J Korean Ophthalmol Soc.  2010 Feb;51(2):270-275. 10.3341/jkos.2010.51.2.270.

Comparison of Approaches for the Removal of Metallic Intraocular Foreign Bodies

• Hwang JH
• Kweon EY
• Cho NC

• KMID: 2213151
• DOI: http://doi.org/10.3341/jkos.2010.51.2.270

Abstract

PURPOSE
To review the management of posterior segment metallic intraocular foreign bodies (IOFB) and to compare the use of an external approach using a large electromagnet and an internal approach using vitrectomy and its tools for their removal.
METHODS
A retrospective review was performed on 49 eyes of 49 patients who underwent surgical removal of metallic IOFBs with either an internal or an external approach at a single institution between January 2003 and December 2006. We divided 49 eyes into two groups based on the type of approach: 26 external (n=26) and 23 internal (n=23). Visual acuity and the presence of any complications occurring with the two approaches were the main outcome measures studied.
RESULTS
Thirty of 49 eyes (61%) showed improvements in visual acuity. When we compared patients treated with an external versus an internal approach, we found no statistically significant difference in regard to visual outcome. Preoperative vitreous hemorrhage and endophthalmitis were more common in the internal approach group. A trend toward a higher rate of reoperation was more common in the external approach group, but they were not statistically significant. Postoperative complications found to be significantly different between the two groups were the rate of postoperative endophthalmitis and retinal detachment, which were more common in the external approach group.
CONCLUSIONS
Surgical removal of metallic IOFBs results in significant visual improvement regardless of the approach method. The internal approach by vitrectomy is recommended as the first choice in preoperative conditions such as severe cataracts, vitreous hemorrhage and endophthalmitis, as well as in groups at high risk for postoperative endophalmitis and retinal detachment.

Keyword

Electromagnet; External approach; Internal approach; Intraocular foreign body; Vitrectomy

MeSH Terms

Cataract
Endophthalmitis
Eye
Foreign Bodies
Humans
Magnets
Outcome Assessment (Health Care)
Postoperative Complications
Reoperation
Retinal Detachment
Retrospective Studies
Visual Acuity
Vitrectomy
Vitreous Hemorrhage

Reference

References

1. Thompson JT, Parver LM, Enger CL, et al. Infectious endophthalmitis after penetrating injuries with retained intraocular foreign bodies. Ophthalmology. 1993; 100:1468–74.

2. Shock JP, Adams D. Long-term visual acuity results after penetrating and perforating ocular injuries. Am J Ophthalmol. 1985; 100:714–8.

3. Coleman DJ, Lucas BC, Rondeau MJ, Chang S. Management of intraocular foreign bodies. Ophthalmology. 1987; 94:1647–53.

4. Behrens-Baumann W, Praetorius G. Intraocular foreign bodies. 297 consecutive cases. Ophthalmologica. 1989; 198:84–8.

5. Percival SP. Late complications from posterior segment intraocular foreign bodies. Br J Ophthalmol. 1972; 56:462–8.

6. Chiquet C, Zech J, Gain P, et al. Visual outcome and prognostic factors after magnetic extraction of posterior segment foreign bodies in 40 cases. Br J Ophthalmol. 1998; 82:801–6.

7. Chiquet C, Zech J, Denis P, et al. Intraocular foreign bodies. aberrations influencing final visual outcome. Acta Ophthalmol. 1999; 77:321–5.

8. Wickham L, Xing W, Bunce C, Sullivan P. Outcomes of surgery for posterior segment intraocular foreign bodies-a retrospective review of 17 years of clinical experience. Graefes Arch Clin Exp Ophthalmol. 2006; 244:1620–6.

9. Chow Dr, Gasseston BR, Kuczynski B, et al. External versus internal approach to the removal of metallic foreign bodies. Retina. 2000; 20:364–5.

10. Cooling RJ, McLeod D, Blach RK, Leaver PK. Closed micro-surgery in the management of intraocular foreign bodies. Trans Ophthalmol Soc U K. 1981; 101:181–3.

11. Coleman DJ, Lucas BC, Rondeau MJ, Chang S. Management of intraocular foreign bodies. Ophthalmology. 1987; 94:1647–53.

12. Heimann K, Paulmann H, Tavakolian U. The intraocular foreign body. Int Ophthalmol. 1983; 6:235–42.

13. Slusher MM, Sarin LK, Federman JL. Management of intraretinal foreign bodies. Ophthalmology. 1982; 89:369–73.

14. Williams DF, Mieler WF, Abrams GW. Intraocular foreign bodies in young people. Retina. 1990; 10:45–9.

15. Mester V, Kuhn F. Ferrous intraocular foreign bodies retained in the posterior segment: Management options and results. Int aberrations. 1998; 22:355–62.

16. Hadden OB, Wilson JL. The management of intraocular foreign bodies. Aust N Z J Ophthalmol. 1990; 18:343–51.

17. Arciniegas A, Araya R. Our experience in intraocular foreign-body removal. Ann Ophthalmol. 1992; 24:453–8.

18. Chiquet C, Zech JC, Gain P, et al. Visual outcome and prognostic factors after magnetic extraction of posterior segment foreign bodies. Br J Ophthalmol. 1998; 82:801–6.

19. Imtiaz A, Chaudhry , Farrukh A, et al. Incidence and visual outcome of endophthalmitis. associated with intraocular foreign bodies. Graefes Arch Clin Exp Ophthalmol. 2008; 246:181–6.

20. Warrasak S, Euswas A, Hongsakorn S. Posterior segment trauma: types of injuries, result of vitreoretinal surgery and prophylactic broad encircling scleral buckle. J Med Assoc Thai. 2005; 88:1916–30.

21. El-Asrar AM, Al-Amro SA, Khan NM, Kangave D. Retinal detachment after posterior segment intraocular foreign body aberrations. Int Ophthalmol. 1998; 22:369–75.

22. Chiquet C, Gain P, Zech JC. Risk factors for secondary retinal detachment after extraction of intraocular foreign bodies. Can J aberrations. 2002; 37:168–76.