OSLI Retina

December 2016

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corneal wound was closed. The shape of the IOFB and the punctate facial abrasions oriented linearly were suspicious for a zipper injury. The patient's jacket was inspected postoperatively, and the zipper teeth were identical to the IOFB (Figure G). He underwent a vitrectomy with encircling band for a re-detachment after 2 weeks, and he remains attached at 2.5 years after the second procedure, with best-corrected visual acuity of 20/25+ with a scleral fixated intraocular lens (Figure H). 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 intraocular pathology often limit intraoperative visualization, but a perforating through-and-through injury should be suspected if the IOFB cannot be identified during vitrectomy. A 360° peritomy is also valuable in projectile injuries due to potential occult and contrecoup injury. We also demonstrate that cellulose sponges can be fashioned into temporary corneal plugs in the rare instances of missing corneal tissue to allow visualization for vitrectomy. December 2016 · Vol. 47, No. 12 1163 Figure. Occult penetrating globe injury from intraocular zipper tooth. External photograph of linearly oriented punctate facial abrasions caused by jacket zipper (A). Slit-lamp photograph showing a zone I penetration (arrow heads) (B). CT scan without contrast revealed an intraocular foreign body (IOFB) in the vitreous cavity (C) and lid foreign bodies (D). Pars plana vitrectomy was performed using a tem- porary corneal cellulose sponge to plug a corneal defect caused by missing tissue (E). The FB was identified in the extraocular space adjacent to an exit wound (F), and it matched the zipper teeth of the patient's jacket (G). The retina remains attached 2.5 years later, and visual acuity is 20/25+ (H).

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