Retained intraorbital metallic foreign bodies

PURPOSE: To document the biological tolerance of retained metallic orbital foreign bodies managed with conservative treatment. METHODS: A retrospective chart review of 43 patients treated between 1987 and 1993 with retained intraorbital metallic foreign bodies was performed. Age, sex, injury, imaging studies obtained, location of the foreign body, initial and final visual acuity, length of follow-up, treatment, and related adverse reactions and/or complications were recorded. RESULTS: Fifty cases involving 34 male and 9 female patients ranging in age from 2 through 63 years (median, 25 years) were included. Seventeen cases were the result of gunshot wounds, 17 were from BB gun injuries, and 16 cases were from shotgun injuries. Forty-two patients had CT scans to assess the injury and one patient had plain radiographs. In 37 cases, the metallic foreign bodies were located posterior to the globe. There were 19 ocular penetrating injuries, 11 ocular contusion injuries (sclopetaria, commotio retinae, vitreous hemorrhages), and 20 injuries with no ocular involvement. Initial visual acuity ranged from 20/20 to no light perception, as did final visual acuity. The metallic foreign bodies were retained from 6 months to 68 years (median, 2 years). There were 19 ocular penetrating injuries, including 12 enucleations and 7 primary repairs. When contusion injuries were sustained, treatment consisted of vitrectomy for the removal of persistent hemorrhages (3 cases), exploration of the globe (1 case), and nonsurgical treatment (7 cases). Among the 20 cases with no ocular involvement, only 2 patients had secondary complications that required surgical intervention: One had mechanical strabismus, the other a sterile abscess. Visual acuity remained stable or improved in all cases. There were no late complications from the retained foreign bodies in 36 (95%) of 38 cases when the eye remained intact. CONCLUSIONS: Retained intraorbital metallic foreign bodies are well-tolerated and typically have minimal adverse visual prognosis. They should be managed conservatively in the absence of specific indications for removal.     

螺旋CT多平面重组对眼部异物的诊断价值

目的探讨螺旋CT多平面重组在眼部异物定位诊断中的价值。方法经眼科手术证实的眼部异物12例（13眼）。采用螺旋CT进行眼眶轴位薄层扫描,并利用多平面重组（MPR）技术对异物进行三维定位分析。结果所有异物定位诊断与手术结果相符。结论CT多平面重组技术对眼部异物的三维定位有重要价值。     

Magnetic resonance imaging and computed tomography in a model of wooden foreign bodies in the orbit

Wooden foreign bodies in the orbit are not detectable by standard roentgenography. Reports in the literature on the ability of computed tomography (CT) to detect orbital wooden foreign bodies have varied. To evaluate whether magnetic resonance imaging (MRI) would offer any advantage over CT in detecting wood in the orbit. MRI and CT were performed on an in vitro model of wooden foreign bodies in the orbit. Woods of different types and sizes were studied in vegetable fat backgrounds chosen to simulate orbital fat. On CT, most types of wood were hypodense to fat. Appropriate window settings were critical in the detection of wood by CT: in this model, a window width of 1000 Hounsfield units was optimal. On MRI, all types of wood were hypointense to fat. Small pieces of wood were surrounded by an MRI truncation artifact consisting of hyperintense spots. T1-weighted images demonstrated wood better than T2-weighted images and required less scanning time than either proton density or T2-weighted images, MRI was superior to CT in detecting the smallest pieces of wood. The role of MRI in the detection of orbital wooden foreign bodies in clinical practice remains to be determined.     

Self-insertion of foreign bodies into the orbit and periocular tissue

We describe six patients with 12 separate episodes of self-inflicted periocular foreign body injuries, which presented to our institution recently. All patients were male, relatively young (mean 28.5 years old), incarcerated, and had significant underlying psychiatric conditions. The subjects had inserted staples (6), paperclips (2), or other small metallic wire segments (4) into the periocular region. Most cases (9/12) involved concurrent self-inflicted injury to other body parts. Ten cases involved foreign bodies inserted through the palpebral conjunctiva into the upper eyelid, while two cases involved insertion into the orbit. Identification and surgical retrieval of foreign bodies was successful in most cases (9/11) but was not attempted in one case. Self-inflicted periocular injuries, while rare, are challenging cases for which the ophthalmologist should be prepared. A multidisciplinary approach, including psychiatric assessment and treatment, is important for optimal care.     

Uncommon sites of metallic intraocular foreign bodies

The authors report one case of irido-corneal angle foreign body, three cases of intra-lens foreign body, and one case of foreign body located into the retino-choroidal wall. For this last case, they describe an original technique of treatment including a retinal Argon-Laser photocoagulation round the foreign body followed by a foreign body extraction with endocular forceps and vitrectomy.     

