Intralenticular foreign body: a D-Day reminder

Intralenticular foreign bodies are not uncommon after penetrating eye injuries. This is an observational case report where a patient was found to have an embedded lenticular foreign body for more than 60 years. Following such a long period of time the patient has not experienced any significant cataract formation or compromised ocular function due to the foreign body.     

Intralenticular metallic foreign body

Background: Intralenticular metallic foreign bodies may be well tolerated for many years.
Case Report: A 24-year-old Caucasian man was referred with an intralenticular metallic foreign body present in the left eye for five days. Following initial treatment with topical steroid and antibiotic, the lens remained clear and visual acuity normal. Two years later the left eye developed an anterior uveitis, with reduced vision. A left phacoemulsification lens extraction with removal of the intralenticular foreign body and insertion of a posterior chamber intraocular lens was performed.
Conclusion: Management of intralenticular metallic foreign bodies may be conservative till intraocular inflammation or cataract develops.     

晶状体内异物1例(英文)

晶状体内异物罕见,约占所有眼内异物的5%,并可导致严重的并发症。我们根据晶状体内异物的大小,位置,性质及感染的风险进行相应的处理。本文报告了1例左眼晶状体内金属异物的51岁患者,通过白内障超声乳化术将晶状体摘除并将晶状体内异物取出,然后植入一枚后房型人工晶状体,术后患者获得了良好的视力。     

晶状体内金属异物1例

我们报道1例45岁晶状体内残留铁片伴轻微前葡萄膜炎症状患者。局部使用睫状肌麻痹剂和皮质类固醇后视力改善。6mo后由于白内障形成,视力严重恶化。而晶状体囊外切除联合异物取出术联合后房型人工晶状体植入术后视力明显恢复。本研究说明白内障人工晶状体植入手术能使保守治疗无效的白内障所导致的低视力获得良好的视力。     

Traumatic cataract and intralenticular foreign body

Traumatic cataracts resulting from penetrating injuries occur most frequently from projectile metallic foreign bodies. The majority of intraocular foreign bodies cause sight-threatening damage including traumatic cataract in up to 25% of the cases. A case of traumatic cataract and retained intralenticular foreign body that was removed successfully with phacoemulsification and foldable intraocular lens implantation in the capsular bag is described. This case report highlights the benefit in planning surgical management as a two-staged procedure after appropriate investigations.     

晶状体异物所致单眼轻度前葡萄膜炎1例

报道1例晶状体内异物所致单眼轻度前葡萄膜炎。患者,男,25岁,以右眼持续畏光,流泪2mo主诉就诊,无痛性视力下降。之前有金属物体敲击史。眼科检查显示轻度前葡萄膜炎,晶状体内存留异物,无眼部充血。CT检查证实球内异物。这种情况容易被漏诊和误诊,详细的病史采集和临床检查对避免误诊至关重要。     

Management and treatment of bizarre open globe trauma in three steps: a case report

This is a case presentation of a very bizarre open globe trauma with anterior segment foreign body-fishing hook stuck in the cornea and iris. Complications due to this kind of eye trauma might be very hazardous and with serious impact on visual function. We are representing our approach and experience of three step management of this kind of eye injury: first-extract the foreign body, close and reconstruct the eyeball, second-fight inflammation, and third-restore the visual function by cataract surgery.     

Management and treatment of bizarre open globe trauma in three steps:a case report

·This is a case presentation of a very bizarre open globe trauma with anterior segment foreign body-fishing hook stuck in the cornea and iris.Complications due to this kind of eye trauma might be very hazardous and with serious impact on visual function.We are representing our approach and experience of three step management of this kind of eye injury:first-extract the foreign body,close and reconstruct the eyeball,second-fight inflammation,and third-restore the visual function by cataract surgery.·     

