Dr ali salehi Vitroretinal fellowship Epidemiology According to the United States Eye Injury Registry USEIR the surveillance arm of the American Society of Ocular Trauma ASOT ID: 779357
Download The PPT/PDF document "Intra ocular foreign body" is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.
Slide1
Intra ocular foreign body
Dr ali salehiVitroretinal fellowship
Slide2Epidemiology
According to the United States Eye Injury Registry (USEIR), the surveillance arm of the American Society of Ocular Trauma (ASOT), the frequency in the United States is 16%.
Slide3Foreign bodies
DetectionIndirect is best methodCT next best, including plastic and glassMRI better for organicUS
supplements CT and gives info on retinaPlain
films if no CT
Slide4The most common cause is
hammering; the incidence over time shows a decrease at the workplace and an increase in the home.
Slide5International
The frequency greatly varies (up to 41%) worldwide, depending upon the population surveyed
Slide6Mortality/Morbidity
Most IOFBs cause internal damage, and most will come to rest in the posterior segment. Commonly injured structures include the cornea, the lens
, and the retina
Slide7Sex
According to the USEIR, 93% of patients with IOFBs are male.
Slide8Physical
A complete examination of both eyes is necessary, including the visual acuity.A corneal entry wound and a hole in the iris provide trajectory information.
The slit lamp is extremely useful in detailing all anterior segment
pathologies.
Slide9The indirect
ophthalmoscope through a dilated pupil may allow direct visualization of the IOFB, which gives the most useful information for the surgeon. Gonioscopy and scleral depression are not recommended unless the entry wound has been surgically closed.
Slide10Causes
Hammering and using power tools are the most important causes. Protective eyewear, if appropriate (of
polycarbonate), prevents virtually all injuries
Slide11Imaging Studies
CT scans are the imaging study of choice for IOFB localization.
A consultation with the CT technician is helpful in selecting the optimal section so as to reduce the risk of a false-negative result.
Slide12Plain x-ray
is useful if a metallic IOFB is present and a CT scan is unavailable.MRI is generally not recommended for metallic IOFBs.
Slide13Ultrasound
is a useful tool in localizing IOFBs, and its careful use is possible even if the globe is still open; alternatively, intraoperative use after wound closure can be attempted.
Slide14Other Tests
Electroretinography is useful if a chronic IOFB is found and siderosis threatens or is present.
Slide15Slide16Medical Care
Systemic and topical antibiotic therapy may be started prior to the surgical intervention.
Topical corticosteroids are also important to minimize the inflammation.
A
tetanus booster
may also be
appropriate.
Slide17Surgical Care
The timing of intervention is primarily determined by whether the risk of endophthalmitis is high. If the risk is high, immediate (emergency) surgery, for intraocular foreign body (IOFB) removal as well as vitrectomy
if the IOFB is in the posterior segment, is indicated
.
Slide18In most other cases, the surgeon has the option of deferring intervention for a few days to reduce the risk of
intraoperative hemorrhage.
Slide19The
wound, however, should be closed as soon as possible. A study by Zhang et al examined 1421 eyes in 15 hospitals in China over 5 years and concluded that closing the primary wound within 24 hours, whether by repair or independent self-sealing, reduces the endophthalmitis risk
.
Slide20If
endophthalmitis occurs, it is present at the time of patient presentation in over 90% of the cases.
Slide21IOFBs in the anterior chamber are typically removed through a
paracentesis (not through the original wound) performed at 90-180° from where the IOFB is located.
Slide22Viscoelastics
should be used to reduce the risk of iatrogenic damage to the corneal endothelium and the lens.
Slide23An
intralenticular IOFB does not necessarily cause cataract. Unless there is a risk of siderosis or the loss to
follow-up is high, the IOFB and the lens may be left in situ.
Slide24Otherwise, usually, the IOFB is extracted first, the lens is extracted second, and an intraocular lens (IOL) is implanted simultaneously.
Slide25The posterior
hyaloid should always be removed, and any deep impact should be prophylactically treated. For the actual removal, the best tool to extract a ferrous A posterior segment IOFB requires a vitrectomy, unless the tissue damage is minimal. IOFB is a strong intraocular magnet. For nonmagnetic IOFBs, a proper forceps may be used.
