2020 - 1 Issue

Original article

Transscleral Extraction of an Intraocular Foreign Body From the Posterior Segment of the Eye Without Pars Plana Vitrectomy

Štěpán Rusňák ORCID
Lenka Hecová ORCID

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DOI: 10.31348/2020/2

Published in Czech and Slovak Ophtalmology: 2020 - 1

Published on website: 30.08.2020

Keywords: penetrating eye trauma, metallic IOFB, exomagnet, endomagnet, transscleral extraction, minimal PPV, limited PPV, vitreoretinal traction

Summary

Purpose: Penetrating eye trauma with an intraocular foreign body is very frequent, especially in men in their productive age. Pars plana vitrectomy would be the standard surgical method at our department. However, in indicated cases (metallic intraocular bodies in the posterior eye segment in young patients with well transparent ocular media without detached ZSM and without any evident vitreoretinal traction) transscleral extraction of the intraocular foreign body is performed using the exo magnet, eventually endo magnet with a minimal PPV without PVD induction under the visual control of endo-illumination.

Materials and Methods: Between June 2003 and June 2018, 66 eyes of 66 patients diagnosed with a penetrating eye trauma caused by an intraocular foreign body located in the posterior eye segment were treated. In 18 eyes (27,3 %) with a metallic foreign body in vitreous (body) or in retina, no PPV or a minimal PPV without PVD was used as a surgical method. In the remaining 48 eyes (72,7 %), a standard 20G, respectively 23G PPV method were used together with PVD induction and the foreign body extraction via endo or exo magnet.

Conclusions: As demonstrated by our survey/study, in the cases of a thoroughly considered indication an experimented vitreoretinal surgeon can perform a safe NCT transscleral extraction from the posterior eye segment via exo magnet, eventually endo magnet under the visual control of a contact display system with a minimal PPV. Thereby, the surgeon can enhance the patient´s chance to preserve their own lens and its accommodative abilities as well as reduce the risk of further surgical interventions of the afflicted eye.

References

  1. Al-Amro, SA., Khan, NM., Kangave, D.: Visual outcome and prognostic factors after vitrectomy for posterior segment foreignbodies. Eur J Ophthalmol, 10(4); 2000: 304-311.
  2. Blodi, BA., Paluska, SA.:Cataract after vitrectomy in young patients. Ophthalmology, 104(7); 1997: 1092-1095.
  3. Cillino, S., Casuccio, A., Di Pace, F. et al.: A five – year retrospec - tive study of the epidemiological characteristics and visual outcomes of patients hospitalized for ocular trauma in a Mediterranean area. BMC Ophthalmology, 8(1); 2008: 6.
  4. Ehlers, JP., Kunimoto, DY., Ittoop, S. et al.: Metallic intraocular foreign bodies: characteristics, interventions, and prognostic factors for visual outcome and globe survival. Am J Ophthalmol, 146(3); 2008: 427-433.
  5. Fabian, ID., Moisseiev, E., Moisseiev, J. et al.: Macular hole after vitrectomy for primary rhegmatogenous retinal detachment. Retina, 32(3); 2012: 511-519.
  6. Guevara-Villarreal, DA., Rodriguez-Valdés, PA.:Posterior segment intraocular foreign body: extraction surgical techniques, timing, and indications for vitrectomy. J Ophthalmol, 2016; 2016: 2034509. doi: 10.1155/2016/2034509. eCollection 2016.
  7. Jonas, JB., Knorr, HLJ., Budde WM: Prognostic factors in ocular injuries caused by intraocular or retrobulbar foreign bodies. Ophthalmology, 107(5); 2000: 823-828.
  8. Karel, I., Diblík, P.: Management of posterior segment foreign bo - dies and long-term results. Eur J Ophthalmol, 5(2); 1995: 113-8.
  9. Kuhn, F., Maisiak, R., Mann, L. et al.: Theocular trauma score (OTS). Ophthalmology Clinics of North America, 15(2); 2002: 163– 165.
  10. Li, L., Lu, H., Ma, K. et al.: Etiologic causes and epidemiological characteristics of patients with intraocular foreign bodies: retrospective analysis of 1340 cases over ten years. J Ophthalmol, 2018; 2018: 6309638. doi: 10.1155/2018/6309638. E Collection 2016.
  11. May, DR., Kuhn, FP., Morris, RE. et al.: The epidemiology of se - rious eye injuries from the United States Eye Injury Registry. Gratrauma (phacoemulsification and implantation of a posterior chamber IOL). In the remaining 6 eyes, thanks to the minimally invasive procedure, the cataract did not progress even during the long observation period, and the patients retained their own lens with accommodative capacity. In all patients in the cohort, the intraocular foreign body was small (maximum 5 mm in the largest dimension), which is one of the main positive prognostic factors [14]. In the great majority of cases, we chose a minimally invasive procedure for young patients with a well transparent lens, with preserved accommodative capacity. The exception was a 70 year old man, for whom we would indicate a PPV procedure as standard. However, the patient had well transparent ocular media, so far without a detached posterior vitreous membrane and minimal damage to the posterior segment. For pe
  12. Mester, V., Kuhn, F.: Ferrous intraocular foreign bodies retained in the posterior segment: management options and results. Int Ophthalmol, 22(6); 1998: 355-362.
  13. Modjtahedi, BS., Rong, A., Bobinski, M. et al.: Imaging charac - teristics of intraocular foreign bodies: a comparative study of plain film X-ray, computad tomography, ultrasound and magnetic resonance imaging. Retina, 35(1); 2015: 95-104.
  14. Nicoara, SD., Irimescu, I., Calinici, T. et al.: Intraocular foreign bodies extracted by pars plana vitrectomy: clinical characteristics, management, outcomes and prognostic factors. BMC Ophthalmol, 15; 2015: 151. doi: 10.1186/s12886-015-0128-6. E Collection 2015.
  15. Panissod, PNMR.: study and magnetic properties of vanadium based alloys with transition metals. Journal of Physics F: Metal Physics, 4(3); 1974: 484-496.
  16. Parke 3rd, DW., Flynn Jr, HW., Fisher, YL.: Management of intrao - cular foreign bodies: a clinical flight plan. Can J Ophthalmol, 48(1); 2013: 8-12.
  17. Parke 3rd, DW., Pathengay, A., FlynnJr, HW. et al.: Risk factors for endophthalmitis and retinal detachment with retained intraocular foreign bodies. J Ophthalmol, 2012; 2012: 758526. doi: 10.1155/2012/758526. E Collection 2012.
  18. Weissgold, DJ., Kausha, P.: Late onset of rhegmatogenous retinal detachments after successful posterior segment intraocular foreign body removal. Br J Ophthalmol, 89(3), 2005: 327–331.
  19. Wu, L., Martínez-Castellanos, MA., Quiroz-Mercado, H. et al.: Pan American Collaborative Retina Group (PACORES): Twelve- -month safety of intravitreal injections of bevacizumab (Avastin): results of the Pan-American Collaborative Retina Study Group (PA- CORES). Graefes Arch Clin Exp Ophthalmol, 246(1); 2008: 81-87.
  20. Yeh, S., Colyer, MH., Weichel, ED.:Current trends in the manage - ment of intraocular foreign bodies. Curr Opin Ophthal, 19(3); 2008: 225-233.
  21. Zhang, Y., Zhang, MN., Jiang, CH. et al.: Intraocular foreign bo - dies in China: clinical characteristics, prognostic factors, and visual outcomes in 1421 eyes. Am J Ophthalmol, 152(1); 2011: 66-3.