Management of endophthalmitis with retained intraocular foreign body

AIMS: To assess the impact of primary injection of intravitreal antibiotics and delayed pars plana vitrectomy with removal of intraocular foreign body (IOFB) in patients with clinical features of bacterial endophthalmitis and retained IOFB. METHODS: Retrospective review of all patients with clinical features of infective endophthalmitis and a retained IOFB who had immediate injection of intravitreal antibiotics and delayed pars plana vitrectomy with removal of IOFB in two vitreo-retinal centres during 1995-2001. Nine patients were identified and minimum follow-up was 3 months. RESULTS: Four of the nine patients had a final visual outcome of 6/18 or better. One patient developed total retinal detachment. CONCLUSIONS: The current series suggests that immediate injection of intravitreal antibiotics with delayed removal of IOFB in eyes with clinical features of infective endophthalmitis and a retained IOFB is a possible alternative to immediate removal of IOFB. This management may be associated with preservation of the eye and restoration of useful visual acuity.     

视网膜内界膜剥除在眼内异物伴黄斑部铁锈症的应用

目的:探讨视网膜内界膜剥离在眼内异物伴黄斑部铁锈症眼中的应用,及其临床特点和效果。方法:回顾2000/2004因眼内异物需行玻璃体视网膜手术患者112例(123眼),在经平坦部后部玻璃体视网膜手术中发现黄斑部有铁锈和异常物质附着共5例(5眼),男4例,女1例。年龄13～46岁。病程6d～2a,3眼在3mo内,2眼在1a以上。在玻璃体视网膜手术中仔细寻找视网膜内界膜,直接用自做的钩针(常规10mL针头弯曲针尖的前1/3呈85°)在距黄斑中心凹1～1.2PD处的视网膜表面挑起其内界膜,用眼内镊环形撕除。术前视力LP～0.04。追踪观察6～38mo。结果:眼内异物伴黄斑部铁锈症眼,在黄斑前形成铁锈抑或炎性沉着物,不能用笛针清除,采用内界膜剥离很易彻底去除。病程短的视网膜内界膜能很容易剥除,病程长的视网膜内界膜不容易剥除。术后病程短的3眼均获得解剖和功能上的成功,病程较长的2眼在术后2mo均发生PVR,硅油不能取出,但视功能明显改善。术后视力0.05～0.7,尚未发现由视网膜内界膜剥离所致的严重并发症。结论:视网膜内界膜剥离在玻璃体视网膜手术中的应用越来越广泛,其不但可以解除内界膜对黄斑中心凹处视网膜的牵引,还可以清除紧密附着在黄斑前视网膜表面的毒性物质,改善黄斑区局部的代谢,有利于黄斑功能的恢复。     

Long-term stability of retinal function despite retained intraocular metallic foreign body

BACKGROUND: Persisting metallic intraocular foreign bodies (IOFB) with a ferrous content have been associated with ocular siderosis and retinal degeneration. We describe two patients in whom a metallic IOFB containing iron was left embedded for many years in the choroid and sclera after having penetrated through the vitreous and the retina. HISTORY AND SIGNS: Two male patients, aged 41 and 48 years, presented with a metallic IOFB sustained during a work accident involving metal tools. THERAPY AND OUTCOME: For the first patient it was deemed unwise to operate, as the IOFB was also lodged very deeply in the choroid and sclera in the inferior temporal quadrant. The second patient underwent pars plana vitrectomy, but the IOFB could not be removed surgically as it was too deeply embedded in the sclera and choroid. After a period of 6 years (Case 1) and 4 years (Case 2) of follow-up, visual acuity remained at 1.0 and the IOFB was encased in a fibrotic capsule in both cases. Full-field and multifocal electroretinograms showed an inter-ocular asymmetry at baseline, which remained stable during the follow-up. CONCLUSIONS: Ocular siderosis may not develop in patients with a deeply embedded metallic IOFB. Regular monitoring of both visual function and the electroretinogram is mandatory when the IOFB is left inside the eye.     

An overview of penetrating ocular trauma with retained intraocular foreign body

Penetrating trauma is one of the common causes of ocular morbidity world wide. Violation of the globe integrity, also known as a ruptured globe is an ocular emergency that universally threatens vision. Prompt recognition and management is prudent. Here we report a case of a 26-year-old-female, university teacher, who presented with pain and sudden loss of vision in the left eye of 2 h duration subsequent to a test tube blast in the chemical laboratory. Examinations revealed a ruptured globe with vitreous haemorrhage and an intraocular glass foreign body in the left eye. Primary repair was done with good post operative visual recovery. We report this case to emphasize that protective measures should be taken to prevent such eye traumas.     

眼球铁质沉着征临床分析

本文对52例眼球铁质沉着征进行了回顾性研究，其主要临床表现有：虹膜异色、瞳孔散大、晶体前囊铁锈颗粒沉着、白内障形成、玻璃体液化及视网膜电流图异常等。其中大泡状角膜病变、瞳孔缩小、晶体全脱位、视乳头充血为作者首次报告。同时，对其发病机制进行了探讨。     

Siderosis bulbi resulting from an intralenticular foreign body

PURPOSE: To report a case of siderosis bulbi that resulted from a small intralenticular foreign body. METHOD: Case report. RESULTS: A 36-year-old man with normal visual acuity and a peripheral intralenticular iron foreign body in the left eye was treated conservatively. Nine weeks after the injury, he had ocular signs of siderosis bulbi, with changes in the electroretinogram. A clear lens aspiration with removal of the foreign body was performed. After removal of the iron foreign body, no progression or regression of the ocular signs of siderosis bulbi has occurred, and the electroretinogram has not changed over a 2-year period. CONCLUSIONS: Even in the presence of good vision, a patient with an intralenticular ferrous foreign body should be followed closely, and the foreign body should be removed before irreversible siderosis bulbi occurs.     

Retained intraocular foreign body

The presence of an intraocular foreign body following eye trauma may not be readily apparent. Serous complications may include, inter alia, endophthalmitis, cataract, retinal detachment and siderosis bulbi. We report an iron intraocular injury due to hammering ‘metal on metal’, which was diagnosed using ultrasonic biomicroscopy and successfully removed. Two months postoperatively, unaided vision was 6/6.     

The intraocular foreign body

In a retrospective study, the results of pars plana vitrectomy in treatment of injuries with intraocular foreign bodies were described. The patient material was subdivided into five different groups. In 41.6% of the cases, practical blinding could not be prevented. A visual acuity of 0.2 and better was present in 26.6% of the cases. The preoperative (45%) and postoperative (30%) traumatic retinal detachment have an extremely unfavorable prognosis with a reattachment rate of 40 or 21% respectively. The results in the treatment of injuries with magnetic splitters and their sequelae are very much better than those with nonmagnetic foreign bodies. The gunshot and air rifle pellet injuries were the most unfavorable group.