Management of Corneal Bee Sting Injuries

Purpose: To review the management of keratitis after corneal bee stings and to report a case of deep stromal corneal infiltrate secondary to a retained bee stinger managed conservatively in a patient who presented three days after unsanitary manipulation of the stinger apparatus. Methods: Case report and review of literature. Results: A 57-year-old male beekeeper was evaluated for pain, blurry vision, and photosensitivity after a corneal bee sting. Of note, the venom sac had been removed with dirty tweezers three days prior to his visit. On exam, a focal infiltrate with diffuse edema was seen surrounding a retained bee stinger in the peripheral cornea. Trace cells in the anterior chamber were also noted. Based on a high suspicion for infectious keratitis, a conservative treatment strategy was elected. Administration of broad-spectrum topical antibiotics with concomitant abstention of corticosteroids led to rapid resolution of the symptoms. Over 16 months of follow-up, the stinger has remained in situ without migration and the patient has maintained 20/20 visual acuity without complications. There is debate on the preferred method for the management of corneal injury secondary to bee stings, especially when it is associated with a retained stinger. We herein present our findings in our appraisal of reported cases. Conclusion: In the aftermath of an ocular bee sting, close surveillance for inflammation and infection is essential. Individual manifestations of these injuries vary in timing, type, and severity; therefore, the accessibility of the stinger and the evolving clinical picture should guide therapeutic decisions.     

Corneal bee sting misdiagnosed as viral keratitis

PURPOSE: To report a case of chronic keratouveitis caused by a missed bee sting injury. METHODS: A 17-year-old boy was referred for management of unresponsive viral keratouveitis. Ocular examination revealed corneal edema and scarring, atrophic patches on the iris, and anterior polar cataracts. Surprisingly, examination also revealed a retained intracorneal bee stinger. A retrospective inquiry confirmed a bee sting injury 2 years ago. RESULTS: The patient was started on medical treatment and underwent operative removal of the bee stinger. Postsurgery, visual acuity improved, and the corneal edema regressed over a 1-month follow-up. CONCLUSIONS: In cases of chronic keratouveitis, a meticulous examination is mandatory to rule out unusual causes like a retained corneal bee stinger. A retained intracorneal bee stinger may result in long-term corneal inflammation, which may not be controlled adequately with topical steroids. It should be removed, irrespective of the duration since the injury.     

危及晶状体的穿透性深层角膜异物取出

目的:探讨危及晶状体的穿透性深层角膜异物取出方法。方法:本次观察中共有患者12例12眼,其中植物性11眼,金属性1眼,均为位于瞳孔区的穿透性深层角膜异物。患者术前30min予全身镇静药,缩瞳剂充分缩瞳,以15°角膜穿刺刀作前房穿刺,确保无房水外漏,粘弹剂自穿刺口注入前房并加深其深度,以无齿镊挟持异物将其顶退出角膜表面,另手以有齿镊接应将异物拔除,或将异物拨向虹膜面并将其拽入前房,经角膜切口取出。结果:12眼异物均顺利取出,1眼多发性异物因初始取出经验不足导致术后轻度并发性白内障,8眼有角膜渗漏(其中3眼行角膜缝合),经加压包扎后恢复。结论:对于危及晶状体的穿透性深层角膜异物,术前应设计一个有针对性的周详应对方案,在外路取出存在危险的情况下,内路取出法不失为一个理想的方法。     

Removal of semitranslucent cactus spines embedded in deep cornea with the aid of a fiberoptic illuminator

PURPOSE: To report a rare case of multiple cactus spines embedded deep in the cornea that were removed with the aid of a fiberoptic illuminator. DESIGN: Interventional case report. METHODS: A 20-year-old man had an accidental ocular injury of the right eye when he hit a household miniature cactus plant. There were 80 to 90 spiculated foreign bodies embedded in the cornea, some of them even penetrating the anterior chamber. RESULTS: Removal of the foreign bodies was performed with the aid of a fiberoptic illuminator, which was chosen because it provides superior visualization of the semitranslucent spines. No residual corneal spines were found postoperatively. CONCLUSIONS: Household miniature cactus plants can cause corneal injury, with multiple foreign bodies that can be difficult to localize and remove. The use of a fiberoptic illuminator in such a situation is simple and effective.     

