intraocular foreign body short ant requiered

1. Intraocular Foreign
Body
DR ABHISHEK GHELANI MS
SHANTI SAROJ NETRALAY

2. Epidemio
 Male> female
 At work place
 Corneal wound > scleral wound
 Site
 Vitreous > intraretinal > ant. Chamber/lens

3. Mechanism of injury
 Mechanical
 Nature, Shape, size, velocity
 Path
 Ricocheting
 Chemical
 Reactive metals (nickel, copper, mercury > iron > lead, zinc, aluminum)

4. Siderosis
 Ions (Fe+3)
 Few days to several years aftter
 Signs - deposition

7. ERG
 Initially, deepening of the A-wave with a normal B-wave
 As siderosis progresses, there is a decrease in B-wave amplitude
 Flattening of ERG eventually in 1 to 2 years

8.  IOFBs with iron - best removed
 No encapsulation
 nor an intralenticular location protects against siderosis
 With surgery, siderosis may be reversible

9. Chalcosis
 Cu+2 deposited in limiting membranes
 Pure (>65%) – rapid toxicosis
 Greenish limbal ring

10.  Sunflower cataract

11. Goal
 Restoration of anatomy
 Vision

12. Evaluation
 Stabilize patient
 history
 Nature and mechanism of injury
 Complete examination
 Investigations
 B scan, UBM
 CT

13. Prophylactic Antibiotics
 Intravenous
 Oral
 3rd gen. fluoroquinolones

14. Anterior Segment IOFB
 Corneal wound

15.  Avoid removing from entry wound
 approached via limbal incisions
 AC maintenance
 Constriction of pupil

16. Posterior Segment IOFBs
 Dilate pupil
 Remove Hyphema/Cataract/Vitreous hemorrhage
 Use wide angle viewing systems
 Cut vitreous all around IOFB
 Create retinotomy for access to subretinal IOFB

17.  Make scleral incision depending on IOFB size and axis of removal
 Make incision sufficiently long
 Clear incision of vitreous
 Elevate and align IOFB with intraocular magnet/ forceps
 Secure forceps grasp of IOFB
 Use bimanual technique where needed
 Inspect intraocular tissue for additional pathology
 Treat lesions accordingly and consider prophylaxis

18. Complications
 ERM
 RD
 PVR

19. THANK YOU