OSLI Retina

December 2016

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1162 Ophthalmic Surgery, Lasers & Imaging Retina | Healio.com/OSLIRetina Occult Perforating Globe Injury Caused by Intraocular Foreign Body Yoshihiro Yonekawa, MD; Cynthia X. Qian, MD; Avni V. Patel, MD, MBA; Leo A. Kim, MD, PhD; Dean Eliott, MD ABSTRACT: Intraocular foreign bodies (IOFBs) may be associated with occult exit wounds. The authors present a case of a man who sustained a zipper- tooth IOFB through the cornea from a car tire ex- plosion. CT showed an IOFB within the vitreous cavity, but the IOFB was not identified during vit- rectomy. Extension of the peritomy revealed an exit wound with the foreign body lodged in the extraoc- ular space. This case demonstrates that IOFBs can rest within the vitreous cavity after creating an exit wound, but may escape detection by being driven back out of the globe during vitrectomy due to the pressurized eye. Coexistent ocular surface and in- traocular pathology often limit intraoperative vi- sualization, but a perforating through-and-through injury should be suspected if the IOFB cannot be identified during vitrectomy. [Ophthalmic Surg Lasers Imaging Retina. 2016;47:1162-1163.] A 47-year-old man was inflating a defective car tire without eye protection. The tire exploded, and he developed left eye pain and blurred vision. Visual acuity was hand motions, and external inspection demonstrated linearly oriented punctate facial abrasions (Figure A). Slit-lamp examination revealed a flap-like zone I penetrating injury (Figure B), and there was no view to the posterior segment due to hyphema and traumatic cataract. A "U-shaped" radiopaque intraocular foreign body (IOFB) was detected on orbital CT scan (Figure C), and two other identical foreign bodies were embedded in the lower lid (Figure D). Corneal striae developed upon suturing the laceration due to missing corneal tissue, which prohibited an adequate view for vitrectomy. A cellulose sponge was fashioned as a temporary plug, and it expanded within the defect to allow wound stabilization without full wound closure (Figure E). A pars plana lensectomy and vitrectomy were then performed, but the IOFB was not located after meticulous intraocular inspection with limited views due to active hemorrhage. Extension of the conjunctival peritomy revealed an occult posterior scleral exit wound with a metallic foreign body in the extraocular space (Figure F). The exit wound was closed with suture, a small focal retinectomy was performed to remove the incarcerated retina from the wound, C3F8 gas was used to tamponade the break and associated localized retinal detachment, and the From Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston. Originally submitted August 13, 2016. Revision received August 19, 2016. Accepted for publication August 30, 2016. The authors report no relevant financial disclosures. Address correspondence to Dean Eliott, MD, Associate Director, Retina Service, Massachusetts Eye and Ear Infirmary, Associate Professor, Harvard Medical School, 243 Charles Street, Boston, MA, 02114; email: dean_eliott@meei.harvard.edu. doi: 10.3928/23258160-20161130-14 ■ I M A G E S I N O P H T H A L M O L O G Y ■

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