Significance of topographic diagnosis of foreign bodies situated in the orbit

Clinical picture of extraocular foreign bodies in the orbit is analyzed in 49 patients, specific features of the diagnosis and treatment of this condition are discussed. Study of the topography of foreign bodies in the orbit has helped distinguish the clinically significant area of fragment localization, areas at a high risk of developing complications, and 'quite' areas. A localizing probe on a space molding was found an effective diagnostic tool. Using this probe, stereotopic localization of a foreign body may be associated with roentgen-negative intraorbital structures, i.e. vessels, nerves, muscles. Topographic location of a foreign body helped explain a considerable vision acuity reduction in relatively transparent media, recurrences of hemorrhages to the fundus oculi, and the type of the pain syndrome. Foreign body removal is indicated in stubborn persistent pain and regressive time course of changes.     

眼内金属异物的定位和摘出

目的探讨眼内金属异物的定位和摘出.方法术前安放水平泡定位器作X线摄片定位.术中按定位数据暴露手术野,对磁性或非磁性金属异物分别选用磁性异物探测定位器(磁探器)或金属异物探测定位器(金探器)在相应的巩膜面定位,用电磁铁或直视下摘出异物.结果460例金属异物中401例成功摘出异物395例(98.50%),失败6例(1.50%).手术前、后视力比较术后视力改善(P＜0.01).结论磁探器和金探器能满足眼内金属异物术中的定位要求,定位误差≤0.5mm.     

Origin of intraocular metallic foreign bodies during phacoemulsification

This is the first report of a case of intraocular metallic foreign bodies retained after phacoemulsification in which the source was identified as silver emanating from the brazing of the irrigation tube as it entered the handpiece shell on its inner diameter. Although silver is considered to be inert in the eye and nonmagnetic, manufacturers should evaluate alternate methods of phacoemulsification handpiece design.     

应用探测器定位摘出眼眶内金属异物

目的：探讨应用探测器定位摘出眼眶内金属异物的利和弊。方法：对1986－1998年连续在我科住院，术中应用探测器定位并摘出异物的132例（132眼）进行回顾分析。结果：探测器术中定位的准确性为100％，而摘出成功率为131／132（99．24％），失败1例（0．76％）；手术未造成视力的进一步下降；有13例术后致上睑下垂和眼外肌功能障碍,其中约半数病例经中医治疗得以治愈和改善。结论：本探测器对最大长径＞1.5mm的眶内金属异物能准确定位，位于外下象限距角膜缘平面之后≤25mm之磁性异物摘出较易；位于角膜缘平面之后≥26mm之非磁性金属异物是否手术，应具体分析，权衡利弊。     

CT localization of foreign intra-ocular bodies

In the course of three years from the total number of 124 CT examinations indicated by the Ophthalmological Department of the Regional Hospital in Ustí nad Labem ten examinations of the orbit with an intraocular foreign body were made. Based on a group of 10 eyes the authors present a report of their hitherto assembled experience with the use of computed tomography in the diagnosis of intraocular foreign bodies. They draw attention to the advantages but also certain limitations of the location of foreign bodies by CT. In two of 10 cases the foreign body was located incorrectly by CT in the bulbar wall--although it was retrobulbar. In the remaining eight cases the CT examination was a great asset and contributed greatly to successful operation. 50% of the patients have after operation a vision of 6/6.     

Scanning electron microscopic findings on intraocular metallic foreign bodies

· Background: The study reported here was performed to investigate morphologic intraocular reactions on the surface of metallic intraocular foreign bodies (IOFB) with scanning electron microscopy. · Methods: Twenty-seven extracted IOFB were investigated. Of these, 22 were situated in the vitreous body; 19 had contact with the retina. Five IOFB had been removed from the anterior segment (control group). The duration of intraocular retention was 6 h to 24 days. Immediately after microsurgical removal the IOFB were fixed, dehydrated, dried, sputter-coated and investigated with a scanning electron microscope. Two IOFB from the vitreous were treated for collagen preservation.  · Results: Eighteen of 20 intravitreal IOFB showed fibers of fibrin on its surface; 11 of 20 were covered with a homogeneous layer. Within this layer a net of collagen fibers was detectable. A major cellular reaction was observed only on IOFB that injured the retina, pigment epithelium and choroid. · Conclusions: This morphologic study shows that: (1) a fibrin net develops in the vitreous around intravitreal IOFB; (2) depositions of amorphous material into the spaces of this net lead to dense coverage of the IOFB; (3) cellular reactions are not condition for the development of this coverage; (4) laceration of the retina induces a fibrocellular response. Received: 16 September 1997 Revised version received: 9 December 1997 Accepted: 10 December 1997