Clinical Efficacy of Surgical Removal of Deep Corneal Plant Foreign Bodies

 PURPOSE:To describe a technique for removing deep corneal plant foreign bodies. METHODS:Twelve patients (7 males and 5 females, aged 5 to 56 years) with plant foreign bodies embedded in the deep cornea were treated between July 2011 and December 2012. The course of disease ranged from 1 to 11 d. Four of the patients had wooden foreign bodies, 3 had bamboo foreign bodies, and 5 had flower thorns; all underwent surgical removal. During the surgery, a novel suture needle was used to remove the foreign bodies. For injuries with a deep tunnel caused by the foreign bodies, the tunnel was cut open with a keratome. The foreign bodies were then removed and necrotic tissue was thoroughly debrided. Incisions were closed with interrupted sustures. The corneal foreign bodies were collected postoperatively for fungus and bacterial culture and appropriatemedical treatment was provided. RESULTS:Bacteria were identified in 3 cases, fungus in 3 cases, and no bacteria or fungus in 6 cases. All corneal foreign bodies were embedded deep in the corneal stroma without incidence offull-thickness corneal penetration or intraocular infection. CONCLUSION:Plant foreign bodies embedded in the deep cornea should be removed immediately. During the surgery, the foreign bodies and surrounding necrotic corneal stroma should be completely removed. The injured cornea should be cut open to eliminate necrotic tissues when necessary.     

Corneal honey bee sting: endoilluminator-assisted removal of retained stinger

To report the clinical findings and a novel method of removal of bee sting using an endoillumination light source the following methods were used: clinical presentation, slit-lamp photographs, serial endothelial images and surgical management of a case of retained bee sting in the cornea. The bee sting was surgically removed by forceps under focal illumination with an endoillumination light source. Topical steroids and cycloplegics were given postoperatively to control the inflammation. The patient had complete visual recovery and partial resolution of endothelial changes after 1 year of treatment. The clinical picture of a corneal honey bee sting resembles keratouveitis. Focal corneal infiltrate and associated low-grade uveitis tend to persist if treated with topical steroids only. Early recognition and prompt removal of the stinger may help in the early resolution of anterior segment inflammation and prevent irreversible damage to endothelial cells.     

Descemet-stripping automated endothelial keratoplasty after bee sting of the cornea

We present a case of corneal decompensation and cataract formation following a corneal bee sting in a patient with a history of drug abuse. Clinical findings, anterior segment photographs, and medical and surgical treatment are presented. The stinger was removed from the cornea. Systemic and topical steroids, topical antibiotics, and systemic and topical antiglaucoma medication and antihistamines were prescribed. After 3 months, combined Descemet-stripping automated endothelial keratoplasty (DSAEK), phacoemulsification, and intraocular lens implantation were performed, with significant improvement in visual acuity and corneal edema. To our knowledge, this is the first report of DSAEK combined with cataract surgery for this condition. It was found to be a safe and effective treatment for corneal decompensation secondary to a bee sting.     

角膜深层栗刺伤异物摘出临床分析

目的 探讨角膜深层栗刺异物伤异物摘出方法及临床效果.方法 对60例（60眼）角膜深层栗刺异物伤进行分析.根据栗刺异物的具体表现分别在裂隙灯显微镜下或手术显微镜下采取镊取法、针剔法、板层角膜瓣法,以及手术显微镜下的经前房顶推法进行异物摘出术.结果 60例角膜深层异物全部摘出且无手术并发症发生.50例（83.3％）视力较初诊时提高,基本维持不变者10例（16.7％）,未见下降者.结论 查清全部异物情况,选择合适的手术方式摘出异物,是角膜深层栗刺异物伤治疗的关键.     

