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.

2.13.3.3 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

Summary

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.

References

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