Intraocular foreign body injuring the papillomacular bundle: a case report
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Abstract
Introduction
A 36-year-old man noticed sudden pain and decreased vision in the left eye while cutting metal.
Report
Upon presentation, visual acuity in the left eye was hand motions. Intraocular pressure was 24 mm Hg. There was no relative afferent pupillary defect. The anterior segment exam was notable for a penetrating paracentral corneal wound 2.5 mm in length, as well as a dense white cataract obscuring the posterior pole. Examination of the right eye was unremarkable. Computed tomography of the orbits revealed an intraocular, radio-opaque, likely metallic foreign body in the left eye, measuring ~2.5 mm in width. A decision was made to perform an open-globe injury repair with concurrent removal of the intraocular foreign body. The corneal wound was closed using a 10-0 nylon suture. A standard 3-port, 25-gauge vitrectomy was then initiated. Pars plana lensectomy was performed, revealing a metallic foreign body embedded in the inferonasal peripheral retina, with overlying vitreous hemorrhage. Of note, there was a macular laceration ~1.5 mm in length nasal to the fovea, transecting the papillomacular bundle. This laceration was likely created by the initial impact of the foreign body, which then ricocheted to the retinal periphery. Following a complete vitrectomy, endolaser was applied to the retina surrounding the foreign body, which was then removed through a previously enlarged sclerotomy using a combination of intraocular forceps and a magnet. The foreign body was measured at 3 × 2 × 1 mm. Best-corrected visual acuity in the left eye was 20/400 at postoperative month 3, with vision likely limited by laceration of the papillomacular bundle.
Conclusion
Presence of intraocular foreign bodies must be ruled out during initial examination of open-globe injuries. Metallic intraocular foreign bodies must be removed promptly to prevent long-term complications. Enlargement of a previously made sclerotomy greatly facilitates intraocular foreign body removal.
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