Bee sting of the cornea

Bee stings of the cornea are rarely reported, but have the potential for causing serious ophthalmological injuries. We present a case of corneal bee sting with retained stinger apparatus. A 35-year-old patient presented with an acute, corneal bee sting of the right eye 12 hours after he was stung. The patient suffered from pain, blurred vision, and epiphora. The right eye showed edema of the upper and lower eyelid, conjunctival hyperemia, chemosis, and striate keratitis of the paracentral cornea by biomicroscopic examination. The stinger was identified in the depth of the corneal infiltration. Visual acuity was 5/10. It was removed surgically. After 2 months, the eye only showed a minimal residual corneal opacification. Visual acuity was 10/10. We present a case of bee sting to the cornea with retained stinger apparatus and treatment of this unusual presentation.     

Corneal bee sting-induced endothelial changes

PURPOSE: To report the acute management and clinical findings of a case of corneal bee sting and to report the outcome of corneal endothelial cell analysis 1 year after trauma. METHODS: Clinical findings, anterior segment photographs, corneal endothelial images, and medical treatment of a case of right corneal bee sting are presented. Right and left central corneal endothelial cell analysis was performed by noncontact specular microscopy. RESULTS: The stinger was removed from the cornea. Systemic, subconjunctival, and topical steroids and systemic and topical antibiotics were given. One year later, a corneal scar and anterior capsular opacity of the lens in the right eye were shown by slit-lamp examination. Endothelial cell analysis determined that the endothelial cell density of the right eye was substantially decreased compared with the left eye. CONCLUSION: Corneal infiltration gradually decreased, presumably because of the systemic, topical, and subconjunctival steroids. Late complications observed in this case included a substantial decrease in cornea endothelial cell density, a corneal scar, and anterior capsular opacity.     

Corneal honeybee sting

BACKGROUND: We report the complications and management of a retained bee sting injury to the cornea. The case highlights the acute and chronic management of an uncommon injury and its pathogenesis. METHODS: A 67-year-old man was attacked by a swarm of bees and was referred for severe chemosis on the right eye. A retained corneal bee stinger (ovipositor) was seen but removal was only partially successful. He subsequently developed a large corneal epithelial defect, anterior uveitis, intractable glaucoma, traumatic cataract, toxic optic neuropathy, and corneal scarring. We reviewed the literature on corneal bee sting injuries and their complications. RESULTS: Inflammation was controlled with topical steroids and the patient underwent a combined phacoemulsification and trabeculectomy with mitomycin-C for uncontrolled glaucoma. However, optic neuropathy did not resolve. INTERPRETATION: Corneal bee sting injuries are uncommon but can result in severe sight-threatening complications such as toxic optic neuropathy. Early recognition of the possible complications and appropriate treatment may help to prevent permanent loss of vision. Removal of a retained corneal bee stinger remains controversial.     

Removal of Intralenticular Magnetic Foreign Bodies with Intraocular Magnet

Purpose: To investigate the possibility of conservation of the lens after removal of intralenticular magnetic foreign bodies with intraocular magnet.Methods: Intralenticular magnetic foreign bodies of 15 patients were removed by using an intraocular magnet. The lens of each injury eye was conserved. Follow-up observation of these cases ranged from one to four years.Results: The intralenticular magnetic foreign bodies of 15 patients were successfully removed. The lens of each injury eye was conserved and the transparence of the lens was properly maintained. Sizes of these foreign bodies were measured, ranging from 0.3mm to 3mm in diameter. The follow-up observation showed that the corrected visual acuity of 14 cases was not changed after operation.Conclusions: The intraocular magnet is very helpful for removal of magnetic foreign bodies from the transparent lens. This magnet allows removing of the foreign body by the surgeon and no damage to the lens was induced during the operation. Thus, maintenance of     

