23-gauge vitrectomy with intraocular foreign body removal via the limbus: An alternative approach for select cases

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Abstract

Purpose:

To study the outcome of removal of retained intraocular foreign bodies (RIOFBs) via limbus using 23-gauge transconjunctival sutureless vitrectomy (TSV).

Materials and Methods:

In this prospective, non-comparative interventional case series, fourteen eyes of 14 patients fulfilling the inclusion criteria were enrolled. They underwent 23-gauge TSV for management of posterior segment RIOFB and reviewed at 1 day, 7 days, 6 weeks, 3, 6 and 12 months. Eyes with penetrating eye injury involving cornea or limbus (corneal injury not so severe to hinder vitrectomy), cataract associated with anterior and/or posterior capsular tear requiring cataract surgery and posterior segment RIOFB with minimal posterior segment involvement were included. Main outcome measures include success in removal of RIOFB without enlarging sclerotomy, ability to preserve capsular support, improvement in visual acuity and complications, if any.

Results:

All eyes underwent the successful RIOFB removal through limbal port without enlarging scleral ports. None of the eyes required suturing of the sclera, cornea or conjunctiva. Anterior capsular rim could be preserved in all eyes except one. Postoperatively follow up ranged from one year in 8, 6 months in 4 and 3 months in 2 eyes. The mean logMAR visual acuity at 3, 6, and 12 months showed significant improvement. There were no intraoperative complications. Postoperative complications include microscopic hyphema and loose blood in vitreous cavity in one eye.

Conclusion:

The advantages of 23-gauge TSV for removal of RIOFB may be passed on to select cases. RIOFB removal through limbal route obviated the need for scleral port enlargement and preserved capsular support for early visual rehabilitation.

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Most cited references 23

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Post-traumatic proliferative vitreoretinopathy. The epidemiologic profile, onset, risk factors, and visual outcome.

L Omphroy, Richard Kimura, Shantá D. Hinton … (1997)

The purpose of the study was to characterize the clinical development of proliferative vitreoretinopathy (PVR) after trauma in the human eye. A chart review was performed on the records of 1564 patients with ocular trauma seen at a large metropolitan hospital. The frequency, type of ocular trauma, time to onset, potential risk factors, and visual outcome for PVR were evaluated. Proliferative vitreoretinopathy occurred in 71 (4%) of 1654 injured eyes. Of these 71 injured eyes, 30 (42%) resulted from rupture, 15 (21%) from penetration, 13 (18%) from perforation, and 7 (10%) from confusion. Six (9%) were associated with an intraocular foreign body (IOFB). The frequency of PVR following perforation, rupture, penetration, IOFB, and contusion was 43%, 21%, 15%, 11%, and 1%, respectively. Overall, those eyes that developed PVR had a poorer visual outcome, with PVR being the primary reason for visual loss. The time from injury to onset of PVR was shortest after perforation (median, 1.3 months), followed by rupture (2.1 months), IOFB (3.1 months), penetration (3.2 months), and contusion (5.7 months). Vitreous hemorrhage was the strongest independent predictive factor for the development of PVR. A long, posteriorly located wound and persistent intraocular inflammation were also important risk factors for PVR. These results suggest that PVR is a common complication following a variety of ocular injuries, and that it is associated with a poor visual outcome. Its frequency, onset, and outcome are strongly dependent on the nature of the trauma. Specific high-risk groups are identified as candidates for more aggressive therapy.

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Current trends in the management of intraocular foreign bodies.

Frances M. Colyer, Eric D Weichel, Steven Yeh (2008)

