Phacoemulsification, Pars Plana Vitrectomy and Metallic Intraocular Foreign Body Removal Through Sclerocorneal Tunnel, Using a Novel Magnet Handshake Technique


ABSTRACT

Introduction:

Intraocular foreign bodies are significantly associated with penetrating injury in 14% to 45% and are important cause for visual loss in young males. Lens injury is not uncommon in these patients. These selected cases have been managed by combined phacoemulsification, vitrectomy and IOFB removal. Commonly IOFB are removed by enlarging one of the sclerotomy port, though limbal route has been described for larger IOFB. Removal of IOFB through sclerotomy needs enlargement of the wound and associated with complications like hypotony,vitreous incarceration and retinal detachment. In this study we describe outcomes of removal of IOFB through the sclerocorneal tunnel, in patients with traumatic cataract and metallic IOFB using a novel “Magnet Handshake” technique.

Setting:

Vitreo-Retinal Services, Aravind Eye Hospital, Pondicherry, India

Methods:

Hospital records of 14 patients between 2010 to 2016 were reviewed retrospectively. These patients presented with open globe injury, traumatic cataract and metallic IOFB. Pre-operative complete eye examination was done. Surgical Technique Corneal tear repair was done in 8 of 14 patients, while one patient needed scleral tear suturing. In other 5 patients the corneal wound was self-sealing. All patients underwent phacoemulsification or lens aspiration through a 5 mm small incision sclerocorneal tunnel. PPV and IOFB removal was done using “Magnet Handshake” technique. Vitrectomy was combined with 360◦ scleral indentation and removal of vitreous debris. IOFB was identified and freed from surrounding vitreous. Intraocular magnet was introduced through 20 G vitrectomy port. Metallic foreign body was lifted through the posterior capsule defect, to the iris plane. In patients where posterior capsule was intact, small defect was created using a vitrectomy cutter. A second intraocular magnet was introduced through the scleral tunnel. IOFB was then lifted in a “Magnet handshake” manner and delivered outside the eye through the scleral tunnel. Cryotherapy and endolaser was done in patients with retinal tears. Silicone oil tamponede was used in 2 patients. Primary intraocular lens (IOL) implantation was done in 7 patients, secondary IOL was done in 4 patients and 3 patients were left aphakic at last follow. Mean follow up duration was 15.7 months (range 4-48 months) RESULTS All 14 patients were males with mean age of 33.2 years (range 15-55 years). Entry site was corneal in 13 patients and scleral in 1 patient. Two patients had retinal detachment with choroidal detachment at the time of presentation. One of these 2 patients developed phthisis bulbi post-surgery and did not undergo further surgical intervention. The other had silicone oil removal at 1 year follow up. Retina was attached at last follow up. Post operatively 1 patient developed RD and underwent re- surgery with scleral buckling and silicone oil tamponede. Retina was attached under Silicone oil at last follow. Visual acuity of 20/60 or better was observed in 11 of 14 patients (78.57%) of our patients. Primary anatomical success was achieved in 12 of 14 patients (85.71%). Final re-attachment with more than one surgery was achieved in 13 patients (92.85%).

Conclusion:

Combined phacoemulsification and removal of metallic IOFB through the sclerocorneal tunnel with “Handshake Magnet” technique can be a good option in selected patients. Good final BCVA and anatomical success were achieved. This was comparable to the other studies who have done simultaneous phacoemulsification, PPV, IOFB extraction through sclerotomy port, and intraocular lens (IOL) implantation. In conclusion it would be logical to take advantage of the sclerocorneal tunnel for the removal of metallic IOFB associated with traumatic cataract, rather than its removal by enlarging the sclerotomy port.


CONTACT DETAILS

Pankaja Dhoble
Pondicherry, India
Email : pankajadhoble@yahoo.co.in
Cell Phone: +919585194314
Work Phone: +9104132619100