角膜缝线效应对外伤性白内障人工晶状体度数测算准确性的影响

目的:探讨缝线效应对外伤性白内障人工晶状体度数测算准确性的影响。方法:前瞻性研究。收集2017-03/2019-03拟在我院实施Ⅱ期人工晶状体植入术的角膜穿通伤缝合联合白内障摘除术后患者57例57眼并进行分组,观察组于术前1wk拆除角膜缝线,对照组于术中拆除角膜缝线。比较观察组患者角膜缝线拆除前后角膜曲率、角膜散光、前房深度、眼轴长度及理论人工晶状体度数的变化,观察两组患者术后裸眼视力和角膜散光情况。结果:角膜缝线拆除前后,观察组患者角膜曲率(43.15±1.32D vs 45.05±1.20D)、角膜散光(-5.23±2.52D vs-2.04±1.44D)及理论人工晶状体度数(22.24±2.36D vs20.40±1.46D)均有差异(P<0.05),而前房深度、眼轴均无差异(P>0.05)。术后1d,1wk,1、3mo,观察组患者裸眼视力均优于对照组,角膜散光均低于对照组(P<0.05)。结论:角膜缝线效应对外伤性白内障患者角膜散光和理论人工晶状体度数测算及术后屈光状态影响显著。     

Removal of corneal foreign bodies following laser in situ keratomileusis

PURPOSE: To report the outcome of uncomplicated removal of corneal foreign bodies in patients who previously underwent laser in situ keratomileusis (LASIK). METHODS: Nine eyes of eight patients presented with corneal foreign bodies after LASIK. RESULTS: In three patients, diagnosis of corneal foreign bodies was delayed due to reduced pain and symptoms. Removal of foreign bodies was performed with no flap-related complications. Corneal wound healing was normal. Final visual acuity was not decreased. CONCLUSION: Corneal foreign bodies can be removed safely and effectively from corneas after LASIK.     

角膜嵌顿眼前段玻璃纤维异物取出新法

目的探讨角膜嵌顿的眼前段玻璃纤维异物的取出新法。方法以1.4mm矛形刀穿刺前房,视玻璃纤维直径及刺入深度,酌情采用眼用粘弹剂或眼内灌注液加深前房,使玻璃纤维自晶状体、虹膜退出或使其前端产生足够的操作空间,然后以自制7#驱逐针头托玻璃纤维后退,以显微持针器轻轻夹持退出部分全部拔除。结果本组7例(7眼)角膜嵌顿的眼前段玻璃纤维异物,全部被安全快捷地取出,无一发生手术误伤及手术并发症,且术后反应均很轻微。结论本手术方法不仅特别适用于取出角膜嵌顿的眼前段玻璃纤维异物,也可用于取出其他类似比较坚挺光滑的异物,如铅笔芯等。对取出比较松软之金属细丝、木刺等异物,有时也有一定帮助。     

Free Migration of Intraocular Glass in Aphakia after Glaucoma Surgery

PurposeTo describe a case of free migration of intraocular glass in aphakia after glaucoma surgery.MethodsWe report the case of a 27-year-old man with a history of perforating injury to the right eye 10 years previously and glaucoma surgery 1 year previously presenting with 1 month of pain and frequent floaters in front of the right eye. On examination, the glass fragment was seen to lie free in the anterior chamber or migrate backwards through the pupil, remaining mobile on the inferior retinal surface when the patient was prone or supine, respectively.ResultsThe fragment was surgically removed.ConclusionLate migration of glass intraocular foreign bodies is a rare clinical entity, and the exact mechanism causing the migration of intraocular glass remains controversial. Early intervention must be weighed against the hazards of removal and the necessity of close follow-up.Key Words: Glass intraocular foreign bodies, Glaucoma surgery, Corneal edema     

Removal of corneal foreign bodies that project into the anterior chamber: use of a suture needle

PURPOSE: To describe and illustrate a simple and reliable technique for removing penetrating corneal foreign bodies. METHODS: A 6-mm needle was placed through the cornea beneath the corneal foreign body to provide support and illumination posteriorly. RESULTS: In eight eyes of eight patients all penetrating corneal foreign bodies were removed completely without severe complications. CONCLUSIONS: The use of a suture needle during removal of penetrating corneal foreign bodies is simple, effective, reliable, and inexpensive.     

