Removal of a Large Metallic IOFB in an Eye wth Good Vision

Maneesh Bapaye MD

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Small-gauge vitrectomy surgery and an intraocular magnetic aid in the removal of a 10.5-mm iron IOFB lying in vitreous cavity. Maneesh Bapaye, MD, opens the conjunctiva around the point of entry to suture the wound closed. Vitrectomy is performed around the foreign body to ensure adhesions are severed and that the object was freely floating. A magnetic instrument is inserted through an enlarged sclerotomy to deliver the IOFB and avoid damaging the crystalline lens or retina. After IOFB removal, a vitrectomy, fluid-air exchange, and endolaser around area of suspected retinal break are performed.

Posted: 11/12/2010

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Name: Removal of a Large Metallic IOFB in an Eye wth Good Vision
Uploaded: 2010-11-12T17:29:00+00:00

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Removal of a Large Metallic IOFB in an Eye wth Good Vision

Maneesh Bapaye MD

Posted: 11/12/2010

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Comments

Diego Ruiz

14 years ago

Nice surgery again, Maneesh. What would you use if you didn´t have that instrument?, Maybe serrated forceps? Nice to see a video of yours again.

Maneesh Bapaye

14 years ago

Hi Diego, Thanks for your comments. Without this magnet it would have been very difficult to get the same result. I am almost sure that I would have to sacrifice the lens without this magnet. I will highly recommend it to all vitreoretinal surgeons.

José López

14 years ago

Your surgery is excellent, but I have one question, passing the metal through the scleral incision did not exist the danger that this fall?. I dont se your other hand help. thank you a congrattulation. I finish my fellowship in retina three moth ago I dont have much experience, just did 3 such surgery in 18 moth. congratulation I like your surgery. Beltrán ( Nicaragua)

WASEEM JAFRI

14 years ago

congratulations. Excellent surgery excellent video. but I have one question.how you managed the Inferior retinal detachment..?

Christoph Faschinger

14 years ago

What a wonderful video with successful outcome. The music fits so well, so please let me ask who is the author of this Derwish music, what the name of this mystic group of musicians... Thank you very much Christioh.faschinger@medunigraz.at

Maneesh Bapaye

14 years ago

Dear Dr.Mayfield, thank you for your compliment. The magnet is indeed excellent. I believe any iron IOFB can be removed using this magnet. As for frosted branch angitis, it did resolve following removal of FB. But pt still c/o some filed loss in corresponding visual field. The vit specimen was sent for culture. It showed staphylococcus which was sensitive only to meropenam and augmentin. Postop pt received both antibiotics for a period of 10 days and didn't have any infetive signs.

Nicholas Mayfield

14 years ago

Thanks for the that excellent video. I am curious about the frosted branch angiitis. Did it resolve following the removal of the IOFB? The magnet must have tremendous force in order to secure the IOFB from the posterior pole all the way through the enlarged sclerotomy. Very impressive!

Nikoloz Labauri

14 years ago

Dear Dr. Maneesh Thank you for such a nice demonstration f IOFB removal. I’d like to add some comments and share with you the alternative way of removing IOFB as I ve done this technique only 2 times. As we all knowt the way how to remove the IOFB always depends to the nature and sizes if FB itself. Ive done 2 similar cases (one with macula “ON RD”). In both cases the IOFBs were long but with tiny architecture as in your case we saw. Ive start with 23G trocar placement , following by routine phaco. After that Ive proceeded with PPV and performed large posterior capsulotomy (leaving the ant. Capsule and CCC intact). Using usual 23G forceps Ive delivered the IOFB through the pupil to AC and I removed it through the main incision ( In 1 case I required to enlarge the CCI a little bit to deliver the IOFB outside). At the end of the procedure Ive implanted multipiece foldable IOL in the sulcus. In 1st case Ive used SiO for tamponade and in another case - nonexpansile gas. Using this technique Ive suicide the clear lens but avoided to incise pars plana widely, which by itself causes high astigmatism (due to suturing) and increases the risk of iatrogenic break(s) formation, which can lead to recurrent RD. Thanking you once again for beautiful video

Maneesh Bapaye

14 years ago

Dear Dr.Nikoloz, I contemplated various approaches while planning for this surgery. In absence of the Kuhn magnet, I would have used the shakehand technique using 2 intraocular forceps and it would have required scarificing clear lens. But this magnet is very good. It is 17G in size, has very strong magnetic action and that too only at the tip. I have used it in 4 to5 cases of differrnt sized IOFBs. This FB was longest.But almost any sized iron fb can be removed with ease. As the patient was a young aged person I think that leaving accomodation intact in both eyes is much better than having pseudophakos in one eye. Risk of RD postoperatively can be reduced by examining fundus intraoperatively and doing cryo in case of break, as was done here. The astigmatism this patient got was quite acceptable and didn't induce signifiacnt anisometropia. But I do agree that the approach suggested by you is excellent in such cases. Thank you for your comments and interest in the video.

Maneesh Bapaye

14 years ago

Dear Sharaf, Thank you for your interest in my case. Intraoperatively I did consider use of PFCL but decided against it because if I injected a large bubble of PFCL it would have flown over the FB as against displacing it nasally since FB was heavy. I thought that would make removal of FB difficult. If I put a small bubble only over posterior pole, the volume would be too less to avoid retinal trauma from a large FB in event of it falling down. I might be wrong, but that was the thought process. About the small gauge system, I feel greatets advantage was smooth induction of PVD at suction of 600mmHg. I don't think it would have been that easy with 20G system. Secondly the closed system reduced intraocular turbulenece and hence movement of FB thereby avoiding retinal trauma.

Mohamed Sharaf el din

14 years ago

what the advantage of use 23gauge in this case? and do you think it was appropriate to use PFCL especially with the retinal damage?

Removal of a Large Metallic IOFB in an Eye wth Good Vision

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Removal of a Large Metallic IOFB in an Eye wth Good Vision

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