ABSTRACT

Background & Objective:

As a general rule, removal of an intraocular foreign body (IOFB) is recommended at the time of repair of the entry site, because the inflammation caused by the IOFB can make surgical removal more difficult later. This is especially true in the case of metal foreign objects. However, if the foreign body is positioned near the macula, there is a high possibility of macular damage during its removal. We report here three cases of surgical treatment, with or without removal of the macular foreign body, and would like to discuss whether metallic IOFBs, including copper alloys, should be removed if they are near the macula.

Methods & Results:

Case 1: A 31-year-old woman presented with ocular pain and visual disturbance in her left eye, after an accident sustained during metal crafting. Ocular examination revealed total hyphaema with full thickness scleral laceration and iris prolapse. Computed tomography showed metallic IOFB embedded in the posterior sclera. We performed vitrectomy and removed the IOFB. However, the traction resulting from IOFB removal site caused retinal wrinkling, retinal detachment and proliferative vitreoretinopathy 2 months after surgery. Then we conducted encircle buckling to reattach the retina. However, the eyeball was not stable without silicone oil and the patient’s best corrected visual acuity was lower than 20/200.
Case 2: A 46-year-old man presented with ocular pain in his right eye, after an occupational injury with a hammer. Ocular examination revealed total hyphaema, and full thickness laceration of the temporal limbus. Computed tomography revealed a metallic IOFB embedded in the posterior sclera. We conducted primary repair and vitrectomy with silicone oil tamponade, without IOFB removal. Close follow-up was conducted to check for secondary inflammation of IOFB and infection. After 6 months, mild retinal folding and dragging were observed. Internal limiting membrane peeling and silicone oil removal were performed. The eye has been stable for 2 years now, and the patient’s best corrected visual acuity is 20/25.
Case 3: A 52-year-old man with penetrating ocular injury sustained while striking a chisel with a hammer, was referred to our clinic. Ocular examination revealed vitreous haemorrhage with full thickness laceration, and computed tomography showed embedded IOFB in the posterior sclera. We kept a close watch for any signs of change in the metallic IOFB, and for signs of retinal infection for 6 months, and found the retina to be stable. The best corrected visual acuity was 20/40 under silicone oil tamponade.

Conclusion:

If an intraocular metallic foreign body is located near the macula, there is a high possibility of macular damage during removal. In some cases, removal of the IOFB may result in greater retinal damage due to enlargement of the penetration site, excessive fibrosis after surgery, and retinal traction. Hence, if the IOFB penetrating the retina does not cause immediate infection or inflammation, management without removal of the IOFB, and maintaining close follow-up could minimize macular damage, and improve visual prognosis.

 

None of the authors have either a financial or proprietary interest in any of the presented materials or methods.


CONTACT DETAILS

 

Hyun Seung YANG*1, Jung Kee MIN
1 Department of Ophthalmology, Seoul Shinsegae Eye center, Eui Jung Bu, Gyeonggi-do, South Korea
2 Department of Ophthalmology, University of Ulsan, College of Medicine, Ulsan University Hospital, Ulsan, South Korea
Email : yangg961@gmail.com
Cell Phone: +821089663827
Work Phone: +821089663827