外伤性白内障并眼内异物手术疗效

目的　探讨外伤性白内障并眼内异物的手术疗效。方法　晶状体异物者 ,行晶状体异物摘除联合白内障摘出IOL植入 ;玻璃体异物者 ,根据是否后囊膜破裂及晶状体皮质溢出 ,或行球内异物摘除联合白内障摘出IOL植入 ,或先行异物摘除 ,后行白内障摘出IOL植入 ,或球内异物摘除联合白内障摘出术后 ,分期植入IOL。结果　眼内异物摘除联合白内障摘出IOL植入者 17例 ;先行异物摘除 ,后行白内障摘出IOL植入者 4例 ;球内异物摘除联合白内障摘出术后 ,拟分期植入IOL者 2例。术后视力≥ 0 3者 18例 ,视力≥0 5者 14例。结论　对合并有眼内异物的外伤性白内障 ,根据眼内异物的部位、是否后囊膜破裂及晶状体皮质溢出而采用不同术式 ,安全可靠 ,疗效满意。     

Intralenticular metal foreign body: case report

Intralenticular foreign bodies comprise about 5% to 10% of all intraocular foreign bodies and can result in serious complications. The management depends on some factors like size, location, material type and the risk of infection. We present a patient with an intralenticular metal foreign body in the left eye that, following initial treatment with topical steroid and antibiotic, underwent lens aspiration with removal of the intralenticular foreign body and insertion of a posterior chamber intraocular lens with good visual outcome.     

复杂性眼外伤治疗

本文报告开放性眼球损伤1例,鱼钩卡在角膜和虹膜处。由于这种复杂眼外伤可能导致非常危险的并发症,并且严重影响视觉功能。现将处理方法总结如下:首先,取出异物,缝合眼球;其次,抗感染治疗;最后,实施白内障手术以便视力恢复。     

眼内异物合并外伤性白内障的联合手术治疗：附88例分析

眼内异物合并外伤性白内障是眼外伤常见的致盲原因之一,各地报告的致盲率为20%～48.9%。本文对88例眼内异物合并外伤性白内障患者采用联合手术治疗,收到较好疗效,术前视力0.05以下占85.2%,术后矫正视力0.05以下占27.3%,矫正视力0.06～1.5占73.7%,其中矫正视力0.6～1.5者占22.8%。根据异物的性质、在眼内部位和晶体损伤情况选择不同的手术方式一次联合手术摘出异物和白内障,术后采用中西药配合治疗。联合手术可提高疗效,减少术后并发症.减少手术次数,减轻病人的痛苦,缩短病程,减少医疗费用.眼科学报1993;9:216—218.     

An intraorbital metallic foreign body

A 30-year-old male presented with diplopia for 20 days post occupational accident involving left side of his nose, while he was working with a nail gun. He was fully conscious and did not have any neurological deficits. Patient narrated the mechanism of injury and was sure that the nail fell down after hitting the left side of his nose. He had normal vision, but extra ocular movements were restricted and painful. Computed tomography (CT) scan revealed a curved metal object lodged in the posterior aspect of the left orbit extending diagonally from medial wall to the anterior-superior aspect of the orbital roof. The object was removed via a small surgical approach, inflicting least possible surgical trauma. Post surgery, the patient recovered with complete resolution of diplopia. The original aspects of this case are the lack of signs of a foreign body entry and its relative harmlessness in spite of its large size.     

Combined lens and vitreoretinal surgery in patients with traumatic cataract and intraocular foreign body

AIM: To analyze the postoperative anatomical and functional outcomes as well as complications after combined phacoemul- sification, pars plana vitrectomy (PPV), removal of the intraocular foreign body (IOFB) and intraocular lens (IOL) implantation in patients with traumatic cataract and intraocular foreign body. METHODS: Medical records of 13 patients(13 eyes) with traumatic cataract and IOFB who had undergone combined phacoemulsification, PPV, foreign body extraction and IOL implantation were retrospectively analyzed. The postoperative follow-up ranged from 2 to 12 months. The main measure- ments of outcomes were the extraction success of cataract and intraocular foreign body, intraoperative and postoperative complications and the final best corrected visual acuity (BCVA). ·RESULTS: The mean age of 13 patients(10 male, 3 female )was 36.8 years (range: 17-65 years). All eight IOFBs were removed. Four intraocular lenses were implanted after vitrectomy intraoperatively. In 5 cases, intraocular lenses were implanted during the second operation. Intraocular lenses were not implanted in 4 cases. BCVA at last ranged from 0.8 to hand movement. BCVA was 0.5 or better in four eyes, 0.1 to 0.4 in five eyes, less than 0.1 in four eyes. Intraoperative complications were encountered in 3 patients. They had vitreous hemorrhage. Postoperative complications were encounter- ed in 2 patients. They had retinal detachment. The reoperations of the two patients were successful. CONCLUSION: The combined phacoemulsification, PPV, removal of IOFB and IOL implantation is safe and effective for patients with traumatic cataract and intraocular foreign body. The visual outcome depended primarily on the corneal or scleral wound and underlying posterior segment pathology and sites.     