The aim of this article is to present the recent literature on the preoperative assessment, intraoperative management and postoperative care of patients with intraocular foreign bodies and present a management algorithm. The preoperative assessment includes an evaluation of concomitant, potentially life-threatening conditions, as well as a relevant history and ophthalmic examination. Neuroimaging, preferably with noncontrast helical computed tomography, provides excellent information about intraocular foreign body size, shape and location. The preoperative assessment provides valuable information for prognosis, counseling, and intraoperative guidance. The decision of delayed versus immediate intraocular foreign body removal must be guided by the patient's medical status, availability of adequate operating facilities and staff, and the presence of clinical endophthalmitis. The administration of perioperative systemic and topical third or fourth-generation fluoroquinolones may play a role in decreasing the incidence of postoperative endophthalmitis. Intravitreal antibiotics warrant consideration in patients with a Gram stain positive for organisms, in cases suspicious for endophthalmitis, and in high-risk settings. Both the material and size of the foreign body are considerations in the choice of instrument and extraction site used (sclerotomy versus scleral tunnel) at time of pars plana vitrectomy and intraocular foreign body removal. Postoperatively, patients should be monitored closely for the development of endophthalmitis, retinal detachment and proliferative vitreoretinopathy. This review summarizes the recent literature on the assessment of intraocular foreign bodies and techniques for their removal. An algorithm provides guidelines for their perioperative and operative management.

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Infectious endophthalmitis after penetrating injuries with retained intraocular foreign bodies. National Eye Trauma System.

S. Thompson, P Liggett, W Mieler … (1993)

To determine the risk factors and prognostic indicators of infectious endophthalmitis in eyes with penetrating injury and retained intraocular foreign body. From the National Eye Trauma System (NETS) Registry, 492 eyes with intraocular foreign bodies were reviewed for signs of infectious endophthalmitis. Thirty-four eyes (6.9%) with intraocular foreign bodies had evidence of infectious endophthalmitis, and 31 (91.2%) of those eyes had signs of infection at the time of removal of the intraocular foreign body. The majority of eyes with an intraocular foreign body with or without endophthalmitis were in patients between 10 and 39 years of age, but the risk of endophthalmitis developing increased with age, especially in patients 50 years of age or older with delayed primary repair (P = 0.005). Endophthalmitis was more likely to develop in eyes with home or occupational injuries (33/358, 9.2%) than in those with injuries from other settings (1/128, 0.8%; P = 0.001). Infectious endophthalmitis was much less likely to develop in eyes with primary repair within 24 hours of the injury (10/287 = 3.5%) than in eyes with primary repair more than 24 hours after the injury (22/164, 13.4%; P < 0.0001). Bacilli or staphylococci were isolated in 21 (95%) of 22 eyes with positive cultures. Visual prognosis was reasonably good with 15 (58%) of 26 eyes attaining a visual acuity of 20/200 or better. Removal of a retained intraocular foreign body within 24 hours of injury markedly reduces the risk of infectious endophthalmitis developing. Older persons are at high risk for endophthalmitis developing after retaining an intraocular foreign body when there is delayed surgical repair.

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Author and article information

Journal

Journal ID (nlm-ta): Indian J Ophthalmol

Journal ID (iso-abbrev): Indian J Ophthalmol

Journal ID (publisher-id): IJO

Title: Indian Journal of Ophthalmology

Publisher: Medknow Publications & Media Pvt Ltd (India )

ISSN (Print): 0301-4738

ISSN (Electronic): 1998-3689

Publication date (Print): June 2014

Volume: 62

Issue: 6

Pages: 707-710

Affiliations

[1]Advanced Eye Center, Post Graduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh, India

Author notes

Correspondence to: Dr. Ramandeep Singh, Advanced Eye Center, Post Graduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh – 160 012, India. E-mail: drramandeepsingh1972@ 123456gmail.com

Article

Publisher ID: IJO-62-707

DOI: 10.4103/0301-4738.116458

PMC ID: 4131324

PubMed ID: 24008799

SO-VID: 35c40365-2551-4a22-8569-855909b3948e

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

23-gauge vitrectomy with intraocular foreign body removal via the limbus: An alternative approach for select cases

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Abstract

Purpose:

Materials and Methods:

Results:

Conclusion:

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Clinical Virtual Research Center Journal of Ophthalmology

Most cited references 23

Post-traumatic proliferative vitreoretinopathy. The epidemiologic profile, onset, risk factors, and visual outcome.

Current trends in the management of intraocular foreign bodies.

Infectious endophthalmitis after penetrating injuries with retained intraocular foreign bodies. National Eye Trauma System.

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