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Charles C. Wykoff MD, PhD
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An 18-year old male presents with a metallic object in the back of the eye after a BB gun accident. Slit lamp exams shows a peripheral corneal entrance wound, iris defect, and dense vitreous hemorrhage. Charles Wycoff, MD, begins the case by suturing the entrance wound and places two 23G trocars and one 20G. After removing vitreous and blood, the IOFB is engaged with forceps and retracted through an enlarged pars plana sclerotomy to spare the crystalline lens. There is a full thickness retinal break with blood oozing from the choroid so Dr. Wycoff increases IOP and applies light diathermy to stop the bleeding.
Posted: 5/04/2011
Charles C. Wykoff MD, PhD
An 18-year old male presents with a metallic object in the back of the eye after a BB gun accident. Slit lamp exams shows a peripheral corneal entrance wound, iris defect, and dense vitreous hemorrhage. Charles Wycoff, MD, begins the case by suturing the entrance wound and places two 23G trocars and one 20G. After removing vitreous and blood, the IOFB is engaged with forceps and retracted through an enlarged pars plana sclerotomy to spare the crystalline lens. There is a full thickness retinal break with blood oozing from the choroid so Dr. Wycoff increases IOP and applies light diathermy to stop the bleeding.
Posted: 5/04/2011
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Just Now
Charles Wykoff
14 years ago
I saw this patient today for his 3 month follow-up after silicone oil removal. His retina looked great and he is 20/30.
matias iglicki
14 years ago
astonhing video !!!! congratulations on that. , may i know current patient`s BCVA .
Charles Wykoff
14 years ago
In my experience with metalic IOFBs that are resting on the retina, the number one priority it to engage the FB without damaging adjacent ocular structures. It is important to do this the most straightforward way possible so as to minimize the possibility of touching the retina. Once engaged, I feel it is best not to attempt repositioning the FB in the forceps so as to minimize the possibility of having the FB fall back onto the retina which can cause more retinal damage. When removing IOFBs through the pars plana I believe it is important to make a wound larger than you think you actually need so as to avoid damaging adjacent structures or the FB getting stuck in the wound. This is especially true when preserving the native crystalline lens. I give intravitreal antibiotics to all patients with intraocular foreign bodies. The rate of traumatic endophthalmitis in such cases is high and while there is certainly no prospective, randomized data to support this practice I have had no cases of endophthalmitis and have had good success with it. I used 1000cc silicone oil in this case of a preserved macula given the high rates of PVR in the setting of a posterior choroidal rupture with subretinal blood. Again there is no prospective data to support this, but I believe temporary SO tamponade in a setting like this may suppress PVR in its early stages. I removed the silicone oil after 3 months without difficulty and the patient has remained phakic with excellent vision without PVR.
SHALABH SINHA
14 years ago
If the IOFB had been oriented to pass the scleral wound with the shortest width, such a large sclerotomy would have been avoided. What concentration of intravitreal antibiotics have you used? Any change with oil in the eye? Is there not a risk of high concentration being achieved in a particular region of the retina depending upon the posture of the patient? Most metallic IOFB are sterile when they enter the eye, unless if they are large or irregular, why inject antibiotics when no signs of infection are present, such as a hypopyon?
Mario Zambrano
14 years ago
Great case, I Would have oriented the foreign body better as dr Shalabh said and would have used C3F8