Intracorneal hematoma after canaloplasty and clear cornea phacoemulsification: surgical management

Purpose. This is a case report of intracorneal hematoma after canaloplasty and clear cornea phacoemulsification. Methods. A 75-year-old woman presented with primary open angle glaucoma and visually significant cataract. Canaloplasty and clear corneal phacoemulsification were performed. Postoperatively she had an intracorneal hematoma, which was removed through a clear corneal tunnel. Results. Preoperative best-corrected visual acuity (BCVA) was 20/40 in the right eye and mean intraocular pressure (IOP) was 20 mmHg. Uneventful canaloplasty, clear corneal phacoemulsification, and implantation of a posterior chamber intraocular lens were performed. One day after the operation, BCVA was 20/400 in the right eye. The IOP was 8 mmHg. Anterior segment examination revealed a nasally located intrastromal hematoma between corneal stroma and Descemet membrane. The intracorneal hematoma was removed through a clear corneal tunnel. Six months postoperatively, BCVA was 20/25 in the right eye. The IOP with one medication was 17 mmHg. Conclusions. This operation was a minimally invasive technique to remove intrastromal hematocornea after viscocanaloplasty.     

多发性角膜深层异物取出临床观察

目的:探讨多发性角膜深层异物取出方法。方法:本组患者42例45眼,其中异物穿透角膜全层并部分伸入前房者13例。磁性异物2例,非磁性异物36例,混合性异物4例。未穿透角膜者可用显微镊直接拔出,或作一浅层角膜切开后拔出。穿透角膜者,充分缩瞳,以15°角膜穿刺刀作前房穿刺,确保无房水外漏,黏弹剂自穿刺口注入前房并加深其深度,以顶退的方式自角膜面将异物稍加送出,露出异物尾端,此时不急以拔除,而以相同的手法处理其余异物,待所有异物尾端均露出角膜面后,再以多个有齿镊同时将异物取出。结果:45眼异物42眼顺利取出,3眼因初始取出经验不足导致术后并发性白内障,8眼合并虹膜炎,10眼发生角膜炎均为伤后超过1wk方来就诊者。在伤后3d内及时就诊的患者,术后视力改善几率明显高于1wk者。结论:对于多发性深层角膜异物,尤其是多发性穿透性角膜异物的取出,应争取尽早就诊手术,手术设计应以保护晶状体为前提,尽量减少手术并发症的发生。     

Central penetrating keratoplasty with peripheral intrastromal tuck

PURPOSE: To report a new technique of central penetrating keratoplasty with peripheral intrastromal tuck in cases of chronic corneal decompensation. METHODS: Central penetrating keratoplasty with peripheral intrastromal tuck was undertaken in 8 eyes with chronic corneal decompensation. An 8-mm donor tissue with a peripheral flange of 2 mm was fashioned and sutured into a 7.5-mm recipient bed having a 2-mm intralamellar pocket. Sixteen full-thickness interrupted sutures were passed. Suture removal was possible as early as 1 month, and all sutures were removed by 4 months. RESULTS: Postoperative BCVA improved to 20/40 to 20/80 in all eyes, and astigmatism was <4 diopters in all cases at the last follow-up, which ranged from 5 to 16 months. CONCLUSIONS: Central penetrating keratoplasty with peripheral intrastromal tuck is a useful technique because it allows early suture removal and visual rehabilitation.