外伤性白内障眼内异物晶状体玻璃体联合手术

目的:分析超声乳化玻璃体切除眼内异物取出人工晶状体植入联合术治疗外伤性白内障眼内异物的疗效。方法:回顾分析13例(13眼)眼球穿通伤外伤性白内障眼内异物患者行超声乳化玻璃体切除眼内异物取出人工晶状体植入联合术的术中,术后并发症及术后最佳矫正视力。术后随访2~12mo。结果:13例患者(男10例,女3例)平均年龄36.8(17~65)岁。所有患者眼内异物均取出。4例术中于玻璃体切除眼内异物取出后植入人工晶状体,5例于联合术后二期植入人工晶状体,4例患者未植入人工晶状体。术后最佳矫正视力为手动~0.8.最佳矫正视力0.5以上者4眼,0·1~0.4者5眼,0.1以下者4眼。术中发生玻璃体出血3例,术后发生视网膜脱离2例,二次手术视网膜复位。结论:超声乳化玻璃体切除人工晶体植入联合术治疗白内障眼内异物伤是安全有效的方法。患者术后的视功能取决于角膜、巩膜和视网膜损伤部位及病变程度。     

An unusual case of intraorbital foreign body and its management

Intraorbital foreign bodies are usually the result of accidental trauma and can lead to considerable morbidity. We report an unusual case of an industrial injury in a plastic manufacturing unit wherein hot molten plastic splashed and solidified inside the orbit. The resultant increased intraorbital pressure led to loss of vision in that eye. The extreme temperature of the foreign body caused extensive thermal damage to the surrounding adnexal structures. Staged reconstructive surgery was undertaken to repair the damage, with an acceptable final cosmetic outcome. Employment of protective eye wear to prevent such accidents in high-risk occupations should be made mandatory.     

用玻璃体切除方法经球内取出球壁异物

目的：通过对视网膜下异物取出途径及手术时机的选择进行分析,探讨不同部位视网膜下异物最佳的手术方法及手术时机。方法：回顾分析了我院开展玻璃体手术后,后极部视网膜下异物经玻璃体切除术顺利取出后视力、矫正视力及视网膜的情况。结果：平均随访9个月,视网膜完全复位。2例形成黄斑前膜,术后矫正视力0.01,未形成黄斑前膜者,术后矫正视力0.8。结论：用玻璃体切除术联合视网膜钩的应用对视网膜下异物及嵌顿于脉络膜的异物,为一损伤小,手术效果好的办法。     

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。     

Coexistante of intraocular eyelashes and anterior chamber cyst after penetrating eye injury: a case presentation

We herein describe a patient in whom two intraocular eyelashes and an anterior chamber cyst embedded into the anterior surface of the iris was detected following penetrating eye injury. After a one year asymptomatic period, the patient was hospitalized because of uveitic reaction in the anterior chamber which may be due to cyst development. The lashes and cyst were removed surgically, and examined pathologically. There was no complication in one year follow-up period.     

玻璃体视网膜联合术治疗复杂眼球穿通伤伴眼内异物

目的：探讨玻璃体视网膜联合术治疗复杂眼球穿通伤伴眼内异物的疗效。方法：应用玻璃体切割术、眼内异物取出术、外伤性白内障摘除术、眼内光凝、眼内充填术,部分病例结合巩膜外加压术等玻璃体视网膜手术治疗复杂眼球穿通伤伴眼内异物41只眼。结果：41只眼异物均一次手术取出,术后视力高于术前者36只眼（87．80％）,等于术前者4只眼（9．76％）,下降者1只眼（2．44％）。3个月至3年随访期间,无一便发生复发性视网膜脱离。结论：复杂眼于穿通伤伴眼内异物常导致眼内多种组织的严重损伤。玻璃体切割、异物取出等联合手术是准确、安全、有效的治疗方法,可挽救患者一定视功能。