A 30-year-old male patient was referred to our eye clinic from an external center with an IOFB in his right eye. A small piece of iron shaving sprung into his right eye while he had been striking a nail with a hammer. He had been told that he had a foreign body in his eye and that he should have undergone vitrectomy; thus, 1 mg vancomycin+2 mg ceftazidime was injected into his eye.
On ophthalmologic examination, visual acuity in his right eye was 0.2 (Snellen), and a lamellar corneal cut with negative Seidel test in the right cornea in the area corresponding to the upper edge of the pupil was observed. Perforation on the anterior capsule of the crystalline lens and opacification of the lens material that protruded from the capsule to the anterior chamber were observed. The details of the ocular fundus were not selected.
Retinal detachment was not observed in Ultrasonography. On orbital tomographic examination, an image of 1.5x1.5 mm consistent with a metallic object was observed in the intraocular area, close to the equator (Fig. 1). The left eye was emmetropic without loss of its visual acuity. Moxifloxacin eye drops (8x1/d) and oral ciprofloxacin (500 mg tb bid) were given to the patient. Under general anesthesia (UGA) cataract surgery, IOL placement and PPV were planned in the same session for removal of IOFB. UGA after local antisepsis, blepharostat was placed to keep the eyelids open. The conjunctival sac was irrigated with 5% povidone-iodine solution. Transconjunctival sclerotomies were prepared from 3.5 mm away from the limbus using a 23-gauge trocar. Corneal side accesses were performed at the 10 and 2 o'clock positions using a 20-gauge MVR. The anterior capsule was stained with trypan blue after air was insufflated into the anterior chamber.
The anterior chamber was filled with a viscoelastic (VES) material. It was entered with a clearcorneal incision at the 12 o'clock position. Anterior capsulectomy was performed, and the opacified lens material was removed by aspiration/irrigation. A 2x2 mm gap was detected in the posterior capsule. A foldable IOL was placed inside the capsule. The main corneal incision was closed with a 10/0 nylon suture. The anterior chamber was completely cleared from VES. An infusion cannula was inserted into the previously placed trocar in the inferior temporal region. During PPV used a wide field visualizing system (EIBOS). An IOFB on the equatorial region hanging close but not touching the retina was observed without haze in the vitreous. With the aid of endoillumination through the trocar in the upper temporal area, an ocutome was passed through the trocar in the upper nasal area into the vitreous area. So as not to cause traction during the removal of IOFB, the vitreous tissue around the IOFB was scraped to create a tunnel-shaped cavity between the ocutome, trocar tip, and IOFB in the vitreous tissue. After removal of the trocar in the upper nasal region and dilation of the sclerotomy site, the foreign body was picked up and extracted through the enlarged sclerotomy path. With this approach, approximately 1-2/8 parts of the vitreous were extracted, and 6-7/8 parts of it were left in situ. Retinal tamponade was not used. After removal of the foreign body with dimensions of 1.5x1.5x0.5 mm, sclerotomies were closed with 8/0 vicryl sutures, and subconjunctival injections of gentamicin and onadron were performed. The patient was discharged with a prescription of eye drops of moxifloxacin (0.5%, 8x1/d)+prednisolone sodium phosphate (10 mg/ml, 4x1/d) and tropicamide (1%, 1x1). Doses of drug therapy were gradually reduced and discontinued after 35 days. On postoperative months 1, 3, 7, and 30 and 2, 3, and 4, the pupil was regular, the IOL was centralized (Fig. 2), the retina was attachedand the fundus, and the macula was observed naturally (Fig. 3). Endophthalmitis or severe inflammation were not observed. Intraocular pressure was 17 mm Hg.Visual acuity was -1.50 to 10/10 at all visits.