (1968) Nature of injury. Int Ophthalmol Clin 8: 147-152

[4] Bryden FM, Pyott AA, Bailey M, McGhee CNJ (1990) Real time ultrasound in the assessment of intraocular foreign bodies. Eye 4: 727-731

[5] Budde WM, Junemann A (1998) Chalcosis oculi. Klin Monatsbl Augenheilk 212: 184-185

[6] Camacho H, Mejia LF (1991) Extraction of intraocular foreign bodies by pars plana vitrectomy. Ophthalmologica 202: 173-179

[7] Cooling RJ, McLeod D, Blach RK, Leaver PK (1981) Closed microsurgery in the management of intraocular foreign bodies. Trans Ophthalmol Soc UK 181-183

[8] Coyler M, Weber E, Weichel E, Dick J, Bower K, Ward T, Haller J (in press) Delayed intraocular foreign body removal without endophthalmitis during Operations Iraqi and Enduring Freedom. Ophthalmology

[9] De Souza S, Howcroft MJ (1999) Management of posterior segment intraocular foreign bodies: 14 years' experience. Can J Ophthalmol 34: 23-29

[10] Eckardt C, Eckert T, Eckardt U (2006) Memory snare for extraction of intraocular foreign bodies. Retina 26: 845-847

[11] El-Asrar AM, Al-Amro SA, Khan NM, Kangave D (2000) Visual outcome and prognostic factors after vitrectomy for posterior segment foreign bodies. Eur J Ophthalmol 10: 304-311

[12] Jonas JB, Budde WM (1999) Early versus late removal of retained intraocular foreign bodies. Retina 19: 193-197

[13] Karel I, Diblik P (1995) Management of posterior segment foreign bodies and long-term results. Eur J Ophthalmol 5: 113-118

[14] Keeney AH (1971) Intralenticular foreign bodies. Arch Ophthalmol 86: 499-501

[15] Kuhn F, Mester V, Morris R (2002) Intraocular foreign bodies. Thieme, New York, pp 1201

[16] Lansing M, Glaser B, Liss H, Hanham A, Thompson J, Sjaarda R, Gordon A (1993) The effect of pars plana vitrectomy and transforming growth factor-beta 2 without epiretinal membrane peeling on full-thickness macular hole. Ophthalmology 100: 868-872

[17] Mester V, Kuhn F (2000) Ferrous intraocular foreign bodies retained in the posterior segment: management options and results. Int Ophthalmol 22: 355-362

[18] Mieler WF, Ellis MK, Williams DF, Han DP (1990) Retained intraocular foreign bodies and endophthalmitis. Ophthalmology 97: 1532-1538

[19] Monterio ML, Ulrich RF, Imes RK, Fung WE, Hoyt WF (1984) Iron mydriasis. Am J Ophthalmol 97: 794-796

[20] Neubauer H (1979) The Montgomery Lecture, 1979. Ocular metallosis. Trans Ophthalmol Soc UK 99: 502-510

[21] Pieramici D, Capone AJ, Rubsamen P, Roseman R (1996) Lens preservation after intraocular foreign body injuries. Ophthalmology 103: 1563-1567

[22] Roper-Hall MJ (1954) Review of 555 cases of intra-ocular foreign bodies with special reference to prognosis. Br J Ophthalmol 38: 65-99

[23] Sneed SR (1988) Ocular siderosis. Arch Ophthalmol 106: 997

[24] Thompson W, Rubsamen P, Flynn H, Schiffman J, Cousins S (1995) Endophthalmitis after penetrating trauma. Risk factors and visual acuity outcomes. Ophthalmology 102: 1696-1701

[25] Weiss MJ, Hofeldt AJ, Behrens M, Fisher K (1997) Ocular siderosis. Diagnosis and management. Retina 17: 105-108

[26] Wickham L, Xing W, Bunce C, Sullivan P (2006) Outcomes of surgery for posterior segment intraocular foreign bodies-a retrospective review of 17 years of clinical experience. Graefe's Arch Clin Exp Ophthalmol

[27] Yamaguchi K, Tamai M (1989) Siderosis bulbi induced by intraocular lens implantation. Ophthalmologica 198: 113-115

Was this article helpful?

0 0

Post a comment