Author: Joana Fernandes (Portugal)
Co-authors: Ricardo Machado Soares, Catarina Cunha Ferreira, Paula Sepúlveda, Miguel Bilhoto
Purpose
Rhegmatogenous retinal detachment (RRD) is the most common form of retinal detachment (RD). It results from a retinal break or full-thickness defect in the neurosensory retina and is frequently associated with posterior vitreous detachment or trauma. However, rarer causes may go clinically unnoticed, resulting in a late diagnosis and, consequently, severe complications. This case report intends to describe a case of a retinal detachment submitted to vitrectomy, complicated by the discovery of a foreign body (FB) lodged in the posterior segment.
Setting/Venue
Department of ophthalmology of Centro Hospitalar Vila Nova de Gaia/Espinho.
Methods
Case report of a patient with a retinal detachment who underwent a pars plana vitrectomy combined with phacoemulsification. After insertion of the intraocular lens, a metallic foreign body retained in the pars plana was detected. A minimally invasive surgical technique for the management of an intraocular foreign body detected intraoperatively is described.
Results
A 54-years-old man presented to the emergency department with recent complains of floaters and blurry vision in the left eye (LE). Best-corrected visual acuity was 7/10 in the LE. Fundoscopy showed a superior RD without macular involvement. There was no evidence of rhegmatogenous tears. He was promptly referred for pars plana vitrectomy combined with phacoemulsification, which was performed in less than 48 hours. After phacoemulsification and intraocular lens (IOL) insertion, sclerotomies created with 20-gauge instruments were performed to initiate vitrectomy. Unexpectedly, during peripheral scleral indentation, a perforating FB lodged in the pars plana was revealed. The first step was to perform a posterior capsulotomy with the vitreous cutter. Then, the FB was passed through the posterior and anterior capsulotomies into the anterior chamber, with the support of the chopper to move away the IOL. Posteriorly, it was removed through the main corneal incision. Two peripheral dialysis associated with upper RD were identified, as well as vitreoretinal proliferation grade A. Subsequently, patient's medical history was reviewed in order to clarify the origin of the FB. In fact, the patient had a history of periocular trauma with an iron bar in the LE 4 years ago.
Conlusions
The presence of intraocular FB secondary to eye injury is not always immediately evident. Despite the few cases described in the literature, RD can be a form of presentation of a hidden FB. Its location in the posterior segment and the entry more than 5 mm from the limbus seem to be risk factors for this complication. The surgical approaches more commonly described for the extraction of FB from the posterior segment include the enlargement of sclerotomies or through a sclerocorneal tunnel. The present case is a pioneer in describing a surgical technique, minimally invasive, for handling and removing a posterior intraocular foreign body in the presence of IOL in the capsular bag.
Financial Disclosure
none
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