Slide26External electromagnets
should not be used since they do not allow controlled extraction.Rarely, a scleral cut-down is used.
Slide27In early clinical tests, this procedure has proven to be very effective in the prevention of the development of both proliferative
vitreoretinopathy (PVR) and radiating retinal folds
Slide28Medication Summary
The goal of pharmacotherapy is to reduce morbidity and to prevent complications, such as posterior synechia
(pupillary dilation),
inflammation
(corticosteroids), and intraocular pressure
(IOP)
elevation.
Slide29Antibiotics
For use in every case (systemic and topical); intravitreal usually only if infection is present or the case is high risk.
Vancomycin
(
Vancocin
,
Vancoled
,
Lyphocin
)
Slide30Ceftazidime
(Ceptaz, Fortaz, Tazicef, Tazidime)
First-line choice for
intravitreal
gram-negative coverage.
Third-generation
cephalosporin with broad-spectrum, gram-negative activity; lower efficacy against gram-positive
organisms.
Slide31Their mechanism of action may involve an alteration of
RNA and DNA metabolism or an intracellular accumulation of peroxide that is toxic to the fungal cell.
Slide32Amphotericin
B (Amphocin, Fungizone)Produced by a strain of Streptomyces
nodosus; can be fungistatic
or
fungicidal
. Binds to sterols, such as
ergosterol
, in the fungal cell membrane, causing intracellular components to leak with subsequent fungal cell
death.
Slide33Siderosis
bulbiis a disease caused by a retained intraocular iron-containing foreign body (IOFB). A history of ocular trauma combined with heterochromia
, mydriasis
,
pigmentation
of the anterior chamber structures and a reduced
electroretinographic
response all provide an inkling of the diagnosis.
Slide34Affected eyes can often present with a severe increase in intraocular pressure
(IOP) (Talamo et al. 1985). A precise radiological and/or echographic localization of the IOFB, ideally supported by histological analysis of a biological sample, are vital to the confirmation of the disease.
All epithelial cells defected.
Slide35Siderosis
bulbiIRON tends to deposit in epithelial tissues
Iris - heterochromia
, mid-dilated, poorly-reactive pupil
Lens
- brown dots and cortical yellowing
Retina
-
pigmentary
degeneration +
vesseles
sclerosis
ERG
- flat within 100 days
Used to monitor
Slide36Chalcosis
<85% pure - chalcosis, >85% - sterile
endophthalmitis (acute)
Copper
deposits in
basement membranes
cornea
-
Kayser
-Fleischer ring
Iris
- sluggish, greenish hue
Lens
capsule - sunflower cataract
Vireous
opacification
ERG
like
siderosis
Improves if Cu removed
Slide37Slide38Slide39Visual outcome and complications after removal of posterior segment intraocular foreign bodies through pars
plana approachRESULTS: Among the 50 patients, there were 45 (90%) males and 5 (10%) females. Average age of the patients was 31.52 +9.52 (ranging from 20 to 50) years. The pre-operatively visual acuity finger counting to perception of light was 78% cases. The best corrected final visual acuity was 6/6 in 1 (2%) patient, 6/9 in 5 (10%) patients, 6/12 in 5 (10%) patients,,
6/18 in 3 (6%) patients, 6/24 and 6/36 in 4 (8%) patients each, 6/60 in 4 (8%) patients, finger counting in 8 (16%) patients, hand movement in 4 (8%) patients, projection of light in 9 (18%) patients and no projection of light in 3 (6%) patients. The postoperative complications were corneal opacity in 8 (16%) patients
Slide40anterior chamber inflammatory reaction in 6 (12%) patients, increased intraocular pressure in 1 (2%) patient, silicone oil in anterior chamber in 1 (2%) patient, macular scar in 7 (14%) patients,
cystoid macular edema in 1 (2%) patient, endophthalmitis in 4 (8%) patients, retinal detachment in 11 (22%) patients and phthisis bulbi in 3 (6%) patients.
Slide41CONCLUSION:
Acceptable visual results were achieved after the removal of posterior segment intraocular foreign bodies by vitrectomy. However, multiple complications can be encountered which require meticulate postoperative care.
Slide42پایان