Successful removal of large intraocular foreign body by 25-gauge microincision vitrectomy surgery

Abstract

We describe a new technique for removing a large intraocular foreign body by 25-gauge microincision vitrectomy surgery (25G-MIVS). Noncomparative interventional case series were performed at a single centre. Two patients with a long smooth intraocular vitreal foreign body underwent phacoemulsification and aspiration, intraocular lens implantation, 25G-MIVS, and extraction of the foreign body. The foreign body was removed through a posterior capsulorhexis, anterior continuous curvilinear capsulorhexis, and a corneal incision. In both cases, the foreign body was safely removed through the corneal incision, and IOL was implanted and well positioned. The surgical incision did not require suturing. No postoperative complications associated with this technique were found. The corneal endothelial cell density was maintained over 2000 cells/mm(2) in both cases during recent follow-up examinations. Our findings indicate that 25G-MIVS with this technique can be used to extract a long slender smooth foreign body. It is safe, without complications, and can be performed without enlarging the 25-gauge sclerotomy.

Figures

Figure 1

Preoperative slit-lamp photographs, preoperative fundus photograph, preoperative computed tomographic image, and intraoperative photographs of intraocular foreign body (Case 1; (a, b, c), Case 2; (d, e, f)). (a) Preoperative slit-lamp photograph shows a slight penetrating wound in the iris and lens at the 9 o'clock position and a posterior subcapsular cataract at the same position. (b) Fundus photograph showing vitreous haemorrhage and retinal tear with subretinal haemorrhage located on the temporal side of the macula. Computed tomographic image showing a large foreign body. (c) Intraoperative fundus showing a large metallic intraocular foreign body anterior to the retina. (d) External photograph showing the penetrating wound at the 4 o'clock position and the corneal wound was closed by corneal sutures during the initial surgery. (e) Slit-lamp photograph showing that the posterior subcapsular cataract has progressed. (f) Intraoperative fundus photograph showing large glass intraocular foreign body anterior to the retina.

Figure 2

Intraoperative photographs and postoperative slit-lamp photographs of Case 1 (a, b, c) and Case 2 (d, e, f). (a) and (b) Metallic foreign body extracted through an anterior and posterior capsulorhexis, and corneal incision (triple C-through technique). (c) Slit-lamp photograph (inverted image as seen by the surgeon) 1 day postoperatively showing no need of suturing, no subconjunctival haemorrhage, and well-positioned intraocular lens. (d) and (e) Glass foreign body extracted through an anterior and posterior capsulorhexis, and corneal incision (triple C-through technique). (f) Slit-lamp photograph (inverted image as seen by the surgeon) 1 day postoperatively showing no need of suturing, except the original penetration wound, no subconjunctival haemorrhage and well-positioned intraocular lens.